The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met June 3−4 at the College’s headquarters in Chicago, IL. The following is a summary of their discussions and actions.
As of May 10, the ACSPA’s political action committee (ACSPA-SurgeonsPAC) had raised more than $887,265 from more than 2,500 College members and staff. During the 2015−2016 election cycle, the PAC has disbursed more than $760,000 to more than 130 congressional candidates, leadership PACs, and party committees. In line with congressional composition, 60 percent of these funds were given to Republicans and 40 percent to Democrats.
Approval of Statements
At their June meeting, the Board of Regents reviewed and approved the following updated and new statements submitted by the Committee on Perioperative Care:
- Health care industry representatives in the operating room
- Safe surgery checklist, and ensuring correct patient, correct site, and correct procedure surgery
- Surgical technology training and certification
- Prevention of unintentionally retained surgical items after surgery
- Sharps safety
- Documentation and reporting of accidental punctures and lacerations during surgery (new)
- Distractions in operating room (new)
These statements will be published in the October issue of the Bulletin.
Division of Advocacy and Health Policy
The ACS continues to educate and influence Congress on implementation of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA). The ACS submitted testimony to the House Energy and Commerce Committee for an April 19 hearing on physician efforts to prepare for MACRA Medicare payment reforms. Additionally, the ACS lobbying team, along with Frank G. Opelka, MD, FACS, Medical Director, Quality and Health Policy, ACS Division of Advocacy and Health Policy (DAHP), has conducted extensive meetings on Capitol Hill to ensure that policy leaders are up-to-date on the ACS-driven alternative payment model (APM) project with Brandeis University, Waltham, MA, and the Center for Surgery and Public Health at the Brigham and Women’s Hospital and their Harvard faculty in Boston, MA. The meetings are aimed at educating legislators on how the ACS APM will coalesce many surgical disciplines into a single framework for building APM solutions, applicable to Medicare and other public and private payors.
The ACS is supporting the work of Sens. John Thune (R-SD), Lamar Alexander (R-TN), Mike Enzi (R-WY), Pat Roberts (R-KS), Richard Burr (R-NC), and Bill Cassidy (R-LA), who recently released draft legislation that would ease some of the administrative burden associated with reporting on meaningful use (MU) of electronic health records (EHRs) for 2016. Specifically, the legislation would shorten the reporting period for eligible providers from 365 days to 90 days, which would give physicians and hospitals more time to implement EHR systems, relax the “all-or-nothing” nature of the current program requirement, and extend the timeline for eligible providers and hospitals to apply for a hardship exemption.
Responsible data disclosure
The ACS DAHP is working toward introduction of the Responsible Data Transparency Act. Championed by Rep. Bill Flores (R-TX), the bill would halt the Centers for Medicare & Medicaid Services (CMS) disclosure of raw Medicare physician claims data to outside entities.
Surgical workforce in underserved areas
Reps. Larry D. Bucshon, MD, FACS (R-IN), and Ami Bera, MD (D-CA), introduced H.R. 4959, the Ensuring Access to General Surgery Act of 2016. This legislation would direct the Secretary of the Department of Health and Human Services (HHS) to conduct a study on the designation of a general surgery Health Professional Shortage Area (HPSA). The Health Resources and Services Administration has developed designation criteria to determine whether certain geographic areas, population groups, or facilities qualify for HPSA designation.
The College is tracking opioid-related bills, monitoring congressional hearings, and meeting with key congressional leaders on this issue. The ACS Legislative Committee has drafted a policy document, which was submitted to the Health Policy Advocacy Group for review.
Graduate medical education
The ACS continues to monitor congressional activity on direct and indirect graduate medical education funding reform. Patrick V. Bailey, MD, FACS, Medical Director, Advocacy, ACS DAHP, has convened a workgroup of Fellows and experts to develop an ACS plan to address four aspects of GME reform: workforce, finance, governance, and accountability.
MACRA, discussed earlier in this article, includes a provision that prohibits CMS from implementing a policy that would have transitioned 10- and 90-day global codes to 0-day global codes. Instead, Congress called upon CMS to collect data on the number and level of visits furnished during the global period beginning by 2017. CMS is mandated to use these data starting in 2019 to improve the accuracy of the valuation of surgical services. The provision also allows the withholding of 5 percent of the surgical payment until information is reported at the end of the global period.
Over the last year, the ACS has worked to influence the implementation of this new policy. In a comment letter on the 2016 Physician Fee Schedule proposed rule, the ACS provided recommendations on how CMS should go about collecting data on the number and level of visits associated with global codes. Members of the ACS General Surgery Coding and Reimbursement Committee (GSCRC) also met with CMS February 22, 2016, to discuss the recommendations in more detail and followed up with a letter. Going forward, the GSCRC will continue discussions on how the agency will collect data starting on January 1, 2017, and how the data will be used to improve the accuracy and valuation of global surgical services starting in 2019.
In March, Highmark, a subsidiary of Blue Cross Blue Shield, announced it would cut provider reimbursement rates by 4.5 percent. Highmark reports that it lost $221 million in 2014 from health plans in Affordable Care Act exchanges. This reduction in reimbursement became effective April 1 and for now affects Pennsylvania only. For the average physician, this change would reduce revenue by 0.5 percent.
CMS released the fiscal year 2017 Inpatient Prospective Payment System (IPPS) proposed rule in April. For general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful users of EHRs, the proposed increase in operating payment rates is 0.9 percent. CMS also proposes to permanently remove a 0.2 percent reduction in inpatient payments related to the two-midnight rule. The ACS has evaluated these and other proposals to determine the impact on surgery and has submitted comments to CMS.
Medicare Part B drug payment
On May 9, the ACS regulatory staff submitted a comment letter to CMS on the Medicare Part B Drug Payment Model proposed rule, released in March. The ACS comment letter requests that CMS withdraw the Part B Drug Payment Model until the agency has adequately collaborated with affected stakeholders, specifically physicians and patients.
PQRS Qualified Clinical Data Registries
The ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and specific trauma measures within the Surgeon Specific Registry were approved by CMS as Physician Quality Reporting System (PQRS) Qualified Clinical Data Registries for 2016.
This year, CMS will post information on the care delivered by individual providers and groups on the Physician Compare website. In response, the ACS is creating a detailed Web page on Physician Compare that includes educational material and resources to explain to Fellows what information will be reported. (An article on Physician Compare was published in the March issue of the Bulletin.)
Surgical Quality Alliance
The Surgical Quality Alliance (SQA) met April 19 and addressed the following topics:
- The future of meaningful use, MACRA
- Core measures developed by America’s Health Insurance Plans (AHIP) in collaboration with CMS
- Current work on the development of patient-reported outcomes measures for surgical care
- The Brandeis and ACS APM development project
- An update on legislative issues relevant to surgical care
The SQA continues to discuss the current quality landscape, National Quality Forum activities, and member experience with CMS quality programs.
State Affairs uses an online search service to identify and monitor state legislation of interest to surgeons. In 2015, more than 2,400 bills were tagged as potentially related to ACS issues, with approximately 500 actively monitored. Numbers are similar for 2016, with more than 2,000 bills tagged and more than 400 monitored.
State legislative highlights
- The Georgia Society of the ACS successfully pursued passage of legislation based on the Uniform Emergency Volunteers Health Practitioners model. The bill was signed by the governor on April 26.
- The Kansas Chapter joined with numerous medical and patient organizations to pursue legislation restricting the use of tanning beds to individuals ages 18 and older. At the time of the meeting, the bill was awaiting action by the governor.
- Oklahoma surgeons began contacting their state legislators to support the Medicaid Rebalancing Act of 2020. A major component of this initiative would add $1.50 to the tobacco tax, with funds to be used to improve Medicaid payment rates to physicians. It would also expand private insurance to 350,000 Oklahoma citizens.
- Approximately 300 messages were sent in New York opposing cuts in the excess medical liability insurance program. Originally included in the governor’s budget proposal, this provision was removed from the final budget.
- Rhode Island considered legislation to change the description of the physician assistant’s relationship with physicians from “supervisory” to “collaborative.” The ACS Legislative Committee reviewed the bill and developed a position in opposition to it. Following committee hearings, the legislation is being held for further study.
- Tennessee surgeons contacted their state legislators over an opioid bill restricting initial prescriptions to seven days. Thinking this was too short a time, the chapter’s council began working to amend the bill to at least 14 days. A decision was made to focus on making amendments next year to give surgeons time to advocate with their own legislators.
- Tennessee again saw failed attempts to repeal mandatory motorcycle helmet usage.
Lobby Day Grant Program
In its fifth successful year of operation, the ACS Chapter Advocacy Lobby Day Grant Program attracted 18 applicants in 2016, the largest number of applicants to date. The program provides funding to ACS chapters seeking to engage with their state legislators on surgical/medical issues. All 18 applicants received grants ranging from $750 to $5,000, with each recipient expected to match half the amount of the grant. Of these 18 applicants’ states, three—Alaska, Pennsylvania, and Wisconsin—had not previously received grants.
2016 ACS Advocacy Summit
Nearly 300 physicians attended the 2016 ACS Advocacy Summit April 11−12 in Washington, DC. ACS Washington Office staff, political insiders, health care experts, and members of Congress provided details on current efforts being made to help shape the future of health care. A total of 231 Lobby Day attendees from 42 states had the opportunity to meet with their members of Congress on Capitol Hill and advance the advocacy efforts of the ACS.
Division of Education
Transition to Practice (TTP) Program
A total of 25 institutions are now approved to participate in the TTP Program in General Surgery, chaired by ACS President J. David Richardson, MD, FACS, and co-chaired by Past First Vice-President R. Phillip Burns, MD, FACS.
Resident duty hours
In response to a communication from the Accreditation Council for Graduate Medical Education (ACGME), an ACS Position Statement on Resident Duty Hours was crafted and sent to the ACGME in January 2016. The statement was co-signed by Dr. Richardson; Valerie W. Rusch, MD, FACS, Chair of the B/R; David B. Hoyt, MD, FACS, ACS Executive Director; and Ajit Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education. Subsequently, Dr. Hoyt presented the ACS position at the ACGME Resident and Duty Hours Congress in March 2016.
Master Surgeon Educators
The B/R had previously approved the creation of an ACS Academy of Master Surgeon Educators. Efforts are under way to establish the framework for this special academy. The goals of this effort are to play a critical role in providing recognition to Master Surgeon Educators; advancing the science and practice of surgical education and training; fostering exchange of creative ideas and collaboration; supporting faculty development and recognition; and underscoring the importance of surgical education and training in the changing milieu of health care. This academy is envisioned as a think tank and an advisory group to the Division of Education. The following members have been appointed to the Steering Committee for the ACS Academy of Master Surgeon Educators: L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCS(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), Chair; Dr. Sachdeva, Co-Chair; Sir Murray F. Brennan, MD, FACS; Dr. Hoyt; Haile T. Debas, MD, FACS; L. Scott Levin, MD, FACS; Leigh A. Neumayer, MD, FACS; and ACS Past-President Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon).
A total of 8,276 physicians (including 1,646 residents and 749 guest physicians) attended Clinical Congress 2015. Other attendees were as follows:
- 532 medical students
- 190 allied health professionals
- 131 PhDs
Clinical Congress 2016 will include the following:
- 24 Tracks
- 127 Panel Sessions
- 17 Didactic/Experiential Courses
- 14 Skills Courses
- 45 Meet-the-Expert Luncheons
- 18 Town Hall Meetings
Surgical skills training
A new Committee on Surgical Skills Training for Practicing Surgeons has been appointed to develop, implement, and support innovative skills courses at the Clinical Congress and at regional sites. The committee is co-chaired by Barbara L. Bass, MD, FACS, and Dr. Sachdeva.
The Surgical Education and Self-Assessment Program (SESAP®) 16 will be released in October 2016 and will include a variety of apps for handheld devices, as well as Web and print versions. John A. Weigelt, MD, DVM, FACS, is the Medical Director of SESAP.
Surgeons as Leaders
ACS Past-President Andrew Warshaw, MD, FACS, will lead the 12th Annual Surgeons as Leaders Course, June 5−8, 2017, in Durham, NC. A module on “Leading Beyond Surgery” has been added along with new modules “Leading in Quality” and “Leading in Advocacy.” The new faculty includes David F. Torchiana, MD, FACS, president and chief executive officer, Partners HealthCare, Boston; Michael Useem, PhD, director of the Center for Leadership and Change Management at the Wharton School of the University of Pennsylvania, Philadelphia; and Matthew M. Hutter, MD, MPH, FACS, associate professor, Harvard Medical School, and director, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital. Returning faculty include Past-Chair of the B/R Julie A. Freischlag, MD, FACS; Larry R. Kaiser, MD, FACS; Chair of the ACS Board of Governors Fabrizio Michelassi, MD, FACS; Dr. Pellegrini; Nathaniel J. Soper, MD, FACS; and ACS Regent Beth H. Sutton, MD, FACS. Once again, demand for the 2016 course exceeded capacity with 80 applicants for only 64 seats.
Surgeons as Educators Course
The 23rd Annual Surgeons as Educators Course took place August 27−September 2, in Atlanta, GA. Once again, demand exceeded capacity, and 61 individuals applied for the 32 seats available. This course is chaired by Paul J. Schenarts, MD, FACS, and the Course Director is Debra A. DaRosa, PhD.
Fundamentals of Surgery Curriculum
Under the leadership of ACS Past-President Patricia J. Numann, MD, FACS, the ACS Fundamentals of Surgery Curriculum® (ACS FSC) now comprises 110 case scenarios spanning the following 14 essential content areas:
- Patient and Workplace Safety
- Preoperative Assessment
- On-Call Issues
- Pain Management
- Unresponsive Patients and Agitated Patients
- Respiratory Management
- Gastrointestinal Conditions
- Wound Management
- Nutritional Support
- Fluid and Electrolyte Management
- Cardiac Conditions
- Vascular Conditions
- Cardiothoracic Conditions
Approximately 1,700 residents at more than 200 training programs are enrolled in ACS FSC.
Fundamentals of Laparoscopic Surgery
The Fundamentals of Laparoscopic Surgery® (FLS) Program, now in its 11th year, is a collaborative program between the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and ACS. It was initially developed by SAGES and is now jointly led by SAGES and the ACS. More than 10,000 residents, fellows, and practicing surgeons have received an FLS certificate. Expansion of the program continues with 80 testing centers located throughout the U.S. and Canada, and one each in Singapore and Israel. The Joint FLS Steering Committee is co-chaired by Gerald M. Fried, MD, FACS, FRCSC, and Lenworth M. Jacobs, Jr., MD, MPH, FACS.
Program for Accreditation of Education Institutes
A total of 94 simulation centers now are accredited through the ACS Program for Accreditation of Education Institutes (ACS-AEI) as Comprehensive ACS-AEIs, and 12 are accredited as Focused ACS-AEIs. Of the ACS-AEIs, 14 are outside the U.S., including four in Canada, one in the U.K., two in Sweden, two in France, one in Greece, one in Italy, one in Argentina, one in Saudi Arabia, and one in Spain.
The Ninth Annual ACS-AEI Consortium Meeting, which took place March 7−8 in Chicago, IL, attracted a record 222 attendees. The keynote speaker was Graham T. McMahon, MD, MMSc, president and chief executive officer of the Accreditation Council for Continuing Medical Education (ACCME).
ACS CME Accreditation Program
The ACS Continuing Medical Education (CME) Accreditation Program of the Division of Education now ranks as one of the largest within the ACCME System. It was accredited with commendation in 2014 and now accredits all CME credit-bearing educational programs of the ACS and the educational programs of most surgical societies that do not have their own accreditation systems. In 2015, the program accredited 2,252 CME activities; of these activities, 292 were jointly accredited.
The number of ACS members using the MyCME program to request transfer of their CME credits to the American Board of Surgery has steadily risen. From July 1, 2015, to April 29, 2016, more than 5,300 members requested this service. Plans are in place to explore similar opportunities with other surgery specialty boards.
Offered for the first time in 2015, the Fellowship in Surgical Ethics, sponsored by the ACS Division of Education and MacLean Center for Clinical Medical Ethics at the University of Chicago, has been successful. Applications for 2016−2017 are currently being accepted.
Division of Member Services
Recruitment and retention
As of June 1, the College had 78,458 members: 64,368 Fellows (57,299 U.S., 1,334 Canadian, and 5,735 International), 3,495 Associate Fellows, 8,466 Residents, 1,850 Medical Students, and 279 Affiliate Members.
The B/R accepted resignations from 18 Fellows:
- One colorectal
- One general
- One neurological
- Two ophthalmic
- Three orthopaedic
- Three otolaryngology
- Three plastic and reconstructive
- Four urological
The B/R also approved a change in status from Active (dues paying) to Retired for 94 Fellows and from Senior (non-dues paying) to Retired for 15 Fellows—a total of 109 Fellows.
The Regents approved a Committee on ACS Global Engagement through Operation Giving Back, with the following subcommittees: International Volunteerism, Domestic Volunteerism, Disaster, Advocacy, and Global Health Education.
Division of Research and Optimal Patient Care
Joan L. and Julius H. Jacobson II Promising Investigator Award
In 2004, Julius H. Jacobson II, MD, FACS, established through the College the Joan L. and Julius H. Jacobson II Promising Investigator Award to recognize outstanding surgeons who are engaged in research, are advancing the art and science of surgery, and have demonstrated early promise of significant contribution to the practice of surgery and the safety of surgical patients. This year’s award, administered through the ACS Surgical Research Committee (SRC), is in the amount of $30,000.
After careful consideration, the SRC made the following selections for the 2016 Joan L. and Julius H. Jacobson II Promising Investigator Award:
- Recipient: Ankit Bharat, MB, BS, FACS, Northwestern University, Chicago
- Alternate: Jason K. Sicklick, MD, FACS, University of California, San Diego
ACS National Surgical Quality Improvement Program
A total of 744 hospitals participate in the ACS National Surgical Quality Improvement Program (ACS NSQIP®)—658 sites in the adult option, and 86 in ACS NSQIP Pediatric. The Essentials option, which is the conventional sampling frame, has the highest enrollment of adult participation with 318 sites, and the Procedure Targeted option follows with 279 hospitals enrolled. The Pediatric option, which continues to grow, represents 12 percent of overall participation.
Following is the breakdown of participating sites by the ACS NSQIP option:
- Small and Rural: 61
- Procedure Targeted: 279
- Essentials: 318
- Pediatric NSQIP: 86
There are currently 804 participating Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers; 702 are fully accredited and 63 are initial applicants. The remaining 39 are data collection centers that participate in the MBSAQIP Data Registry but did not complete the process to meet full accreditation status.
The ACS has continued to develop Surgeon Specific Registry (SSR) as a tool for capturing individual surgeon data. The SSR has approximately 6,000 surgeons who have submitted at least 20 cases, and contains nearly 6 million records.
ACS Clinical Scholars in Residence
The ACS Clinical Scholars in Residence program is a two-year on-site fellowship in applied surgical outcomes research, health services research, and health care policy. This program offers surgery residents a unique opportunity to work with the College. The application submission period for 2017−2019 appointments closed May 1. The interview process has begun to identify scholar(s) for the next appointment cycle.
Committee on Trauma (COT)
The accomplishments of the COT and its constituent programs are as follows:
- At the time of the meeting, 1,067 Advanced Trauma Life Support® (ATLS®) Courses had been presented in 2016 and offered to 17,516 students.
- A total of 55 Rural Trauma Team Development Courses (RTTDCs) have been offered to 886 international students; promulgation is occurring in Kuwait.
- The RTTDC program fourth edition is complete, and several sites are already offering this format.
- The Disaster Management and Emergency Preparedness Course has been presented 19 times in 2016 to 299 students.
- The Advanced Surgical Skills for Exposure in Trauma (ASSET) Course has been presented 33 times to 315 students, with international promulgation occurring in France and Germany.
- The ASSET program continues to grow, and the committee is now in discussions to begin revisions.
- The Advanced Trauma Operative Management Course has been offered 23 times to 126 students.
- The Trauma Evaluation and Management program has been offered free of charge in the following countries:
- Trinidad & Tobago
- As of May 16, 429 hospitals and 424 ACS-verified trauma centers are participating in the Trauma Quality Improvement Program (TQIP®); of these facilities, 397 participate in Adult TQIP, and 99 are in Pediatric TQIP.
The Third Annual Advocacy Committee Planning Meeting took place February 8−9 in Washington, DC. After a robust discussion about legislative and regulatory policy issues that affect the quality of cancer care, committee members went to Capitol Hill to discuss five priority issues with legislators:
- Resolution Recognizing Commission on Cancer Accreditation
- Removing Barriers to Colorectal Cancer Screening Act
- Cancer Care Payment Reform Act
- Cancer Drug Coverage Parity Act
- Planning Actively for Cancer Treatment Act
The eighth edition of the Joint Committee on Cancer’s Cancer Staging Manual will be published in October 2016 and will apply to all cases diagnosed beginning January 1, 2017.
Interest in National Accreditation Program for Breast Centers (NAPBC) accreditation remains strong in the U.S. and internationally. More than 600 U.S. centers are accredited, with 38 new applications received in 2016. Reaccreditation rates for 2015/2016 remain at 99 percent. Two accredited international centers and surveys are pending in South Africa and Chile. The NAPBC Best Practices Conference convened May 13−14 in Orlando, FL.
Division of Integrated Communications
In the first four months of 2016, more than 2,200 individuals completed tests on Journal of the American College of Surgeons (JACS) articles, earning a total of 33,061 credits toward Maintenance of Certification. JACS articles were picked up by major news media including Reuters, Philadelphia Inquirer, Detroit News, Seattle Times, and U.S. News & World Report.