Looking forward – December 2016

David B. Hoyt

David B. Hoyt, MD, FACS

The American College of Surgeons (ACS) experienced another successful year in 2016 and launched a range of initiatives that we believe will make surgery safer for patients and the profession more hospitable for all individuals who are drawn to health care careers. Details about these programs are outlined in the Executive Director’s annual report in this issue, but I would like to use this column to point out a few high points here.

Advocacy and Health Policy

The ACS is playing a leading role in ensuring that the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) is implemented in a way that encourages the provision of safe, quality, reliable care. Implementation of the new payment system developed under MACRA is discussed in the Medicare Physician Fee Schedule final rule that the Centers for Medicare & Medicaid Services issued in mid-October. This plan calls for the establishment of a Quality Payment Program (QPP), which will center initially on a Merit-based Incentive Payment System (MIPS), with eventual expansion to include Alternative Payment Models (APMs). The November “Looking forward” column provides a comprehensive summary of MIPS and its four components: Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement Activities.

The College urges all Fellows to prepare for the transition to MIPS and is offering a range of resources and services to help them succeed in 2017 and beyond.

To assist in the development of APMs, the ACS is collaborating with Brandeis University, Waltham, MA, and the Center for Surgery and Public Health at the Brigham and Women’s Hospital, Boston, MA, and has formed a task force to advise our staff. The project has continued to evolve, but, at press time, we expected to have a proposal to submit to the relevant government agencies in December.

Quality

The ACS is dedicated to making surgery safer across the continuum of care—from the initial patient consult through the patient’s full recovery—and across all specialties and patient demographics.

To ensure that all patients are in optimal condition to undergo surgical care, the ACS will be leading a national Strong for Surgery initiative. Under the Strong for Surgery model, health care providers use a series of checklists and tools to assess four modifiable areas to ensure the patient’s readiness for operative care: nutrition, blood sugar control, smoking cessation, and medication use.

The College is committed to ensuring patient safety throughout the perioperative period and has issued a number of statements regarding surgeons’ responsibilities throughout this stage of care. In response to concerns about surgeons performing concurrent operations, the College updated its Statements on Principles to include, among other directives, the following admonishment: “A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is inappropriate.”

In addition, the College responded to a number of requests that the ACS issue a position statement addressing surgical attire. The statement, which endorses the use of either the bouffant hat or the surgical skull cap and makes a number of recommendation about the wearing of scrubs in and out of the operating room, has been published online and in the October Bulletin.

To improve care after an operation has been completed, the College intends to promote and expand at the national level the enhanced recovery after surgery (ERAS) programs in place at Kaiser Permanente hospitals. With the tagline, “Get up, get moving, get better,” ERAS calls for the development of a detailed plan for each patient, including specific pre- and postoperative instructions for pain control, diet, exercise, and other factors that affect recovery.

Furthermore, the ACS has developed programs to address the unique needs of pediatric and geriatric patients. With respect to pediatric care, we have developed the Children’s Surgery Verification (CSV) Program, and earlier this year we released Optimal Resources for Children’s Surgical Care—the nation’s first and only multispecialty standards for children’s surgical care. With respect to care for elderly patients, the Coalition for Quality in Geriatric Surgery (CQGS) Project, funded by the John A. Hartford Foundation, completed its first year in development. This year, the CQGS Project developed 88 standards under four domains: continuum of care, clinical care, program management, and patient outcomes and follow-up (see related story in this issue).

At the heart of these efforts are the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and other ACS clinical registries. These databases provide the evidence we need to determine best practices in surgical care and are being integrated into the registry platform of the future.

The Committee on Trauma (COT) led several important initiatives this year, including the development of the Needs Based Assessment of Trauma Systems (NBATS) program. The COT also offered support for the recent report from the National Academies on Science, Engineering, and Medicine (NASEM), A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.

The ACS COT and the Hartford Consensus continue to lead efforts to “Stop the Bleed” at mass casualty events. Specifically, the College partnered with national security and law enforcement agencies to launch BleedingControl.org, a new website designed to assist the public and first responders in the event of a mass casualty or other bleeding control emergency. We also have launched a program to teach laypeople how to effectively control hemorrhaging and have developed bleeding control kits that can be accessed in public places.

Our Cancer Programs have been working on two manuals. The ACS Clinical Research Program has completed work on Operative Standards for Cancer Surgery, Volume 2, and the American Joint Committee on Cancer completed work on the eighth edition of the Cancer Staging Manual.

Education

Every year, Clinical Congress attendees tell me that this event just gets better and better. This year’s conference in Washington, DC, comprised 24 Tracks, 128 Panel Sessions, 18 Didactic Courses, 14 Skills Courses, 45 Meet-the-Expert Luncheons, and 18 Town Hall Meetings. Three Special Sessions were offered on Firearm Injury Prevention, ACS Strong for Surgery, and Global Engagement and were well-received.

Another mainstay in the College’s educational programming repertoire is the Surgical Education and Self-Assessment Program (SESAP®). At this year’s Clinical Congress, we unveiled SESAP 16, which features a variety of apps for handheld devices, and is available in Web and print versions. Additional SESAP products include the SESAP Sampler—a Web-based resource consisting of monthly modules designed to enhance surgical decision making through ongoing self-assessment and review of surgical content—and SESAP Audio Companion.

Importantly, the College is working to ensure that surgeons experience a smooth transition from one phase of their career to the next. A key initiative aimed at achieving this objective is the growing Transition to Practice Program. And to make certain that surgeons are well prepared to perform advanced procedures, the Committee on Emerging Surgical Technology and Education continues to identify and track innovations, evaluating their surgical potential and promoting their safe and effective adoption. In addition, the ACS Accredited Education Institutes continue to promote patient safety through the use of simulation to develop new education and technologies, identify best practices, and promote research and collaboration among our institutes.

Member Services

This year’s Initiate class was the largest ever, with a total of 1,823 new members. I would argue that growing interest in ACS Fellowship demonstrates that surgeons recognize that the College is responsive to their needs and concerns in an ever-changing health care environment.

Key to the College’s ability to meet changing member expectations is the Board of Governors. Members of this body are surveyed annually to determine the issues of greatest importance to their constituents. This year’s survey had a high response rate and was invaluable in helping us develop a strategic plan with a focus on such topics as implementation of the Affordable Care Act, graduate medical education, and surgical workforce issues.

The Young Fellows Association conducted a study on OR attire, which was useful in the development of the position statement mentioned earlier. Similarly, the Resident and Associate Society (RAS-ACS) is conducting a survey to examine handoff training at different institutions and played an important role in promoting the findings from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.

Operation Giving Back continues to coordinate efforts to further ACS global and domestic engagement, volunteerism, and disaster response. In addition, the Military Health Services Strategic Partnership ACS played a vital role in establishing a Military-ACS NSQIP collaborative, working with the Department of Defense to develop a curriculum for military surgeons in austere environments, and in responding to the NASEM report.

Integrated Communications

The Division of Integrated Communications played a pertinent role in launching Bleedingcontrol.org and continuously strives to bring news and information to the membership in formats that are compatible with the needs of today’s busy surgeons.

Efforts are under way to transition Bulletin readers from the print version to online only beginning January 1, 2017. Each month, members receive an e-mail alerting them when the new issue is available and information about how to access the Bulletin website, read an interactive version of the magazine, or download the app.

Likewise, the Journal of the American College of Surgeons (JACS) launched a redesigned home page at journalacs.org. The layout is more user-friendly, allowing readers to find content quickly, and includes more surgical videos and images, as well as a complete list of the JACS Continuing Medical Education articles for the month.

Similarly, the College’s electronic newsletters underwent a makeover, ensuring that they all have a consistent look and feel and are easily viewed on a computer, tablet, or smartphone.

The College’s social media presence also continues to grow. For details about the growth of the online ACS Communities, see the article in this issue. Furthermore, we continue to see upward participation trajectories on our Facebook, Twitter, and LinkedIn pages.

Looking forward to 2017

As these few examples demonstrate, the College continues to move forward to bring surgeons and their colleagues the tools, resources, and educational opportunities they need to succeed in practice and provide optimal care to their patients. As always, we welcome your suggestions regarding how we can best serve you in the future. Thank you for your ongoing support, and here’s to another transformative year.

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