This year has been an exciting one for the American College of Surgeons (ACS). The staff and volunteers have developed and implemented several new programs that will allow the Fellows and other members of the organization to improve and safeguard surgical patient care. The following summarizes those innovations. This account is presented as I near the end of my 10th year as Executive Director of the College.
Advocacy and Health Policy
The ACS Health Policy and Advocacy Group identified more than 40 issues that the College’s Division of Advocacy and Health Policy should address. Top-ranking issues are as follows:
- Administrative burdens and regulations, including prior authorization
- Payment reform, including adding value-based payment
- Electronic health records (EHRs), including interoperability
- Evaluation and management (E/M) documentation guidelines
- Out-of-network care, including surprise billing
- Firearm safety
- Joint contract negotiations
- Scope of practice
- Trauma advocacy
- Workforce issues
A key way that we are making headway on several of these issues is through ACS THRIVE (Transforming Health Care Resources to Increase Value and Efficiency). THRIVE developed through a collaboration of the ACS and the Harvard School of Business (HBS) Institute for Strategy and Competitiveness. This partnership started in January when Frank G. Opelka, MD, FACS, ACS Director, Quality and Health Policy; Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS Division of Research and Optimal Patient Care (DROPC); and I participated in an HBS course.
THRIVE ties together the ACS Quality Programs’ proven track record of producing better outcomes at lower costs with economic principles that the HBS espouses for creating a value-based health care system. Key components of this system include development of integrated practice units, composed of all health care professionals and facilities involved in every stage of surgical patient care—from diagnosis to postdischarge care; use of time-driven, activity-based costing; and bundled payment. Congressional staff and officials at the Centers for Medicare & Medicaid Services (CMS) have continued to express interest in ACS THRIVE as a means of transforming the U.S. health care system.
Regulatory issues affecting payment
On July 29, CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) proposed rule. This annual rule updates payment policies, payment rates, and quality provisions for services furnished under the MPFS on or after January 1, 2020. CMS estimates a 0 percent impact on total allowed charges for general surgery services relative to its proposals for CY 2020. The final rule was released November 4 and will be described in detail in the January 2020 issue of the Bulletin.
The proposed rule introduces changes related to office/outpatient E/M visits that take effect in 2021. CMS proposes to align Medicare’s office/outpatient E/M coding with changes laid out by the Current Procedural Terminology Editorial Panel for office/outpatient E/M visits, specifically: retain five levels of coding for established patients and reduce the number of levels to four for new patients; eliminate history and physical as elements for E/M code selection and allow clinicians to choose the E/M visit level based on either medical decision making or time; and create add-on codes for prolonged services and for primary care/nonprocedural specialty care. CMS also proposes to increase the values for most office/outpatient E/M codes based on recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee, but these increases will not apply to global surgery codes.
The final rule retains the proposals regarding E/M codes.
The CMS issued the fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) final rule August 2. The IPPS outlines coverage, reimbursement, and quality reporting criteria for Medicare Part A inpatient hospital claims. Because a large proportion of surgical care is provided in the inpatient setting, the provisions in this rule are likely to affect many surgeons. For details, see the article on page 22 in this issue of the Bulletin.
The ACS testified before two congressional committees this year on firearm injury prevention and the Senate Finance Committee on Medicare payment reform. The College also provided extensive comments on the surprise billing issue and actively educated members of Congress and their staffs on this important issue. Furthermore, the College led the effort to achieve passage of the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2019, which includes Mission Zero language.
ACS chapters in 27 states received State Lobby Day grants this year. The financial grants can be as much as $5,000, with a $2,500 match, along with ACS State Affairs staff support for the event. Details about this program were published in the October issue of the Bulletin.
College leaders met with the ACS Private Practice Workgroup in July to discuss the challenges of maintaining this time-honored way of delivering care. We released ACS Resources for the Practicing Surgeon, Volume II: The Private Practice Surgeon at Clinical Congress 2019. This new primer provides an overview of various private practice business arrangements, financial management and revenue cycle processes, relevant health care laws and rules, and mechanisms to ensure the ongoing prosperity of private practice.
The staff and surgeon contributors to the ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC) attended more than 150 fundraisers and meet and greets for members of Congress in 2019.
The ACS continues to steer the national strategic direction in surgical education, training, validation, credentialing, and accreditation.
Education and training for practicing surgeons
The ACS Academy of Master Surgeon Educators launched in 2017. Initial Members and Associate Members were inducted in October 2018. The Members and Associate Members submitted suggestions regarding initiatives the Academy should pursue. Steps are being taken to pursue the top two priorities for 2019–2020. The second class of Members and Associate Members and new Affiliate Members wereinducted October 4, 2019.
The ACS Certificate Program in Applied Surgical Education Leadership (CASEL) launched in September. Modules and focused sessions of CASEL included Navigating Change, Evaluating Program Outcomes, Leading and Supporting Faculty Development and Advancement, and other programming content.
The one-day, annual course, Surgical Education: Principles and Practice, is offered at the Clinical Congress. Plans are under way for regional dissemination of this course, and an online Faculty Development Program on the Fundamentals of Assessment is in development.
A new Comprehensive Faculty Development Program will address national needs through a complete portfolio of courses and programs anchored to the four levels of professional accomplishment of surgeon educators—Teacher, Master Teacher, Educator, and Master Educator.
Activities directed at senior surgeons include the following:
- Introduction to simulation-based teaching helps senior surgeons acquire teaching skills in simulation-based education and training.
- A new program for senior surgeons interested in coaching mid-career and junior surgeons is in development.
- Courses on effective teaching, assessment, and evaluation are being designed using the Surgical Education: Principles and Practice Course model.
The 15th anniversary of the Surgeons as Leaders: From Operating Room to Boardroom Course was celebrated at the 2019 course in April.
The Fourth Annual ACS Summit on Surgical Training convened in May and focused on Competency-based Surgical Education and Training. A panel addressed this topic from the perspectives of the ACS, American Board of Surgery (ABS), Association of Program Directors in Surgery (APDS), and Resident and Associate Society of the ACS (RAS-ACS).
The Future of General Surgery Training Collaborative includes leaders from the ACS, ABS, APDS, Accreditation Council for Graduate Medical Education, Residency Review Council for Surgery, and American Surgical Association. The collaborative is focusing on resident selection, end-product of training, resident attrition, and other issues.
We have initiated a project to develop an Optimal Resource Guide for Surgical Training to define the essential resources needed for modern surgical training.
The flagship simulation-based education and training program is the ACS-Accredited Education Institutes (ACS-AEIs). In total, 98 institutions have ACS accreditation, and 16 ACS-AEI Simulation Fellowship Programs have been established. The 2019 Annual ACS Surgical Simulation Summit (12th Annual Meeting of the Consortium of ACS-AEIs) took place in March.
A Joint Program with Engineers took place prior to the 2019 Surgical Simulation Summit. Key individuals from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Defense (DoD), and National Institutes of Health (NIH) participated and provided information on funding opportunities.
The ACS was awarded a DoD subcontract to design and conduct validation for the Advanced Modular Manikin Project of the University of Washington, Seattle, and the University of Minnesota, Minneapolis. Three ACS-AEIs have been selected to participate in this project.
The ACS Fundamentals of Surgery Curriculum® was awarded a patent by the U.S. Patent and Trademark Office. A total of 109 peer-reviewed case scenarios are available in 14 content areas, and advanced cases are in development.
The ACS Entering Resident Readiness Assessment is an online program in which case simulation is used to assess the clinical decision-making skills of entering surgery residents. Advanced cases will be developed over the next year.
The ACS Clinical Congress remains the premier annual surgical meeting, offering a range of educational opportunities to surgeons, residents, medical students, and members of surgical teams. All Skills Courses offered at the Clinical Congress involve verification using the ACS Division of Education’s Five-Level Verification Model. Clinical Congress 2019 offered Continuing Medical Education (CME) and Self-Assessment Credits for most sessions, and Certificates of Verification were provided for Postgraduate Courses.
Now in its 47th year, the Surgical Education and Self-Assessment Program (SESAP®) remains the premier self-assessment and guided cognitive skills education program for practicing surgeons. SESAP 17 was released at Clinical Congress 2019. New features have been added to increase its impact, and a specialty-focused program, Advanced SESAP 17, will be released in 2020.
Cosponsored by the ACS and ABS, the Alternate Pathway includes individualized study plans with in-person coaching for surgeons who have either not taken board examinations and have run out of eligibility or repeatedly have failed the exams. To date, the pass rate for participants in the program is twice that of nonparticipants.
A three-day course, ACS Core General Surgery Review for Residents, has been developed, which should benefit individuals preparing for the General Surgery Qualifying Examination or transitioning to general surgery practice. The inaugural course took place in July.
A multidisciplinary panel is developing Optimizing Perioperative Pain Management: An Evidence-based Approach.
The third edition of Ultrasound Essentials for Surgeons, released in May, includes several updates and enhancements. A companion course for residents, Ultrasound Essentials for Residents, has been developed.
The Bariatric Surgery volume of the Multimedia Atlas was released this spring. The atlas contains videos, medical illustrations, didactic presentations, and expert commentaries.
Resident and medical student education
The simulation-based ACS Surgery Resident Objective Structured Clinical Examination program includes 10 integrated stations on patient safety and is aimed at entering surgery residents.
The ACS/APDS Surgery Resident Skills Curriculum is a proficiency-based skills curriculum designed to address the needs of surgery residents. Efforts are under way to replace resource-intense models with simulators.
At Clinical Congress 2019, the Division of Education again partnered with the Division of Member Services and the RAS-ACS to offer an integrated two-day program focused on Essential Skills for Surgery Residents.
Clinical Congress 2018 and 2019 included a session, Pathways in Surgical Education for Residents and Medical Students. Developed as a collaborative venture between the ACS and ASE, the one-hour session provided an informal forum for residents and medical students to learn about opportunities in surgical education.
Surgical Patient Education Program
A focus of the Surgical Patient Education Program over the last year has been on surgical opioid-sparing pain control. The program has grant support and includes resources for patients and providers.
The Patient Education web page has been updated to include patient and caregiver training. Translation of the materials to different languages is being pursued with the ACS international chapters. A new endeavor being pursued by the Patient Education Committee is the use of technology to enhance communication between surgeons and patients.
Continuous Quality Improvement
The Continuous Quality Improvement (CQI) area of DROPC continues to grow, offering an array of programs.
Quality and Safety Conference
The 2019 ACS Quality and Safety Conference took place in July, with more than 2,100 attendees. The conference theme, Putting Our Patients First, was evident during the four-day meeting. For details, see the October Bulletin.
Quality improvement programs
A total of 856 hospitals participate in the ACS National Surgical Quality Improvement Program (ACS NSQIP®)—718 in ACS NSQIP Adult and 138 in ACS NSQIP Pediatric. Approximately 75 percent of ACS NSQIP Adult hospitals are involved in more than 60 formal collaboratives.
Voluntary public reporting on Hospital Compare is available to ACS NSQIP participating sites through CMS. ACS NSQIP sites may voluntarily publicly report three surgery-related, risk-adjusted outcomes measures on the Hospital Compare website.
ACS NSQIP has partnered with the American Society for Transplant Surgeons on the ACS TransQIP Pilot Project to fill a gap in surveillance and data collection for the transplantation community. Discussions to create a full TransQIP program (ACS NSQIP Transplant) continue.
Since the Children’s Surgery Verification (CSV) Program launched in 2017, enrollment in ACS NSQIP Pediatric has increased. Verification for specialty pediatric hospitals began in July. After meeting with leaders from oncology and musculoskeletal specialty hospitals over the last year, CSV developed modified Level I standards that will allow hospitals that offer these services to apply to the program and achieve a Level I designation.
In November 2018, CSV launched the ACS NSQIP Pediatric Antibiotic Stewardship Pilot. Antibiotics were chosen as a focus based on the variation among children’s hospitals and the increasing public health implications associated with antibiotic overuse. The pilot likely will run for a year.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has 912 participating hospitals; 822 are fully accredited.
MBSAQIP’s second national collaborative initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (ENERGY) ended last year. The most important finding from this work is that ENERGY centers cut their lengths of stay in half. Furthermore, centers that closely adhered to process measures were more likely to improve patient outcomes.
In May, MBSAQIP released the third version of its standards. Important changes in this edition include improved direction and support for quality improvement projects, the addition of a patient risk assessment and follow-up protocol, and a medical weight loss accreditation option to recognize centers that offer nonsurgical weight management treatment.
MBSAQIP launched a patient-reported outcomes (PROs) project, which will provide the first results from comparative effectiveness analyses of the three most common metabolic and bariatric procedures (gastric sleeve, gastric bypass, and gastric band) based on patient-centered, patient-reported, one-year outcomes. This program will provide patients and providers with timely metrics on what patients care about most to inform decision making.
MBSAQIP unveiled a Bariatric Surgical Risk/Benefit Calculator to support preoperative decision making, enabling patients and clinicians to select a particular procedure and estimate risk of complications, body mass index reduction, and postoperative comorbidity resolution.
MBSAQIP also launched its third national collaborative project focused on opioid reduction—the Bariatric Surgery Targeting Opioid Prescriptions—and continues its work toward the release of its new data registry in January 2020.
Approximately 5,000 surgeons have entered more than 10.8 million cases into the Surgeon Specific Registry (SSR). In addition to serving as a mobile friendly case log system, the SSR helps surgeons comply with regulatory mandates, such as requirements stipulated in the CMS Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) and the ABS Continuous Certification Program. CMS has approved the SSR to provide MIPS participation through registry-based reporting for the 2019 Performance Year. For the 2019 MIPS Performance Year, the SSR supports the Quality and Improvement Activity (IA) components. Surgeons can choose from 88 surgically relevant IAs for attestation. Surgeons may further select one of the following Quality reporting options for MIPS 2019 participation in the SSR:
- General Surgery Specialty Measures Set includes options for general surgeons and plastic surgeons (MIPS-Qualified Registry)
- ACS Surgical Phases of Care Measures includes options for a range of surgical specialties (MIPS-Qualified Clinical Data Registry [QCDR])
The ACS Surgical Phases of Care QCDR includes a measure for electronic PROs (ePROs). A total of 266 surgeons submitted MIPS 2018 data using the SSR; 223 participated in the General Surgery Specialty Measures Set and 11 in the ACS Surgical Phases of Care Measures Set. Some individuals reported on the Quality and the IA components, but 43 submitted IAs only.
The ACS Quality Data Platform Project is ongoing. Eventually, all ACS clinical data platforms will migrate to a single platform to allow a common data entry platform, data warehouse, and advanced reporting and data visualization tools. The SSR, ACS NSQIP, AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR), NSQIP Pediatric, and Trauma registries are active on the Quality Data Platform, and the Cancer and MBSAQIP registries will move to the platform in 2020.
Another part of the project aims to improve data quality and reduce the data entry burden through the use of an EHR Adapter, which has been piloted at several ACS NSQIP sites and is being modified based on pilot hospital feedback and survey results. The platform will incorporate PROs to give participating hospitals insights into the quality of care from the patient perspective. The ACS has tested PROs in NSQIP, MBSAQIP, and SSR.
Strong for Surgery (S4S) continues to grow. More than 500 sites have accessed the online program toolkit since its release in July 2017. The S4S toolkit offers four original checklists—nutrition, blood glucose control, smoking, and medication—and has added four new checklists—delirium, prehabilitation, advance directives, and safe and effective pain control. Six comprehensive checklists were added to S4S this year, covering topics such as chronic disease management, mental health, and substance abuse.
The four-year Coalition for Quality in Geriatric Surgery (CQGS) Project, funded by The John A. Hartford Foundation, aims to improve care for older patients. The project recently concluded with many milestones completed, including the finalization of geriatric surgery standards, initiation of a media campaign, and launch of the Geriatric Surgery Verification (GSV) program.
The 30 GSV standards, Optimal Resources for Geriatric Care, were released this year for use in all U.S. hospitals. The program will prepare hospitals for the influx of older adults with care standards that define the resources hospitals need to provide surgical care to this vulnerable population.
The AHRQ Safety Program for ISCR is a collaborative program between the ACS and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, to enhance recovery for surgical patients. ISCR is a five-year project that seeks to improve clinical outcomes by supporting hospitals in the implementation of evidence-based enhanced recovery pathways that improve perioperative care and reduce variability. ISCR will now comprise five cohorts, each lasting 12 months. Hospitals can now implement enhanced recovery pathways for colorectal, orthopaedic (hip and bone), gynecology, and emergency general surgery patients. The emergency general surgery cohort will launch in March 2020. (See the January 2020 Bulletin for details.)
Several organizations have approached the ACS to partner in the development of new specialty-specific verification programs. Clinical areas of development include: high-risk gastrointestinal surgery, vascular, thoracic, emergency general surgery, and rural surgery. Other areas are in discussion. Pilot testing with the Society for Vascular Surgery, the Society of Thoracic Surgeons, and the American Association of Trauma Surgeons will begin soon.
The ACS CQI team has been involved in THRIVE, described in the Advocacy and Health Policy section of this report. The program will be piloted at U.S. hospitals, focusing on measuring the full cycle of care for three surgical conditions. Once the program has better defined participation criteria, hospital recruitment will begin.
The College is developing adjunct resource standards based on the Optimal Resources for Surgical Quality and Safety to develop a Red Book Verification Program. An initial draft of the standards and a prereview questionnaire have been completed. Pilot site visits occurred throughout 2019, and the program standards are nearly complete.
The December 2018 Health Services Research Methods Course had 51 attendees and 14 faculty members. The course was designed to meet the needs of clinical and health services researchers with varying degrees of experience in the field. The course was introductory and best suited for new researchers, suggesting that a more advanced course for experienced members should be explored.
The College continues to provide opportunities for surgical residents to become involved with ACS Quality Programs through the ACS Clinical Scholars in Residence Program. At present, the ACS has four Clinical Scholars in Residence; two are receiving support through The John A. Hartford Foundation for the CQGS, one is receiving support from the AHRQ Safety Program for ISCR, and one has funding from his home institution and is focusing on quality in colorectal and oncologic surgery.
The six ACS Cancer Programs continue to function at a high level, delivering on their mission to improve cancer patient care.
The CoC is the largest and most mature cancer program and accredits more than 1,533 Commission on Cancer (CoC) hospitals. Strengths of the program include its size, legacy, and impact. New standards for the CoC have been drafted, reviewed, and finalized for implementation in 2020.
The National Accreditation Program for Breast Centers (NAPBC) certifies 647 specialty centers. The NAPBC is the first accreditation program focused on specialty care for a site-specific disease. Peer-review publications demonstrate superior outcomes for patients treated at NAPBC centers, providing support for the value of NAPBC and its mission.
The National Accreditation Program for Rectal Cancer (NAPRC) is the second accreditation program focused on specialty care and has recently been added to the portfolio of multidisciplinary programs focused on the quality of cancer care. NAPRC has 13 newly accredited centers, with 37 in the pipeline.
The National Cancer Database (NCDB) has curated more than 39 million cancer records and is the largest database of its kind in the U.S. The NCDB, through CoC-accredited sites, continues to collect roughly 1.5 million cancer cases with each annual call for data, which represents 72 percent of all newly diagnosed cancer cases in the U.S. Nearly 300 data items are collected for each cancer patient, and 10 reports are provided to CoC institutions, including Rapid Quality Reporting System, survival outcomes, hospital comparison benchmarks, Cancer Program Practice Profile Reports, and Cancer Quality Improvement Program reports. The NCDB supports approximately 1,000 research projects annually.
The eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual comprises 80 chapters and 100 staging systems. The manual can be formatted to meet different stakeholder needs, and the electronic content can be licensed to EHR vendors and partner organizations. The eighth edition has incorporated biologic markers of cancer outcomes as a foray into personalized medicine.
The Cancer Research Program (CRP) has conducted several research projects on cancer surveillance and has led several clinical trials (Z6051, Z6041, and Z0011, Z1071), each of which has informed and affected oncologic care in the U.S. CRP recently has focused on the dissemination of new knowledge generated from clinical trials through the development of informational videos distributed to multidisciplinary tumor boards.
Since 2011, the CRP has developed Operative Standards for Cancer Surgery manuals, two of which have been published, covering nine cancer sites. It is anticipated that the introduction of six operative standards into the 2020 CoC standards will accelerate the dissemination and implementation of these technical standards. Theoretically, the CRP could serve as a knowledge engine and could advance the methodologies associated with alternative trial design, as well as standards and quality, for example by defining the characteristics and thresholds of an impactful standard.
Cancer Programs staff performed an assessment of these programs as part of the onboarding of the new leadership. A total of 191 surveys and 604 individual comments were reviewed and discussed at a January 2019 retreat. Survey data support that the programs remain strong in staging and standards, with less support for an authoritative role in quality. Each program was reviewed for strengths and challenges.
Participation in ACS Trauma Quality Programs has grown this year.
A total of 834 hospitals participate in the Trauma Quality Improvement Program (TQIP) and 18 in the collaborative. In addition, 555 hospitals are ACS-Verified Trauma Centers.
The 2019 TQIP Conference took place November 16–18 and featured the release of “Non-Accidental Trauma Best Practice Guidelines”; sessions on the TQIP mortality study, error management, and getting the most out of your TQIP reports; and a general session that included a live trauma simulation and debriefing. The Committee on Trauma (COT) also launched the Advancing Leadership for Trauma Center Management Course at the TQIP Conference. This course provides insight on the infrastructure necessary to develop and lead a trauma center to success.
The ACS surveyed U.S. members to gain a better understanding of their views on firearm ownership and firearm injury prevention strategies. The results were presented during a Special Session at Clinical Congress.
Representatives from 45 professional medical and injury prevention organizations and the American Bar Association met February 10–11 for the inaugural Medical Summit on Firearm Injury Prevention. Details about the Summit were published in the October issue of the Bulletin.
The COT has convened the ISAVE (Improving Social determinants to Attenuate ViolencE) panel to study the causes of violence and recommend innovative programs within the trauma systems to reduce the prevalence of intentional violence.
The COT hosted a Research Methods Conference in July for COT and Coalition for National Trauma Research (CNTR) members. In partnership with CNTR, the COT is exploring opportunities to submit grant applications to leverage the TQIP infrastructure for high-quality research.
The ACS, in partnership with the National Association of State EMS (emergency medical services) Officials and with support from the National Highway Transportation Safety Authority, drafted a joint statement on linking traffic collision data across the trauma/EMS care continuum.
The COT PROs workgroup held a consensus conference in January that focused on patient inclusion criteria, data elements to be collected, and data collection methodology. The conference brought together national and international experts to discuss and plan strategies to achieve PROs in trauma.
The transition from the ninth to the 10th edition of the Advanced Trauma Life Support® (ATLS®) program ended in September. The 10th edition is the most transformational revision of the ATLS course to date, and more than 10,000 students have completed the 10th edition course. For details, see the March 2018 issue of the Bulletin.
Attendance at the 2019 ATLS Global Symposium has increased over the last five years from 125 attendees to 240 attendees. Representatives from more than 30 countries shared best practices and discussed the evolution of trauma education.
Other trauma education programs
The Basic Endovascular Skills for Trauma course and workshop released updated and expanded course materials and is experiencing expanded international interest. The second edition of the Advanced Surgical Skills for Exposure in Trauma (ASSET) launched this year. In addition to revised and updated content, the new ASSET curriculum features add-on topics, such as ophthalmology, obstetrics, and amputations. In 2020, the third edition of the Advanced Trauma Operative Management course and a fourth edition of the Trauma Evaluation and Management course for medical students will be released.
Stop the Bleed
The Stop the Bleed® program has increased in size and scope. With an expanding reach through the growing roster of instructors, more than 1.2 million people in all 50 states and more than 110 countries have been trained in bleeding control techniques.
The redesigned Stop the Bleed course is more succinct, easier to present to nonclinical audiences, and gives students a graphic presentation of the material. This new course will be translated into several languages for a growing international audience.
A new website, www.stopthebleed.org, will meet the ongoing challenge of bringing information, education, and empowerment to the general public, while still serving as a clearinghouse for Stop the Bleed products, services, and updates. Developed in part with funding from the Hartford, the website’s design is a result of extensive research and marketing guidance.
The ACS has 84,026 members: 64,414 Fellows (56,044 U.S., 1,262 Canadian, and 7,108 International). Of the 64,414 Fellows, 9,654 hold senior status and 16,181 are retired. The ACS has 2,673 Associate Fellows, 11,211 Resident Members, 3,168 Medical Student Members, and 568 Affiliate Members. This year’s Initiate class totals 1,992.
Recruitment and retention
The ACS identified opportunities for recruitment among lapsed members in the Resident, Associate, and Fellow categories; marketed membership to more than 4,500 former residents; and created a marketing plan for nonmember surgeons who have attended College meetings or purchased ACS products. We also tested a Win-Back campaign for lapsed Fellows.
We are developing an onboarding program for Associate Fellows to enhance communications and increase the number of Associates applying for Fellowship. We are developing a plan to involve Regents, Advisory Councils (ACs), Governors, and Chapter leaders in encouraging Associates to apply for Fellowship.
A benchmark analysis was conducted to ensure the ACS membership complements and is competitive with other international organizations and to identify areas for growth.
Member Services promoted engagement among international Initiates at Clinical Congress with WhatsApp groups for individual countries, which allows the ACS to send targeted information about Clinical Congress and facilitate virtual introductions before the meeting. The ACS also facilitated relationships between International Relations Committee (IRC) members and Initiates at Clinical Congress.
ACS chapters work with the College to provide members with benefits, including the opportunity to network with surgical peers locally, to participate in advocacy activities at the state and federal levels, and to attend CME meetings. Chapter Services provides guidance and assistance in these areas to the College’s 114 chapters—67 domestic and 47 international.
Highlights from the last year are as follows:
- Iraq and South Africa were granted chapter charters
- Chapters completed the required annual report summarizing their activities in 2018, and the leadership of each chapter received a personalized report with suggested areas of focus
- The third annual Chapter Officer Leadership Program took place in March to provide domestic chapter leaders with the skills they need to build sustainable success through strong volunteer leadership
- An online toolbox was developed to assist chapters with recruitment
The Board of Governors (B/G) Chapter Activities Domestic Workgroup reviewed the Chapter Guidebook, advised on the Chapter Officer Leadership Program, participated in the Chapter Speed Networking event, and reviewed questions for the Annual Report and provided insights on the collected data.
The ACS has 290 Governors: 154 Governors at-Large, representing each U.S. state and Canadian province and territory; 87 specialty society Governors; and 49 international Governors.
The B/G Executive Committee’s Strategic Planning Retreat in June focused on progress in meeting these priorities, evaluation of the work of the Pillars and Workgroups, and finalization of preparations for the Annual Business Meeting at Clinical Congress. At the Joint Session with the Board of Regents (B/R), attendees engaged in an interactive session, The Healthcare Landscape in the Future, featuring brief talks on the College’s role, private practice surgeons, and Quality Programs.
The B/G is structured under five Pillars and 13 Workgroups. For a summary of their activities, see the October issue of the Bulletin.
The ACs assisted with the review of expert witness testimony for the Central Judiciary Committee (CJC), nominated members for boards and specialty review committees, recommended members to represent the ACS on specialty guidelines writing and review panels, and submitted 123 proposals for Clinical Congress 2020. AC Chairs and Regents communicated with specialty program directors to encourage them to enroll their residents in the ACS.
AC Pillars and B/G Pillars met at the Leadership & Advocacy Summit and Clinical Congress and are working on collaborative efforts. The AC for Rural Surgery is working to develop a resident scholarship for a one-month rotation at a training program with a rural surgery focus, and all the ACs are participating in an ACS Foundation Challenge.
The Young Fellows Association’s (YFA’s) Equity Taskforce works to improve diversity and invited members of the Latino Surgical Society and the Society of Asian Academic Surgeons to join the ACS. The task force also developed a white paper on parental leave.
Eight triads, each composed of one mature Fellow, one young Fellow, and one Associate Fellow, were created for an Annual Mentor Program. More than 50 mentors and mentees participated in an hour-long Speed Mentoring program at Clinical Congress 2019.
The YFA engaged with members and potential members on social media, @yfaacs, and published 15 essays on Surgical Patients: On Becoming the Surgeon Advocate, Leader, and Learner. The YFA also worked with DROPC to begin a Future Quality Leaders program and with Selected Readings in General Surgery to engage young Fellows in content development.
RAS presented the inaugural Outstanding Mentor of the Year Award at Clinical Congress to honor a surgeon who has helped an RAS member become an ACS leader. RAS offered 15 Phone Hangouts to medical students and residents on various subjects, as well as 16 webinars on additional relevant topics. More than 25 residents co-authored four articles and an introduction on Wellness and Resilience in the August issue of the Bulletin.
Two more host countries—Greece and Kuwait—have agreed to participate in the annual International Scholarship Exchange. A total of 70 scholarships were awarded to residents attending the 2019 Leadership & Advocacy Summit.
Operation Giving Back (OGB), in the aftermath of Hurricane Maria in 2017, has worked to establish a volunteer response program for uninsured and underserved people in Puerto Rico. Since March 2019, in partnership with the Puerto Rico Department of Health, the Puerto Rico Chapter of the ACS, and local nongovernmental organizations, OGB has mobilized volunteer surgeons on a rotating, weekly basis.
OGB has worked to establish the inaugural ACS-College of Surgeons of Eastern, Central and Southern Africa (COSECSA) Surgical Training Hub at Hawassa University, Ethiopia. The six-month pilot of this capacity-building program included two-week rotations by each of the 13 participating U.S. academic institutions and concluded in July.
OGB participated in the 2019 Leadership & Advocacy Summit and is developing a global surgery advocacy one-pager to spread awareness. The director of the Fogarty International Center at NIH attended the Hawassa Hub annual workplan meeting, signaling a step forward for OGB’s advocacy agenda.
Five ACS-Pfizer Surgical Volunteerism and Humanitarian Award recipients were honored at the B/G dinner and presented their work at Clinical Congress.
OGB hosted the third annual Global Surgery Program Leaders meeting at Clinical Congress and facilitated one-hour meetings for medical students and residents interested in global surgery.
The ACS-COSECSA Women Scholars Program expanded this year to provide up to 20 scholarships for women to enter specialty tracks upon completion of their basic surgical training. In spring 2019, 10 women were awarded this assistance. This winter, OGB plans to grant funding to four women scholars to cover their final examination and five years of membership in COSECSA and the ACS, with co-funding from the Association of Women Surgeons Foundation.
With assistance from the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) and ACS DROPC, a military Surgical Quality Consortium (SQC) has been formed to include all 47 U.S. Military Treatment Facilities (MTFs) that have inpatient surgical capabilities, as well as a few outside of the U.S.
MTFs are undergoing Red Book consultations, and ACS NSQIP has recognized MTFs as “meritorious.” In addition, Health Affairs recently published a paper describing the inception of the military SQC and its impact on surgical quality within the MHS.
The National Defense Authorization Act of 2017 requires all major MTFs to either participate in their regional civilian trauma system or partner with a civilian trauma center to ensure military trauma surgeons and teams are prepared for deployment. The PAHPAI Act provides funding for civilian trauma centers to train combat casualty care teams and individual physicians. How these centers might be chosen and evaluated, as well as the challenges of establishing such programs within civilian trauma centers, was the focus of several MHSSPACS meetings, resulting in the compilation of standards.
The military Clinical Readiness Program (also known as the Knowledge Skills and Abilities Project) includes all members of the combat casualty care team and has resulted in each group formulating the essential knowledge points and skill sets needed for their specialty. The MHSSPACS has generated more than 500 knowledge-point questions, and from them two versions of a beta test were devised and distributed to 138 military surgeons. The test could distinguish between novice and experienced trauma surgeons and between surgeons with and without extensive deployment histories, indicating content validity. In addition, we have worked to develop a hands-on skills assessment course for the expeditionary surgeon based on ASSET with added elements for damage-control orthopaedics, neurosurgery, ophthalmology, and obstetrics.
The ACS has secured funding from the DoD/Combat Casualty Care Research Project to study posttraumatic pulmonary embolism. This study, which includes 17 U.S. trauma centers, has both a clinical and a basic research component.
The Excelsior Surgical Society has 285 Active, Associate, Distinguished, and Honorary members. In addition to the annual Scientific Meeting, Business Meeting, and reception at Clinical Congress, the society is resurrecting the Senior Visiting Surgeons Program, which will allow for exchange of surgeons between military and civilian centers.
The IRC has created a database of international surgeons who are subject matter experts for the Clinical Congress Program Committee to use in selecting speakers and identified ways to engage international Clinical Congress attendees.
The IRC oversaw the selection of awardees for the 2019 International Chapter Opportunity Program. One of the ACS’ most successful international initiatives, this program provides financial support for chapters to host a local educational course. The Argentina and Australia and New Zealand Chapters were awardees in 2019.
The IRC collaborated with the ACS Foundation to develop a report for the International Chapter Opportunity Program that communicates the impact and reach of the program to its primary funder and prospective supporters. Furthermore, the subcommittee is helping to create an e-book to help breast surgeons in low- and low-middle-income countries to better serve their patients.
The IRC is identifying meaningful benefits and opportunities for international surgeons and is working with the Division of Education to make ACS educational materials available at tiered cost and is working with international Governors to identify chapter meetings where ACS Officers can present on pathways for professional growth and leadership for women surgeons.
The IRC is responsible for scholarships that provide opportunities for international surgeons to attend ACS meetings. In 2019, these programs benefitted 20 international and three domestic surgeons.
Among its activities, the Women in Surgery Committee (WiSC) administers the Women Surgeons Community, which has more than 5,300 members.
The WiSC nominates worthy women surgeons for leadership roles in the College, Honorary Fellowship, and other awards, including the Dr. Mary Edwards Walker Inspiring Women in Surgery Award. The 2019 recipient was Vice Admiral Raquel C. Bono, MD, FACS, retiring Director, Defense Health Agency Medical Corps.
The Mentorship Program Subcommittee pairs women surgeons for one year to address topics such as career development, research goals, work-life balance, practice development, and leadership. The subcommittee received 31 mentee applications for 2019−2020.
The WiSC, with input from the ACS Committee on Diversity Issues, developed the updated Statement on Harassment, Bullying, and Discrimination, which the B/R approved in June.
The Committee on Diversity Issues posts and updates Diversity Resources on the ACS website to assist surgeons with the challenges they may face. These resources address needs assessment, cultural competency, implicit bias, and diverse surgical team building.
The first in a “Profiles in Diversity” series, which spotlights ACS Fellows who have overcome obstacles or have created or led diversity initiatives within their institution, featured Julie Freischlag, MD, FACS, FRCSEd(Hon), Past-Chair, ACS B/R. The podcast is available online, and the interview was published in the April Bulletin.
IPV Task Force
The Intimate Partner Violence (IPV) Task Force, formed in January 2018, has developed the ACS Statement on Intimate Partner Violence; published articles in the October 2018 issue of the Bulletin to raise awareness of this issue during Domestic Violence Awareness month; released an ACS IPV Toolkit; posted a set of pages on the ACS website with information and resources; developed a case scenario on IPV for the ACS Fundamentals of Surgery Curriculum; convened a Town Hall on IPV at Clinical Congress 2018; deployed an ACS Member Survey on IPV; created an IPV Grand Rounds presentation slide set; given an IPV presentation during a RAS-ACS Grand Rounds Webinar; and sponsored an IPV and the Surgical Workforce Panel Session at Clinical Congress 2019.
The CJC reviewed 20 cases this year and has made 16 recommendations to the B/R for disciplinary actions.
Society of Surgical Chairs
The Society of Surgical Chairs (SSC) has 191 dues-paying members. The 2019 annual meeting program focused on the patient and the impact of EHR. The SSC Mentorship Program for new chairs focused on managing up. In April, the SSC Women’s Committee hosted the third annual leadership symposium, Not a Moment in Time.
Leadership & Advocacy Summit
More than 560 ACS leaders and members attended the Leadership portion of the eighth annual Leadership & Advocacy Summit. For details, see the June 2019 issue of the Bulletin.
The ACS Archives responded to 104 research requests over the last year and has received 35 new accessions. The Archives led several projects to increase the accessibility and use of the collections. This included professionally photographing all presidential oil portraits and other ACS artworks and artifacts.
Clinical Congress program books from 2013 to 2018 are now available online for research. More will be added as they are digitized.
The Surgical History Group of the History and Archives Committee published four Bulletin articles this past year based on the 2018 Clinical Congress panel World War I: The Dawn of Evidence-Based Casualty Care.
The second Archives Fellowship was awarded this year to Cynthia Tang, a doctor of philosophy candidate at McGill University, Montreal, QC. Ms. Tang will receive a $2,000 award and will use the ACS Archives to conduct research on the laparoscopic revolution through surgical training.
The Physician Well-Being Index enables users to track fatigue and burnout over time and provides resources for self-education. The ACS provides this online resource to Fellows and residents.
Earlier this year, Member Services hosted leaders involved in well-being initiatives at their institutions to discuss areas of focus for future initiatives. The ACS is working on the following initiatives as follow-up to this meeting: a survey of specialties to understand well-being and wellness initiatives and potential collaboration on areas of mutual interest, multimedia content for the ACS website, guides for career stages, increased programming at the Leadership & Advocacy Summit, and further incorporation of wellness opportunities at ACS events.
The Division of Integrated Communications supports the College’s public profile and visibility, member communications, and marketing activities. A new Director of Integrated Communications, Cori McKeever Ashford, began working in the Chicago headquarters December 2.
Public profile and visibility
The GSV Program captured national media attention this summer, with several news articles on the need for the program and how it will improve outcomes for older surgical patients. Stories were published in the New York Times, Associated Press, Kaiser Health News, AARP.com, Reuter’s Health, Becker’s Healthcare, and Fierce Healthcare. An estimated 98 percent of these articles included a link to the ACS website. An ACS press release, along with the program launch video link, captured 503 media mentions, representing a potential audience reach of 549.6 million readers/viewers/listeners.
ACS trauma surgeons appeared on CBS Sunday Morning to discuss a public health approach to firearm violence. The interviews appeared on the heels of two mass shooting incidents in August. The segment featured a panel of seven surgeons and physicians working with the American Foundation for Firearm Injury Reduction in Medicine. Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs—who was featured along with COT member Stephanie Bonne, MD, FACS—laid out some of the work already under way to tackle firearm violence as a public health problem, as recommended at the Medical Summit on Firearm Injury Prevention.
Following are print and online media clip highlights on a variety of ACS initiatives and programs:
- Race May Matter for Liver Transplant Success, U.S. News & World Report, January 15
- Sweeping Study Finds Overlapping Surgeries Generally Safe—With Exceptions, WBUR, February 26
- Turning Bystanders into First Responders, New Yorker, April 8
- Military Considers Sweeping Changes to Surgical Safety Programs, U.S. News & World Report, May 23
- Hospitals look to cut opioids from surgery and beyond, Modern Healthcare, July 8
- Harvard, American College of Surgeons team up to improve health care quality, BenefitsPRO, July 24
Integrated Communications played an integral role in launching StoptheBleed.org—the College’s first entirely public-facing website. Content developed by Integrated Communications, Stop the Bleed staff, and COT leaders reflects a new approach to informing, educating, and empowering the public to learn more about the program.
The ACS launched an artificial intelligence-driven version of ACS NewsScope. Disseminated twice a week, My ACS NewsScope delivers customized content to each recipient. The database curates information from nearly 80 sources of both clinical and nonclinical information on topics that are relevant to surgeons. Each issue also includes a “News Brief” on an ACS program and occasional updates from the Washington office.
This new version of NewsScope was developed partly to fill the void when ACS Surgery News ceased publication December 31, 2018. Pilot testing began in February with a randomly selected pool of ACS members. In response to the demand for more clinical information, we added posts from the top 50 surgical journals. My ACS NewsScope launched College-wide May 1.
The traditional ACS NewsScope continues to be disseminated to more than 55,000 recipients on Thursday nights.
Integrated Communications met in January to develop a strategic plan to keep both the print and online editions of the Bulletin fresh. As a result, some incremental content and design changes have been made in both the print and online versions.
The Bulletin has recruited 10 new editorial advisors to provide input and guidance from a broad pool of College leaders, including not only ACS Regents, but also Governors, AC members, young surgeons, and residents.
With the January 2019 issue, the Journal of the American College of Surgeons (JACS) unveiled a redesigned cover to reflect a more modern look. The January 2019 issue centered on 13 papers presented at the Clinical Congress 2018 Scientific Forum. It was the first Scientific Forum-dedicated issue of JACS, and the January 2020 issue will feature highlighted papers from the 2019 meeting.
At the end of 2018, JACS successfully achieved a subscription benchmark of converting 40 percent of College members to an online-only format and has recently incorporated an interactive PDF version that is distributed via a monthly e-Table of Contents.
Upward trajectories continue on the ACS Facebook, Twitter, and LinkedIn sites. In October 2018, a multistep process was used to create a Twitter strategy, which was approved and implemented.
After five years, the ACS Communities continue to be a popular member benefit. Since its launch in 2014, the platform has received 4.2 million page views. The 123 ACS Communities have become the go-to place for ACS members who want to collaborate with their peers. Popular discussion topics in 2019 included gender equity, family members in the hospital, surprise billing legislation, health care access, gender reassignment surgery, and surgeon replacements. In all, site visitors have posted more than 93,000 discussion group posts and viewed library items 155,000 times.
Demand for marketing and design services continues to grow, reflecting the success of the College’s programs, meetings, and conferences. Projects range from program branding, advertising, and supporting materials, to developing and executing comprehensive marketing plans and signage for ACS conferences and meetings. Marketing and design for ACS conferences accounted for more than half the projects the marketing team completed this year and contributed to the continued growth in awareness of and attendance at our meetings.
Weber-Shandwick has played an instrumental role in launching ACS THRIVE and recommending future areas of opportunity for our Communications team, particularly with regard to developing a more deliberate social media strategy and website redevelopment. Weber-Shandwick also is responsible for Clinical Congress Highlights, which focuses on scientific meeting coverage at the conference and supplements Clinical Congress News, which covers more general programs and activities and is staffed by the Bulletin team.
The number of individual contributors to the Foundation increased by 14 percent, rising to 1,316 in this fiscal year. The annual Fall Appeal generated $147,481, a 21.5 percent increase from FY 2018 and a 17.3 percent increase in individual donors.
National Doctors’ Day has experienced strong growth since its inception in 2016. Contributions have increased to $92,086 in FY 2019 from $17,280 FY 2016, representing a 433 percent increase.
The Sponsor a Medical Student initiative, in its second year, offers donors the opportunity to cover the cost of medical students attending Clinical Congress. OGB, Stop the Bleed training in rural communities, international scholarship travel awards, fellowship research awards, as well as the ACS Greatest Needs Fund continue to be supported by philanthropic gifts from Fellows.
Corporate grants secured by the ACS Foundation provided support for the Resident Surgical Skills Competition, 13 Skills Courses at Clinical Congress, and Patient Education resources.
The College continues to be fiscally sound and to offer generous benefits and training opportunities to its staff. This year, the College’s headquarters building is being renovated and we are updating our technology capabilities—a tremendous undertaking, but one I believe will pay off in terms of our ability to grow and continue to provide ACS Members with the tools and services they need to deliver quality care.
I want to thank the ACS volunteers and staff for their dedication to improving the care of the surgical patient. Through their hard work and commitment, the ACS continues to lead the way in ensuring patients have access to value-based surgical care.