Report on ACSPA/ACS activities, February 2012

American College of Surgeons Professional Association (ACSPA)

In 2011, the ACSPA’s political action committee (ACSPA-SurgeonsPAC) raised $665,692. Approximately 77 percent of U.S. Governors of the American College of Surgeons (ACS) contributed an average of $467. The SurgeonsPAC Board met for a strategic planning session in January in an effort to update and align 2012 strategic objectives with tactics.

On the 10-year anniversary of ACSPA-SurgeonsPAC, the SurgeonsPAC Board and management see 2012 as a crucial year for growth. As of September 2011, the SurgeonsPAC had contributed $306,500 to 95 candidates, leadership PACs, and party committees. For more information about the ACSPA-SurgeonsPAC, go to http://www.facs.org/acspa/index.html.

American College of Surgeons (ACS)

Committee on Optimal Access

The Board of Regents approved the formation of a new Committee on Optimal Access in October 2011. The basic goals of this committee are as follows:

  • To determine the metrics and analyses required to accurately assess the magnitude of health care disparities in the various disciplines of surgery
  • To develop specific strategies for addressing health care disparities in select surgical environments—particularly areas having a documented propensity for extreme inequalities in surgical care
  • To orchestrate alliances and partnerships with specific regional entities and organizations known to have “best practices” for combating health care disparities in surgery
  • To establish funding mechanisms (for example, the Robert Wood Johnson Foundation, National Institutes of Health, Centers for Disease Control and Prevention, and the Bill and Melinda Gates Foundation) for major strategic initiatives designed to address the health care disparities in the care of the surgical patient

Research and Optimal Patient Care

A total of 453 sites are participating in the ACS National Surgical Quality Improvement Program (ACS NSQIP®), and more than 50 additional sites are in the process of enrolling. In addition, more than 200 sites, including many international hospitals, currently are in talks with ACS NSQIP representatives about joining the program.

Approximately 60 percent of ACS NSQIP participating hospitals are in a collaborative where either quality improvement ideas and/or ACS NSQIP data are shared. A total of 28 collaboratives are now operational, and approximately seven more groups are interested in starting regional, system-wide, or virtual collaboratives.

In order to provide proven, more robust quality information, the ACS has been working with the Centers for Medicare & Medicaid Services (CMS) to allow ACS NSQIP to publicly report outcomes on the U.S. Department of Health and Human Services’ Hospital Compare website voluntarily, beginning this summer. Participating hospitals will voluntarily report on any combination of three National Quality Forum-endorsed measures: elderly surgery outcomes, colectomy outcomes, and lower extremity bypass.

Johns Hopkins University and ACS NSQIP are partnering to develop, implement, and evaluate a program intended to improve surgical patient outcomes and prevent complications. Based on the successful Comprehensive Unit-Based Safety Program, this pilot program will launch with 100 ACS NSQIP hospitals—10 hospitals in 10 states. The program will focus on implementing evidence-based protocols, improving teamwork, and sustaining organizational change.

The 2012 ACS NSQIP National Conference will take place July 21–24 in Salt Lake City, UT, at The Grand America Hotel and will include multiple preconference sessions. Brent C. James, MD, MStat, from Intermountain Healthcare, will be the keynote speaker.

The ACS Bariatric Surgery Centers Network (ACS BSCN) also is expanding. The ACS BSCN is composed of 141 fully approved and seven provisionally approved centers, and five initial applications were under review at the time of the meeting.

The ACS BSCN responded to a request for comment on the CMS proposal for a national coverage determination to include the sleeve gastrectomy as a covered procedure for Medicare patients.

The American Society of Metabolic and Bariatric Surgery (ASMBS) announced the termination of its contractual relationship with its vendor. This action sped up the ongoing discussions regarding unification of the ACS and the ASMBS bariatric surgery accreditation programs to create a joint body administratively supported by the ACS, which became effective on April 1.

The ACS has continued development of a Surgeon-Specific Registry (SSR) that will target the following three items currently being used to assess individual surgeons:

  • Maintenance of Certification (MOC) by the American Board of Surgery (and other specialty boards)
  • The Physician Quality Reporting System (PQRS) by CMS
  • The Ongoing Practice Performance Evaluation by The Joint Commission

Decisions are being evaluated regarding configuration, pricing, auditing, and data entry screens. The SSR will likely be offered with options. One option will target MOC Part IV. The second option will be nearly identical to the Case Log. The SSR is also being designed to meet PQRS’ requirements.

With regard to ACS Cancer Programs, the Commission on Cancer (CoC) concluded 2011 with the launch of two major initiatives. First was the release of new standards for cancer program accreditation. A patient-centered approach is the focus for the Cancer Program Standards 2012: Ensuring Patient-Centered Care. These new standards are required for implementation by all CoC-accredited cancer programs beginning in 2012. Second was the release of the Rapid Quality Reporting System, a tool to facilitate quality cancer care delivery. Enrollment is open to CoC-accredited facilities, and participation is voluntary. Since the program’s release, 15 percent of the CoC’s 1,500 accredited cancer programs have enrolled.

The CoC held an application process for a two-year fellowship in surgical oncology outcomes and health services research. The CoC has a two-year position, supported by Genentech, available beginning July 1, 2012. The fellow will work in the Cancer Programs Department to conduct clinical research and further the research agenda of the CoC’s National Cancer Data Base with the goal of improving the quality of care for cancer patients.

A communication was sent to all CoC-accredited cancer programs regarding implementation of the new standards for accreditation. In addition, a brief PowerPoint presentation was provided, which explains the new standards. The CoC Surveyor and Consultant Training Program convened. This program focused on educating the surveyor and consultant teams regarding the new standards scheduled for implementation by all CoC-accredited cancer programs in 2012.
The ACS and the American Cancer Society hosted a two-day meeting to explore future opportunities for collaboration to address the changing health care environment and advance each organization’s respective agendas. In addition, as a key collaborator with the CoC, the American Cancer Society is seeking to enhance its ability to support the 2012 Cancer Program Standards, and, to this end, has collaborated with the CoC on a document, Cancer Program Standards 2012: Ensuring Patient-Centered Care, a Guide for ACS Field Staff and CoC-Accredited Programs. The goal is to identify American Cancer Society resources that will support specific standards. The guide presents key highlights of the 2012 standard revisions and matches American Cancer Society resources.

The Trauma Programs continue to be quite active. Some of the activities in the area of trauma education include:

Advanced Trauma Life Support Course®

  • 9th edition of the manual and e-course will be released in October 2012
  • 2011 Promulgation: Syria, Oman, Egypt, and Iran
  • Approved applications: Bangladesh, Belize, Bosnia, Croatia, Czech Republic, Georgia, Ghana, Honduras, Iraq, and Poland
  • Partnering with Operation Giving Back to provide course materials to surgeons on humanitarian missions

Rural Trauma Team Development Course

  • New countries: American Samoa, Canada, and India
  • New online course management system in testing phase

Disaster Management and Emergency Preparedness Course

  • 2012 scheduled courses: 17
  • New country: Brazil
  • Online course management system and e-course is under development (projected release in spring 2012)

Advanced Surgical Skills for Exposure in Trauma (ASSET) Course

  • 2012 scheduled courses: 17
  • Special report published in Journal of Trauma (December 2011) on Potential Role of the ASSET Course in Canada

Advanced Trauma Operative Management Course

  • 2012 scheduled courses: 41
  • New countries: Italy and Paraguay

Optimal Trauma Center Organization and Management Course (OPTIMAL)

  • ACS now offers continuing medical education (CME) credits to physicians participating in OPTIMAL

Trauma Outcomes and Performance Improvement Course (TOPIC)

  • ACS now offers CME to physicians participating in TOPIC

In addition, the trauma center Verification, Review, and Consultation (VRC) program is enjoying vigorous activity and continued growth. During calendar year 2011, the VRC conducted 158 on-site verification or consultative reviews, including one foreign review in Landstuhl, Germany. There are currently 354 verified trauma centers in the U.S. The trauma center verification standards found in Resources for Optimal Care of the Injured Patient are being reviewed and revised with publication expected sometime in 2012 or early 2013. A policy and procedures manual that formalizes a performance improvement process for the program has been approved. Additionally, other nations are expressing increased interest in the program. The VRC and the Trauma Systems Evaluation and Planning Committee are working collaboratively with other trauma programs to develop a comprehensive strategy to best meet the needs of foreign hospitals and systems, taking into account the wide variations in culture and resource availability found in different parts of the world.

The Rural Trauma Committee completed the development of criteria for Level IV trauma centers after an exhaustive review of the standards and requirements imposed by states across the nation. The Rural Trauma Team Development Course is enjoying remarkable success.

The Trauma Quality Improvement Program (TQIP®) held its annual conference in November 2011, in Chicago, IL. The TQIP all-patients report was delivered in November 2011 and the report on elderly patients in January 2012. Upcoming report subjects include trauma brain injury and shock.

The Committee on Trauma (COT) Facebook page had nearly 200 “likes,” and its fan base was continuing to grow rapidly. In addition, a COT Twitter page was soon to be activated.

Rural surgery

The Board of Regents heard a discussion led by Tyler G. Hughes, MD, FACS, and Philip R. Caropreso, MD, FACS, that focused on the unique needs of rural surgeons and the role that the ACS may play in supporting rural surgeons. The discussion provided insight into ACS options regarding rural surgery as it relates to access to high-quality surgical care for the more than 50 million Americans who live in rural locations.

Drs. Hughes and Caropreso pointed out the personal rewards and fulfilling aspects of rural practices. Dr. Caropreso highlighted current College activities relative to rural surgery/surgeons, such as the rural surgery open forums at the annual Clinical Congress, the co-sponsored meetings held at College headquarters, the Rural Surgery Community site in the Web portal, the rural surgery skills courses co-sponsored by the Nora Institute for Surgical Patient Safety, the rural surgeons’ listserv that Dr. Caropreso maintains, and the dedication of the February edition of Selected Readings in General Surgery (SRGS) to rural surgery. That edition of SRGS centers on the rural surgery workforce, including the characteristics of rural surgery and rural practice, educating surgeons for rural practice, the challenges of recruitment and retention of rural surgeons, and the unique clinical problems encountered in rural surgical practice.

It was emphasized that the rural surgery workforce is shrinking, and that burnout is a factor in this predicament. The College was commended for its attention to rural surgery/surgeons, but was asked to do more. The need for an honest and open dialogue regarding the issues was highlighted, as was a growing “us and them” (FACS and ACS) outlook because the College insufficiently presents itself as an advocate for the rural surgeon.

The College was asked to appoint a rural surgery representative to its Board of Regents and dedicated staff for rural surgeons. It was also requested that the current activities of the College in the rural surgery arena be continued.
Appreciation was expressed to J. David Richardson, MD, FACS, for bringing this issue forward. Various College leaders implored the Board of Regents to support rural surgery/surgeons, due to the rural surgery crisis. The Regents approved the formation of a rural surgery task force and appointed Dr. Richardson to serve as its Chair.

Communications and public profile

Two overarching priorities for the ACS in 2012 are the development of a content strategy and the creation of a bona fide marketing function. The proliferation of news and other information, and the increase in the delivery tools available, have created a need to determine how best to communicate with the College membership. To help ensure that the ACS delivers the information its various members want in the manner they prefer, the ACS is embarking on an initiative to develop a content strategy that will provide the much-needed communications blueprint. This plan is likely to have significant implications for the ACS website, Web portal, e-mail newsletters, and, to a lesser extent, its print publications.

The College needs a more formalized marketing function. The formalization of such an area in the College would provide the strategic marketing counsel and the technical expertise to ensure that it approaches marketing with the level of sophistication and effectiveness needed to raise awareness and demand for the breadth of its programs, products, and services.

The Bulletin and Surgery News have benefited from readership surveys conducted over the past six months. Both surveys provided improvement opportunities, and editorial and design changes to the Bulletin are being planned. The new Bulletin format will be presented at the 2012 Clinical Congress. In addition, work is being done to create a visually attractive and easy-to-navigate Bulletin microsite, accessible through www.facs.org. The College also is analyzing how the Bulletin may make better use of social media and is planning to develop a version of the magazine that can be accessed and read on tablets, smartphones, and other digital devices.

The College has a new Facebook page, as well as separate pages for various programs, such as the Resident and Associate Society. In addition, the College has a robust Twitter presence and a growing YouTube presence.

The Inspiring Quality campaign has provided an opportunity to strengthen the College’s brand(s). With the development of branding standards it now has a model that ensures that the brand is applied consistently and, as appropriate, co-branded with various programs, such as ACS NSQIP. In addition, the College is developing standards to govern the use of its sub-brands by outside entities.

With the recent hiring of a Communications Manager for the College’s Washington, DC, office, the organization is in a strong position to effectively communicate the array of advocacy and health policy initiatives that the organization carries out on behalf of its members. (Subsequently, Chantay P. Moye officially filled this position). Key to this effort will be the development and execution of a strategy that reflects the unique challenges of communicating about issues that may lack membership consensus or that do not produce bona fide “wins” for College members.

Manuscript submission to publication time was decreased for the Journal of the American College of Surgeons (JACS). While the number of submissions is increasing, JACS is cutting the time from submission to acceptance, and from submission to publication. In addition, most articles are going online as e-published articles, at least one month before appearing in the print version of JACS. Also, to enhance the educational value of the JACS CME program, beginning in April 2012, the College was to expand the program to four questions per article, requiring a score of at least 75 percent to obtain credit. The JACS CME website is being redesigned and will give a more streamlined, user-friendly experience. Users will be able to select articles based on specialty and subject, which will be more useful for meeting Maintenance of Certification requirements. In addition, JACS is working to create a JACS app due to roll out this spring, and to develop a Web-based “JACS Resource Center,” an educational tool that will highlight JACS content pertaining to selected topics.

The ACS public website has been enhanced to include a new feature on the home page that highlights ACS programs and activities in a rotating tabbed format. Work also has begun on redeveloping the ACS patient education section with a stronger emphasis on the ACS patient education materials and resources for surgical patients and their families.

As of December 31, 2011, the ACS member-only portal had received a total of 3,702,666 page views since its launch. The “Communities and Specialties” area of the portal continues to provide content targeted toward ACS members’ main interests, such as ethical challenges and rural surgery. The editorial board continues to evolve. In addition to an Editor-in-Chief, a social media manager, and 17 at-large editors, there are now 50 community editors and approximately 235 associate community editors involved in the portal’s editorial board.

The GE initiative

Members of the GE team (http://commsweb.facs.org/index.html) have spent the past six months gathering information about the College from its staff, members, and volunteer leaders. The GE team attended the 2011 Clinical Congress in San Francisco, CA, to speak with some of the College’s Regents, Governors, and various other leaders. The insights gleaned from these activities have been extremely helpful in rounding out GE’s assessment of the College’s operations and culture. In addition, various College leaders and executive staff have participated in retreats related to this project. Substantial time has been invested in talking about ways to improve the Board of Governors. A Governors’ task force may be formed and may hold a retreat in order to further explore ideas that have been presented in these talks.

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