As I enter my seventh year as Executive Director of the American College of Surgeons (ACS), I have paused to reflect on how much the staff and volunteers of this organization have accomplished in this timeframe. This month, I share with you some of my observations about our accomplishments and how we will build on them in the coming months through our strategic planning process.
A primary goal when I started at the ACS was to enhance the College’s databases so that health care institutions and professionals could benchmark their performance and determine what steps to take to improve the quality and safety of patient care. Since then, the ACS National Surgical Quality Improvement Program (ACS NSQIP®) has expanded and is now providing outcomes data to nearly 700 hospitals.
Furthermore, we have established a Trauma Quality Improvement Program and a Cancer Quality Improvement Program, which expand the capabilities of the ACS National Trauma Data Bank® and the ACS National Cancer Data Base, respectively. And, to assist surgeons in offering cancer patients the best treatment options, the College was active in the development of the Cancer Staging Manual and Cancer Staging Atlas offered through the American Joint Committee on Cancer. To make these databases more useful we are engaged in a software replacement effort. We anticipate that this project will lead to significant advances in the capabilities of the ACS quality databases.
We also have developed a broader range of verification and accreditation programs. The ACS has added two such programs—the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and the National Accreditation Program for Breast Centers—and more recently launched the Children’s Surgery Verification program.
Later this year, we will tie all of these concepts together with the publication of the ACS quality manual. This guidebook is designed to assist surgeons who have been asked to serve as the surgical quality officers at their institutions.
Emerging quality issues of concern include the effects of performing concurrent operations and surgeon fatigue on patient care, public reporting of institutional and physician outcomes, and perioperative readiness. The College is partnering with other organizations that represent members of the operative team to address these concerns and develop best practices for resolving any underlying problems.
Advocating for the surgical patient
For more than a decade, repeal and replacement of the sustainable growth rate formula used to calculate Medicare physician payment was a key objective of the ACS. With enactment of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) in April 2015, this milestone was achieved.
Part of our success in this arena is attributable to the establishment of the Health Policy and Advocacy Group (HPAG). This committee is charged with identifying public policy issues that affect surgeons and our patients, establishing the ACS legislative and regulatory agenda, and recommending courses of action to the Board of Regents. HPAG and other College committees will likely play an important role in our strategic plans for ensuring that MACRA is implemented in a way that guarantees patient access to quality surgical care and to the type of information necessary to make informed health care decisions.
The ACS Inspiring Quality Tour, launched in 2011, greatly contributed to our ability to inform health policy decision makers and legislators about how the ACS Quality Programs can be used to improve the value of health care services. As MACRA is implemented, the College will continue to promote the use of clinical, rather than administrative, data for reimbursement and public reporting purposes. Specifically, we are advocating that the Centers for Medicare & Medicaid Services use data from qualified clinical data registries, ACS NSQIP, and the ACS Surgeon Specific Registry for its Physician Quality Reporting System, the Physician Compare website, and the development of the Merit-based Incentive Payment System defined in MACRA.
In 2010, the ACS sought to provide more electronic learning opportunities, developing focused curriculums and assessment techniques, enhancing skills training and validation, and assisting surgeons in achieving Maintenance of Certification.
A key development in this area has been growth of the ACS Accredited Education Institutes program to promote hands-on training through simulation. We also have expanded access to webcasts from the annual Clinical Congress and made other transformational changes in the Clinical Congress program, providing more opportunities to acquire the Continuing Medical Education (CME), Self-Assessment, and Patient Safety and Ethics credits surgeons need to meet the evolving demands of surgical and state licensing boards.
Furthermore, we are providing opportunities for young surgeons to develop their confidence and skills as independent health care professionals through the Transition to Practice Program. With this objective in mind, we also are promoting mentorship programs.
Looking toward the future, the ACS is in the process of selecting a learning content management system, which will include a program for surgeons to manage CME and to maintain a log of their efforts to engage in lifelong learning. In addition, the ACS clinical guidelines program, Evidence-Based Decisions in Surgery, was established in 2014 and is flourishing.
Reaching out to all surgeons
We have sought to foster the growth of the ACS membership by offering the programs and services described previously, as well as through a young surgeon and specialty surgeon recruitment campaign and member engagement activities. Furthermore, we have used strategic planning to revitalize and restructure the ACS Board of Governors, and Advisory Councils are better positioned to represent the needs of their constituents. In addition, Member Services and the Division of Advocacy and Health Policy have combined forces to present the annual ACS Leadership & Advocacy Summit.
The ACS has been working to strengthen its domestic chapters, providing chapter leadership training programs and offering chapters opportunities to receive contracts for their administrative services through the College’s association management services.
In addition, the ACS has established a partnership with military health services, which is enabling the exchange of research findings and cross-educational opportunities. Likewise, we are seeking to expand our international reach by revitalizing the Operation Giving Back program and encouraging the establishment of ACS chapters in every nation. Surgeons in all parts of the world have much to learn from each other, and we would be derelict in our professional responsibilities if we failed to work together to provide quality care to all people.
Furthermore, the College is providing greater opportunities for our members to communicate with each other and with the ACS leadership. For too long, ACS Governors and Regents were isolated from the rank-and-file membership. We have sought to close that divide through various communications vehicles—including the online ACS Communities—and with more interactive activities at ACS programs.
At present, we are surveying individuals who have dropped their ACS membership or have never been members to determine how we can better meet their needs. When those studies are completed, we will develop a strategic plan to address our perceived shortcomings.
It is the staff of the College that is ultimately responsible for implementing the ACS strategic plan. We have expanded the number of staff significantly in recent years, recruiting and developing a world-class team. To ensure that ACS staff members have the skills, resources, and expertise needed to meet your changing needs, we are working with an architectural firm to determine how we can best use our properties to stimulate innovation and creative problem solving. We also have established a Go Positive training program, which focuses on encouraging our team to uphold our values of professionalism, excellence, innovation, introspection, and inclusion.
We have come a long way in developing programs and services that surgeons of all generations, specialties, and practice environments will find useful and relevant—all while maintaining the organization’s financial solvency. We intend to continue the strategic planning process each year to sustain this momentum.