Looking forward – December 2017

David B. Hoyt

David B. Hoyt, MD, FACS

The American College of Surgeons (ACS) had another eventful year. A comprehensive overview of the College’s activities is provided in the Executive Director’s Report. In this column, however, I would like to point out a few highlights.

Advocacy and Health Policy

Efforts to overturn the Affordable Care Act reemerged this year. ACS staff reviewed these proposals to determine likely effects on surgeons and surgical patients, including potential changes in access to surgical care and physician reimbursement. Taking into account expected ramifications of the proposed bills, the ACS reiterated and revised its principles of health care reform and expressed to Congress our priorities and concerns.

Another advocacy issue of considerable concern to ACS Fellows is the Centers for Medicare & Medicaid Services (CMS) efforts to implement the payment reforms in the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015. Specifically, 2017 is the transition year for implementation of the Quality Payment Program’s (QPP’s) Merit-based Incentive Payment System (MIPS), and MIPS data collected in 2017 will be used to determine annual payment updates in 2019.

The ACS has been monitoring implementation of MIPS, and Division of Advocacy and Health Policy (DAHP) staff has worked with consultants and stakeholders to draft a legislative proposal to grant additional flexibility to the Secretary of the U.S. Department of Health and Human Services (HHS) in implementing MIPS. Staff also has worked with staff of the House Energy and Commerce and Ways and Means Committees, the Senate Finance Committee, and other key congressional offices to ensure MIPS flexibility.

In addition to MIPS, the QPP calls for the establishment of Alternative Payment Models (APMs). In December 2016, the ACS submitted a surgical APM proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC). This proposal, the ACS-Brandeis Advanced APM, was among the first two proposals that the PTAC recommended for CMS testing. The HHS Secretary reviewed the proposal and made recommendations for improvement. Efforts to develop the model continue, and the ACS is working with private insurers and entities that may implement the APM model once available.

Education

The Division of Education continues to play a leadership role in surgical education, training, validation, credentialing, and accreditation. A significant effort is aimed at addressing the needs of surgeons who are looking to update their skills. The new Steering Committee for Retraining and Retooling of Practicing Surgeons is focused on defining standards and establishing a national infrastructure to achieve optimal outcomes. The ACS Accredited Education Institutes are at the core of this infrastructure.

Another major development this year was the launch of the ACS Academy of Master Surgeon Educators at Clinical Congress. The goals of the academy are to recognize master surgeon educators, advance the science and practice of leading-edge surgical education and training, foster innovation and collaboration, support faculty development and recognition, and underscore the importance of surgical education and training.

Also at Clinical Congress, the ACS Committee on Ethics unveiled Ethical Issues in Surgical Care, a landmark resource that defines a framework for the field of surgical ethics as it has evolved over the last decade. The book is organized into four sections that address the broad areas of general consideration, the surgeon-patient relationship, the surgeon and the surgical profession, and the surgeon and society.

In addition, the ACS launched ACS Case Reviews in Surgery, which is published six times per year. Each issue features 10 peer-reviewed case reports from an array of surgical specialties.

Quality

The College released Optimal Resources for Surgical Quality and Safety this year. This manual provides a guide for surgical quality leaders seeking to improve quality and safety in their institutions, departments, and practices. Exploratory work is under way to evaluate the feasibility of developing adjunctive or integrated resources/standards and of establishing a Surgical Quality Verification Program.

The quality manual was released at the inaugural ACS Quality and Safety Conference, formerly the ACS National Surgical Quality Improvement Program (ACS NSQIP®) Annual Conference, which took place in July in New York, NY. The conference boasted a record-breaking attendance of more than 1,800 attendees. This year’s theme, Achieving Quality: Present and Future, reflected a more comprehensive approach to quality and safety and included the perspectives of adult, pediatric, geriatric, and bariatric surgeons; nurses; anesthesiologists; and hospital administrators.

The new Children’s Surgery Verification (CSV) Program, which seeks to improve surgical care for pediatric surgical patients, officially launched in January. The first non-pilot site visits occurred this summer, with 16 sites going through the verification process.

The new Surgeon Specific Registry was the first ACS database to launch as part of the College’s integrated registry of the future, which ultimately will allow users to share relevant quality data across individual ACS Quality Programs, such as ACS NSQIP and the Trauma Quality Improvement Program (TQIP®). The ACS is creating this integrated database in partnership with QuintilesIMS.

Other new quality initiatives include the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Surgical Care and Recovery (ISCR), which the ACS is conducting in collaboration with Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD. This program supports hospitals in implementing perioperative evidence-based pathways to improve clinical outcomes, reduce hospital length of stay, and improve the patient experience.

The ACS also became the new home for Strong for Surgery, which was originally developed by surgeons in Washington State. This program empowers hospitals and clinics to integrate checklists into the preoperative phase of care.

In addition, the ACS was awarded a three-year, multimillion dollar R01 grant from the National Institute on Minority Health and Health Disparities. ACS Past-President L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), is the principal investigator on this award, which is aimed at eliminating variances in access to surgical care.

The Committee on Trauma (COT), in collaboration with military partners and the National Highway Traffic Safety Administration (NHTSA), held a conference in April to advance the recommendations in the National Academies on Science, Engineering, and Medicine report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury. The meeting brought together approximately 170 trauma care professionals with the goal of creating the framework for a National Trauma Care System Action Plan.

In addition, the COT Injury Prevention and Control Committee (IPCC) is advocating for a public health/trauma system approach to firearm injury prevention that would implement evidence-based firearm violence prevention programs through its network of trauma centers. These institutions are fostering and providing a forum for a professional dialogue with the goal of moving toward a consensus approach to reducing firearm injuries and deaths.

The Stop the Bleed® program continues to grow and garner support from members of Congress. Leaders of the ACS and the COT hosted a congressional briefing February 28 to highlight the training program. ACS leaders also offered Stop the Bleed training on Capitol Hill October 12 for members of Congress and their staffs.

Member Services

A total of 1,827 surgeons were welcomed into the College this year, making it the largest Initiate class ever. The continued growth in Fellowship can be attributed not only to the programs described previously, but also the College’s specific recruitment and retention activities. Examples of these efforts include release of the Physician Well-Being Index—a validated screening tool that helps members better understand their overall well-being and identify areas of risk—and outreach to Fellows with lapsed or lapsing membership.

The Board of Governors (B/G) continues to implement initiatives through its Pillars and Workgroups. Specific examples from this past year include the release of a white paper on out-of-network billing; production of the now biannual e-newsletter, The Cutting Edge; conduct of the 2017 Board of Governors Annual Survey, which focuses on the Stop the Bleed Campaign, the opioid crisis, work-related injuries/surgical ergonomics, and advanced practice providers in surgery; and development of a standardized letter of recommendation for applicants to surgery training programs. In addition, the B/G received a historically high number of Surgical Volunteerism and Humanitarian Awards nominations—54 versus 44 in 2016.

The Excelsior Surgical Society has been resurrected and is now a formal society within the ACS. The Society has elected officers, developed a charter, and convened a full-day meeting at the last three ACS Clinical Congresses.

The Women in Surgery Committee (WiSC) developed an ACS Statement on Gender Salary Equity, which the Board of Regents approved in June, and selected the second recipient of the second Mary Edwards Walker Inspiring Women in Surgery Award. The WiSC also offered a successful leadership program for 18 women surgeons in conjunction with the ACS Leadership & Advocacy Summit 2017.

Integrated Communications

The ACS website remains a vibrant source of information for members of the College, other members of the surgical team, and the general public, providing content on College programs, initiatives, and surgical news. Moreover, the functionality of the site undergoes continual improvements.

ACS media relations outreach efforts are focused on highlighting original research studies promoting surgical advances and innovation. In Washington, DC, the focus is on building media awareness of our positions and opinions on health care policy issues at the federal and state levels. The College and its activities have been covered in U.S. News & World Report, Reuters Health, New York Times, and USA Today, as well as on National Public Radio and NBC News.

The Bulletin successfully transitioned from a mostly print publication to an online publication in January. At press time, the Bulletin team was gearing up to survey readers on their impressions of the transition. The Journal of the American College of Surgeons also has begun the process of transitioning to an electronic-only journal.

The College’s social media presence continues to grow. In three years, the 115 ACS Communities have become home to more than 4,631 unique contributors who have posted more than 53,279 messages in approximately 8,996 discussion threads. Furthermore, the ACS continues to see upward trajectories on our Facebook, Twitter, and LinkedIn sites.

Looking forward to 2018

As these few examples demonstrate, the ACS is constantly moving forward to offer surgeons and the other members of the patient-care team the tools, resources, and educational opportunities they need to succeed in practice and to provide optimal patient care. As always, you are encouraged to contact the ACS leadership, and let us know how we can best serve you.

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