Each year, the Bulletin publishes an update on the major activities carried out by the American College of Surgeons’ (ACS) staff and volunteers over the course of the last year. This report points to our accomplishments and to the areas in which we are striving to better meet the needs of surgeons and their patients.
Advocacy and Health Policy
In June, Frank Opelka, MD, FACS, and Patrick Bailey, MD, FACS, began serving as Medical Directors of Quality and Advocacy, respectively, in the Division of Advocacy and Health Policy. Given their backgrounds, we believe these surgeons will play a leading role in positioning the ACS as a leader in the health policy, legislative, and regulatory arenas.
One issue that continues to be of great concern to Fellows is Medicare physician payment. The ACS has been working for the last decade to persuade Congress to repeal the broken sustainable growth rate (SGR) formula used to calculate Medicare payment. In 2013–2014, the ACS worked closely with members of Congress to develop legislation that would repeal the SGR and replace it with an alternative.
On February 6, Congress reached a bipartisan, bicameral agreement on The SGR Repeal and Medicare Provider Payment Modernization Act of 2014. This legislation was the product of a yearlong collaborative effort between Congress and key stakeholders, including the ACS. Final passage of the bill, however, was derailed due to funding challenges.
The College played an influential role in efforts to repeal and replace the SGR due to:
- Solid policy recommendations
- Reputation as a quality leader
- Media contacts
- Coalition support
- A strong advocacy team
- Grassroots advocates and a political action committee (PAC)
In addition, more than 200 ACS members from 44 states participated in 229 meetings on Capitol Hill April 1 in conjunction with the 2014 Leadership & Advocacy Summit in Washington, DC. The SGR was a key topic of discussion at those meetings.
Other payment issues that the ACS addressed in 2014 included the repeal of the 96-Hour Rule on discharge of inpatients from critical access hospitals; and the Centers for Medicare & Medicaid Services (CMS) proposed rules pertaining to the Inpatient Prospective Payment System, the Medicare physician fee schedule, and the Outpatient Prospective Payment System/Ambulatory Surgical Centers.
With regard to medical liability reform, the ACS has sought to advance targeted bills, including the Good Samaritan Health Professions Act, the Health Safety Net Enhancement Act, and the Saving Lives, Savings Costs Act. The College also has developed both a primer and a surgeons’ guide to liability reform. In addition, the College is working to avert any changes to California’s Medical Injury Recovery and Compensation Act.
The Institute of Medicine recently released a report on the financing and governance of graduate medical education (GME), and the ACS is developing recommendations. We will hold a summit on GME in 2015 to evaluate proposals for change.
As noted previously, the ACS Professional Association’s SurgeonsPAC and the SurgeonsVoice grassroots program continue to be our most valuable tools in terms of developing relationships with legislators. We now have SurgeonsVoice Region Chiefs and Councilors throughout the country to boost our grassroots presence. Furthermore, we have a completely redesigned SurgeonsVoice website with tools to make getting involved in advocacy easier than ever.
Finally, the ACS continues to lead an active coalition of surgical societies that work together on issues of mutual concern.
In light of widespread concerns regarding the training of surgery residents, the ACS has appointed a Committee on Residency Training (“Fix the Five”). This committee includes leaders of the ACS, American Board of Surgery (ABS), Residency Review Committee for Surgery (Surgery RRC), Accreditation Council for Graduate Medical Education (ACGME), and Association of Program Directors in Surgery (APDS). In addition, representatives of the Royal College of Physicians and Surgeons of Canada and several surgical educators serve on the committee.
The committee meets regularly and has identified the following areas of focus:
- Organizational commitment
- Transitions in residency
- Structured curricula
- Sufficient autonomy for residents
- Residency education environment, including duty hours, financing, and support systems
- Best practices in faculty development and support
- End product of surgical training
A survey of surgery program directors will be conducted to gather more information on these matters and to identify best practices.
The ACS Committee to Enhance Peak Performance in Surgery through Recognition and Mitigation of the Impact of Fatigue (Peak Performance Committee) crafted an ACS statement, which was published in the August Bulletin.
The ACS continues to play a preeminent role in advancing simulation-based surgical education and training and has been recognized for its contributions to this field. Examples of related activities include:
- The ACS plays an important part in the Council of Medical Specialty Societies (CMSS) workgroup on simulation. The workgroup’s activities will culminate in the Second CMSS Simulation Summit, November 19, 2015, in Washington, DC.
- The College is active in a coalition of national surgical specialty societies, Veterans Affairs, Department of Defense (DoD), and other stakeholders interested in simulation-based surgical education.
- The Consortium of ACS-Accredited Education Institutes (ACS-AEIs) continues to advance the field of simulation-based surgical education and training.
- In October 2013, the U.S. Patent and Trademark Office issued a patent (U.S. 8,562,357 B2) for the “Interactive Educational System and Method” of the ACS Fundamentals of Surgery Curriculum®.
- In April 2014, the Association for Surgical Education (ASE) presented an Excellence in Innovation in Surgical Education Award to Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education, for the ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum.
The ACS seeks to help surgeons smoothly transition through each stage of their career. Over the last year, we have focused on early-career transitions. The ACS Transition to Practice in General Surgery (TTP) Program Steering Committee has defined the model for the program: provision of a one-year advanced experience as a junior partner (TTP Associate) for a surgeon who has completed five years of training. The focus is on general surgery and practice management. In 2014–2015, the program is being pilot-tested at 10 sites.
The Eighth Annual Residents As Teachers and Leaders Course was offered in May 2014. The demand for the course exceeded capacity, and course participants gave the course high ratings.
The ACS/APDS/ASE Surgery Resident Prep Curriculum is aimed at graduating medical students to help them transition to residency and to ensure that training programs receive individuals with appropriate knowledge and skills. Pilot testing of the curriculum modules commenced in 2013–2014 at 38 U.S. medical schools. To date, 55 medical schools have expressed interest in joining the 2015–2016 pilot. We anticipate the final curriculum will launch in 2015.
The Clinical Congress program continues to address the evolving needs of practicing surgeons and other ACS members. The Program Committee convened two strategic planning retreats in 2014. Participants included members of the Program Committee, three ACS Regents, and representatives of the ACS Board of Governors, Young Fellows Association, Resident and Associate Society, and key ACS divisions.
To prepare for the retreats, seven task forces were charged with reviewing the Clinical Congress program and providing recommendations for further enhancements. One task force was charged with addressing overall content; the others were to address specific aspects of the program, including Panel Sessions, Scientific Sessions, Didactic Courses, Skills Courses, Town Hall Meetings, and Meet-the-Expert Luncheons. A task force also was appointed to address Communications and Marketing. The retreats resulted in several recommendations that will help improve Clinical Congress.
The 2014 Clinical Congress comprised 25 tracks and 11 Named Lectures, 114 Panel Sessions, 16 Didactic Courses, and 12 Skills Courses. Approximately 1,800 speakers and faculty participated in the program. A total of 1,286 abstracts were received for the Papers and Poster Sessions; 871 were received for the Forum on Fundamental Surgical Problems, and 424 submissions were received for the Video-based Education Sessions. All Scientific and Surgical Forum abstracts will be published in the Journal of the American College of Surgeons (JACS).
Self-Assessment credits were offered for all Panel Sessions, Didactic Courses, Skills Courses, and Video-Based Education Courses. Special certificates in specific domains were expanded to address the evolving requirements for Maintenance of Certification (MOC) and maintenance of licensure, and more robust verification and validation models are being designed. Special Certificates were offered for participation in sessions on Patient Safety, Trauma and Critical Care, Ethics, and Palliative Care.
The 2014 Clinical Congress Webcast package includes 113 Panel Sessions with opportunities to earn Self-Assessment credits. Webcasts include all Panel Sessions and Didactic Courses.
Plans to expand the Skills Courses offered at the Clinical Congress and at regional sites are under way. A new Committee on Surgical Skills Training for Practicing Surgeons has been appointed to develop a strategic plan.
The ACS continues to evaluate new procedures and technologies and to design training programs that address the acquisition and maintenance of skills in these areas. The College has established a relationship with the Australian Safety and Efficacy Register of New Interventional Procedures–Surgical to conduct systematic reviews of the literature; 17 reviews have been developed and posted on the Committee on Emerging Surgical Technology and Education Web page.
The ACS Comprehensive General Surgery Review Course helps practicing surgeons to fulfill Part 2 of MOC requirements and to prepare for the Recertification Examination in Surgery to fulfill the requirements for Part 3 of MOC. The 2014 course attracted 150 attendees.
Evidence-Based Decisions in Surgery includes concise, focused modules derived from practice guidelines. Modules are developed based on diagnoses that are relevant to the 20 most common general surgery operations. The modules are intended for use at point-of-care and are accessible through electronic devices. The first 10 modules were released in October 2013, and the next 20 were released in October 2014.
Other developments in educational opportunities for practicing surgeons include:
- The liver volume of the ACS Multimedia Atlas of Surgery was released in October.
- The Third Edition of the Ultrasound for Surgeons: The Basic Course launched in October.
- The 10th Annual Surgeons As Leaders Course took place in May with demand exceeding capacity.
- The Committee on Ethics conducted a strategic planning session in April. The following action items emerged:
- Author a book that defines surgery ethics as it has evolved in the last decade
- Develop educational programs for surgeons who are committed to advanced study of ethics, as well as for those seeking to apply fundamental principles in surgical practice
- Expand the committee’s membership for better integration across the organization
The ACS also offers educational programs and products that address the core content for surgery residents. For example, ACS Fundamentals of Surgery Curriculum® (ACS FSC) is a simulation-based, interactive, online program that focuses on cognitive skills and is primarily directed at first-year residents. Enrollment has progressively increased; in fiscal year (FY) 2013–2014, 235 programs and 1,884 trainees were enrolled. Many program directors recommend or require entering residents to complete modules of ACS FSC before residency training begins.
The Fundamentals of Laparoscopic Surgery (FLS) program is a collaborative venture between the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the ACS. Version 3.0 of FLS is in development. To accommodate the increased demand for FLS testing, SAGES is accepting FLS Test Center applications from programs outside the U.S. and Canada. FLS International Test Center Standards and Criteria have been developed to help ensure standardized testing, and the feasibility of translating FLS into Spanish is being pursued.
The Ultrasound for Residents course has been reformatted to include the Ultrasound for Surgeons: The Basic Course and Ultrasound for Residents: A Skills Companion DVDs.
The ACS presented two resident education awards at Clinical Congress: the Resident Award for Exemplary Teaching and the Jameson L. Chassin Award for Professionalism in General Surgery, which is presented to a chief resident in general surgery who exemplifies the values of compassion, technical skill, and devotion to science and learning.
The ACS offers a number of programs to address the core content for medical students, including the ACS/APDS/ASE Resident Prep Curriculum described previously. Other examples include the ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum, which addresses core clinical and basic surgical skills. The curriculum was released in April 2013,and has been viewed nearly 3,200 times. A multi-institutional study is being planned to examine the effectiveness of the curriculum; approximately 30 medical schools have expressed interest in participating.
Efforts to develop the ACS/ASE Medical Student Core Surgery Curriculum are proceeding. This curriculum will address the educational needs of all medical students rotating through the core surgery clerkship. In addition, hundreds of aspiring surgeons participated in the three-day Medical Student Program at Clinical Congress.
The College presents several faculty-development programs, including the successful six-day Surgeons as Educators Course. Furthermore, the Division of Education and the International Relations Committee jointly sponsor International Guest Scholarships for faculty at institutions outside of the U.S. and Canada.
The College’s Surgical Patient Education Program is intended to support inclusion of patients and their families in health care decisions and to engage them to fully participate in the perioperative period. Key components of the program include Home Skills Training Kits, Education for Better Recovery, Informed Surgical Prep brochures and e-learning materials, and a new Professional Training Program. Major grants have been secured in collaboration with the ACS Foundation to support development of additional resources.
The ACS-AEI program is considered the gold standard for accreditation of simulation centers. The total number of ACS-AEIs is now 82, including 70 Comprehensive (Level I) Institutes, and 12 Focused (Level II) Institutes. New accreditation standards and criteria for AEIs have been developed based on experience with the program since its inception and advances in the fields of simulation and educational accreditation. The designations were changed from Level I to Comprehensive Education Institute and from Level II to Focused Education Institute. The new accreditation standards, implemented in 2013, are as follows:
I. Learners and Scope of Educational Programs
II. Curriculum Development, Delivery of Effective Education, and Assessment
III. Administration, Management, and Governance
IV. Advancement of the Field
In addition, a special committee was appointed to develop standards and criteria for ACS-AEI Fellowships based on experiences in the field, expert consensus, and input from Consortium members. The standards are as follows:
I. Curriculum Requirements
II. Assessment Requirements
III. Operational Requirements
IV. Resource Requirements
V. Governance Requirements
VI. Advancement of the Field Requirements
Following review, four Fellowship Programs were approved in December 2013.
The Sixth Annual Postgraduate Course of the Consortium of ACS-AEIs took place in August 2013. The Centre for Excellence for Simulation and Innovation at the University of British Columbia hosted the program, which featured didactic sessions and discussion of topics of interest to members of the consortium.
The Seventh Annual Meeting of the Consortium of ACS-AEIs took place in March. A total of 184 representatives from 61 of the 79 ACS-AEIs participated in this meeting.
Committees of the Consortium of ACS-AEIs are engaged in the following activities:
- Developing a textbook on simulation and surgery
- Writing a manual on the principles and practice of simulation-based surgical education research
- Developing a toolkit for directors and administrators of simulation centers
- Creating a taxonomy for surgical simulation and education
- Designing the Program for ACS-AEI Consortium Meetings
- Collecting information on best practices
- Pursuing efforts to address current and emerging needs
The online My CME (continuing medical education) system awards and tracks CME credits. From July 2013 to April 2014, My CME provided approximately 12,000 CME certificates, approximately 9,000 Self-Assessment CME certificates, nearly 2,700 Patient Safety certificates, and more than 2,000 Trauma Certificates.
The ACS provides Category 1 CME Credits for many educational programs presented by the College and other surgical organizations. In 2013, the ACS accredited 2,147 activities, providing more than 26,000 credits to approximately 147,000 physicians.
The College is launching a nationwide ACS Education and Training Campaign, similar to the Inspiring Quality Campaign, to communicate the following messages:
- ACS Education and Training are the cornerstones of excellence
- ACS Education and Training transform possibilities into realities
- ACS Education and Training instill the joy of lifelong learning
Continuous Quality Improvement (CQI)
This year marked the 10th anniversary of the launch of ACS National Surgical Quality Improvement Program (ACS NSQIP®). In July, ACS NSQIP presented its annual conference in New York, NY. Approximately 1,200 representatives from nearly 600 hospitals attended. More hospitals from more locations are enrolling in ACS NSQIP, and new collaboratives are being formed.
The College is working with the surgical specialties to develop specialty-specific modules. For example, a new transplant module is under development. In addition, we are working with CMS to continue the public reporting (Hospital Compare) contract with ACS NSQIP hospitals.
Furthermore, over the last three years, we have been working with a broad-based task force to develop comprehensive guidelines that define the resources needed to perform safe, effective operations in infants and children. Early next year, the ACS will start evaluating participating hospitals’ level of pediatric surgical care. The guidelines were published in the March 2014 issue of JACS in an article titled “Optimal Resources for Children’s Surgical Care in the U.S.” The Wall Street Journal also published a favorable article about the program.
More than 700 hospitals now participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). The MBSAQIP recently issued new standards for accreditation, which are now being used. Site visitors have been trained, and verification site visits are being performed. Hospitals are using the MBSAQIP registry for quality improvement. The registry is a certified CMS Quality Clinical Data Registry, which means surgeons may use the bariatric registry to report outcomes instead of participating in the Physician Quality Reporting System ( PQRS).
The number of surgeons participating in the Surgeon Specific Registry (SSR) continues to rise. Surgeons use the registry to fulfill PQRS and MOC requirements; more than 200 surgeons used SSR for PQRS last year.
The College continues work on a Quality Manual. Many chapters have been completed and are being evaluated, revised, and aligned. The target date for release is summer 2015.
A one-day Leading Quality Course was piloted at Clinical Congress. The course was oversubscribed within a few days of an e-mail announcing its presentation; the ACS sees this program developing into a more comprehensive course with initial presentation in spring 2015.
Finally, the ACS continues to provide opportunities for residents to work on ACS Quality Programs through the Clinical Scholars in Residence Program.
Sharon Henry, MD, FACS, has been selected to chair the Advanced Trauma Life Support® (ATLS®) Committee, and ACS Governor Karen Brasel, MD, FACS, will lead international ATLS efforts.
The ATLS app continues to be successful with more than 66,900 unique downloads and more than 4,320 in-app purchases from 164 countries. The eLearning project is under way, with staff conducting webinars for coordinators across the nation to ensure appropriate planning and application of ATLS requirements.
An interactive eBook has been developed for ATLS. It will include flashcards, text highlighting, video links, and self-check questions.
The Committee on Trauma (COT) continues to review alternate models of international promulgation and is working with region chiefs to promote their independence in adopting course sites. International ATLS activity continues to outstrip North American activity.
The COT is pursuing a more in-depth relationship with the DoD that would allow military trauma centers to participate in the National Trauma Data Bank (NTDB®)/Trauma Quality Improvement Program (TQIP) and thus meet that requirement for verification. The intent would be for an agreement to be reached whereby non-combat data would continue to be sent from each military trauma center to the DoD Trauma Registry, which would then forward records to NTDB/TQIP.
An electronic version of the Resources for the Optimal Care of the Injured Patient 2014 launched this summer; the print version was released in mid-fall. The new guide features streamlined and simplified criteria, and an evidentiary base has been established. The guidelines take effect July 1, 2015.
The COT is working to establish a Future Trauma Leaders Program to engage young trauma and acute care surgeons. The COT Membership Committee will select two individuals for a two-year program under the guidance of a COT mentor; participants will be expected to complete specific projects, train to be COT course instructors, and receive advocacy/leadership training.
The COT has been actively involved in government efforts to establish guidelines for emergency medical services (EMS), including hemorrhage control. COT leaders participated in a federal stakeholder meeting to address the response to mass shootings and improvised explosive devices and discuss protocols for EMS personnel to provide timely care to victims. There was enthusiasm for greater integration of EMS and law enforcement personnel.
The Hartford Consensus, led by ACS Regent Lenworth Jacobs, Jr., MD, FACS, and numerous consensus partners, articulated a framework for increasing survivability in mass shootings, which promotes the use of THREAT: (1) Threat suppression, (2) Hemorrhage control, (3) Rapid Extrication to safety, (4) Assessment by medical provider, and (5) Transport to definitive care. The document also calls upon uninjured or minimally injured victims to act as rescuers, law enforcement to be trained in hemorrhage control, EMS personnel to be more fully integrated into the response process, and surgeons and trauma systems to be used to optimize seamless care.
The Regents approved three injury prevention statements: Statement on Bicycle Safety and the Promotion of Bicycle Helmet Use, Statement on Intimate Partner Violence, and Statement on Older Adult Falls and Falls Prevention.
The COT TQIP team is developing a pilot of an Emergency General Surgery Registry, and is leading an effort to align the COT’s processes with other major ACS quality improvement programs. The goal is to standardize the processes, guidelines, and reports of these programs.
The COT’s Advocacy Pillar conducted a successful day on Capitol Hill, which preceded the COT Annual Meeting in March. Improved processes have reduced the trauma center verification reporting process to approximately seven to eight weeks. A total of 426 sites have been verified to date, and the COT is already scheduling visits into FY 2016.
More than 6 million records have been deposited in the NTDB since its inception; the most recent call for data yielded more than 814,660 records from the following:
- 230 Level I centers
- 265 Level II centers
- 205 Level III or Level IV centers
- 32 Level I or Level II pediatric-only centers
The NTDB training course for 2014 was released to assist registrars. Staff has conducted de-identification reviews to ensure that data released comply with the Health Insurance Portability and Accountability Act.
A total of 208 trauma centers participate in TQIP—131 Level I and 80 Level II, with 40 more centers in the pipeline. Of the Level I centers, 65 percent are ACS-verified, as are 71 percent of the Level II facilities. State participation has continued to grow, and we have been asked to help in the formation of state collaboratives.
The pilot for Pediatric TQIP is complete. A total of 25 centers are participating:
- 15 Level I, eight state-designated and 12 ACS-verified
- Six Level II, three state-designated and four ACS-verified
- 39 centers are in the process of joining pediatric TQIP
The first Pediatric TQIP report was released this fall.
The CoC has accredited more than 1,500 programs that provide care to 71 percent of all newly diagnosed cancer patients in the U.S. and Puerto Rico. The CoC conducted 502 cancer program surveys this past year, and 31 new cancer programs joined the accreditation program. A total of 74 cancer programs received the Outstanding Achievement Award.
One of the CoC’s most significant accomplishments this year involved working with consultants to develop a framework for oncology medical home standards. We have requested grant funding from the Center for Medicare & Medicaid Innovation to support development of the model.
CoC leadership and other stakeholders have developed rectal cancer standards, which will form the basis of a rectal cancer accreditation model. In addition, the CoC established a cross-functional pediatric workgroup to evaluate existing standards and develop an enhanced set of performance measures and will explore possible linkage with the pediatric surgical accreditation program.
The LIVESTRONG Foundation, the Cancer Support Community, the American Cancer Society, and the National Coalition for Cancer Survivorship joined with the CoC to create a Continuum of Care Readiness Survey distributed to all CoC-accredited programs to gauge their preparedness for 2015 phase-in standards: Patient Navigation, Distress Screening, and Survivorship Care Plans. The CoC drew on the survey results to develop clarifications to the requirements for these standards, which were released in September.
More than 300 staff from CoC-accredited programs and programs seeking accreditation attended the two sessions of the new Accreditation 101 workshop in March and September and the advanced Strengthening Your Cancer Program…Enriching the Coordinators’ Role workshop in June.
The National Cancer Data Base (NCDB) has grown over the last year, adding 8.6 million new and updated reports; 1.2 million were newly diagnosed cases in 2012. The NCDB is approaching 26.8 million cases diagnosed.
The Cancer Program Practice Profile Reports (CP3R) has been expanded to include two new sets of quality measures. Three breast-related measures were released in March. Three additional measures will be included in the next data release—two for non-small cell lung and one for gastric cancer—bringing the total released measures to 12. In March 2013, the CoC and the Pennsylvania Health Care Quality Alliance (PHCQA) began working together to post CP3R performance measures on the PHCQA website. The purpose of this project is to provide more comparable information to patients. Presently, 56 of the 72 programs have agreed to participate in public reporting through the PHCQA Web page.
The first Cancer Quality Improvement Program Annual Report (CQIP 2013) was released in February and was well received. This year’s CQIP includes comparative performance on six new quality measures—three breast, two lung, and one gastric. The CQIP 2013 included 30-day mortality rates for selected, complicated surgical procedures. The CQIP 2014 will be expanded to include 90-day mortality rates for complicated operations. One additional cancer disease site will include melanoma of the skin along with risk-adjusted survival rates for breast, colon, and non-small cell lung cancer.
Feedback from the inaugural year of the Participant User File (PUF) program was positive, and interest grew in 2014.
The Rapid Quality Reporting System (RQRS) is a Web-based reporting and quality improvement tool that provides real clinical time assessment of hospital adherence to National Quality Forum-endorsed quality measures for breast and colon cancers and prospectively tracks the progress of individual patients within each measure. Approximately 71 percent of CoC-accredited programs participate in RQRS.
The Prospective Payment System-exempt contract completed its second year. Data are submitted by the 11 members of the Alliance of Dedicated Cancer Centers to the RQRS system. Quarterly data files containing quality measure rates for three measures (two for breast cancer, one for colon) are generated and submitted to CMS for public reporting. CMS met with representatives of the facilities and contractors in June discuss progress to date.
The Cancer Liaison Program engaged in the following activities:
- Presented a State Chair Town Hall session before Clinical Congress and presented awards for outstanding service to three State Chairs
- Hosted a Cancer Liaison Program Breakfast for approximately 250 attendees at Clinical Congress
- Discussed the State Chair role in chapters at the annual meeting of Chapter Executives in December
- Encouraged State Chairs to participate in ACS advocacy efforts
The 2013 CoC Paper Competition winner delivered a 15-minute presentation on “Gastrointestinal Cancers in Young Survivors of Lymphoma: Implications for Earlier Screening” at the 2013 CoC Annual Meeting in Washington, DC. The 2014 Paper Competition winner will present next year.
The American Cancer Society/CoC Collaborations Meeting took place in December 2013. The agenda set the stage for future collaboration between the two organizations. Additionally, American Cancer Society and CoC leaders met to discuss the possibility of ACS Survivorship Care Program Certification.
The Annual Advocacy Committee Planning Meeting took place in Washington, DC, February 10–11, and the CoC held its first legislative briefing at this time. The CoC has been actively engaged in several legislative and regulatory issues, including:
- Support of the One Voice Against Cancer appropriation requests for the National Institutes of Health and Centers for Disease Control (CDC)
- Sign on to H.R. 1666: Patient Centered Quality Care for Life Act
- Sign on to H.R. 1339/S. 641: Palliative Care & Hospice Education and Training Act
- Support H.R. 1070: Removing Barriers to Colorectal Cancer Screening Act
- Support CAG-00439N: National Coverage Analysis Tracking Sheet for Lung Cancer Screening with Low-Dose Computed Tomography
- Comment on recommendations from the National Patient Navigation Consortium
- Sign on to American Medical Association Resolution on Genetic Testing
- Sign on to biomedical research legislation
Other CoC advocacy activities include:
- Issued a written response to the Institutes of Medicine report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis
- Prepared a Statement on Cooperative Cancer Clinical Research Groups and the National Clinical Trials Network System
National Accreditation Program for Breast Centers (NAPBC) accreditation has now been awarded to more than 560 U.S. breast centers. Reaccreditation rates for 2014 and 2015 remain at 99 percent. Approximately 20 percent of centers request to be surveyed with their CoC program. A small team of cross-trained surveyors perform these joint surveys. Efforts are under way to validate NAPBC-accredited centers that are affiliated with a CoC program.
The NAPBC Board held a Strategic Leadership Retreat, January 29–30. Leadership from the CoC and the Division of Research and Optimal Patient Care attended. The retreat resulted in eight specific areas of focus, with an emphasis on improving the value to accredited centers and developing new quality tools.
An international pilot survey occurred November 11 at the Tawam Hospital in the United Arab Emirates. The survey immediately preceded the Emirates Oncology Conference; the two surveyors were invited speakers. A presentation on the NAPBC was delivered at the conference. International interest remains strong, and two additional pilot surveys are planned for 2015.
An Ohio law took effect in March that incorporates the NAPBC standards relating to mastectomy and reconstructive surgery. The Lizzie B. Byrd Act requires that a surgeon, or a health care professional designated by a surgeon, who performs a mastectomy in a hospital must guide the patient through provided or referred services in a manner consistent with NAPBC standards.
A new episode of National Public Radio’s Recovery Room highlighted mammographic screening issues. Rick Greene, MD, FACS, interviewed two NAPBC leaders who discussed common concerns with mammography, the role of insurance companies, magnetic resonance imaging, and a high-profile Canadian study that casts doubt on the effectiveness of mammograms.
The ACS Clinical Research Program (ACS CRP) sponsored several sessions at the 2014 Clinical Congress:
- A Panel Session: Enrolling Patients in Cancer Clinical Trials: The Nuts and Bolts
- A Town Hall: Oncologic Surgery and Cancer Care for Underserved Populations
- Three Meet-the-Expert Luncheons:
- Efficient Disease Management: The Geisinger Model for Cancer Care
- Is My Patient Frail? Assessment and Clinical Implications for Cancer Surgery
- A Framework for Conducting Quality Improvement Projects in a Cancer Surgical Practice
The ACS CRP sponsored five surgical investigator meetings to promote Alliance clinical trials and membership among surgeons. The ACS CRP has completed the manuscript for Operative Standards for Cancer Surgery. Production began in September with a targeted publication date of February 2015.
The ACS CRP received funding for three studies from the Patient-Centered Outcomes Research Institute (PCORI):
- Improving the Effectiveness of Routine Surveillance following Lung Cancer Resection
- Post-Treatment Surveillance in Breast Cancer: Bringing CER to the Alliance
- Patient-Centered, Risk-Stratified Surveillance After Curative Resection of Colorectal Cancer
Another two proposals submitted to PCORI are under consideration: Comparison of Patient-Centered Outcomes According to Ductal Carcinoma in Situ Management Strategies, and Optimizing the Effectiveness of Routine Post-Treatment Surveillance in Prostate Cancer Survivors.
More than 1,200 patients have enrolled in Phase II of the ACS CRP’s ProvenCare lung cancer collaborative. The collaborative has been expanded to include radiation and medical oncology (Phase III), set to launch in early 2015.
Content development for the American Joint Committee on Cancer’s (AJCC’s) eighth edition of the Cancer Staging Manual begins in October. The infrastructure to support more than 500 volunteers, 18 expert panels, five cores, and the editorial board is now in place.
Two new educational presentations were developed specifically for the registrar community to assist in the transition to directly coded AJCC Staging. This transition will occur January 1, 2016. The CDC has provided funding for the development of educational offerings. The initial two presentations were made available for the state registrar meetings; over the coming year an addition 12 presentations will be rolled out as part of a comprehensive curriculum to reinforce registrars’ knowledge of AJCC staging.
CoC marketing-related efforts are being enhanced and include:
- Using data from the American Hospital Association to develop lists of accredited and non-accredited programs to increase market penetration
- Implementing a comprehensive advertising campaign to promote CoC and NAPBC accreditation
- Participating in the combined ACS Quality Program marketing initiative discussed previously
The Division of Members Services continues to implement initiatives in support of its three main focus areas: retention and recruitment of members, member engagement, and governance and internal structures to support individual members.
Presently, the College has 78,361 members: 65,042 Fellows (58,437 U.S., 1,380 Canadian, 5,225 International); 2,743 Associate Fellows; 8,550 Residents; 1,769 Medical Student; and 257 Affiliate Members. Approximately 12 percent of these members are female. This year’s Initiates class—one of the largest ever—totaled 1,640, with 1,184 U.S., 26 Canadian, and 430 International surgeons.
To boost membership, we have launched a Young Surgeons Marketing Campaign, called Realize the Potential of Your Profession, and a Show Your Pride campaign to reinforce use of the FACS insignia. Specialty-specific recruitment strategies also are under way, along with efforts to increase international outreach.
With respect to member engagement, the ACS is evaluating the committee nominations and engagement process, conducting a member and non-member survey, deploying a Leadership Guide, and expanding opportunities for members to become involved in College committees.
The Board of Governors (B/G) continues its work under the reorganization that took place in 2013. Each Governor serves on a Workgroup, which falls under one of the five divisional Pillars: Member Services; Education; Advocacy and Health Policy; Quality, Research and Optimal Patient Care; and Communications. The Workgroups have been very active with a variety of projects that were highlighted in the September Bulletin.
Furthermore, the B/G has completely redesigned its annual survey to better meet the needs of the College, the Governors, and their constituents. The 2014 survey results were presented to the Board of Regents in October.
The Advisory Councils are completing a reorganization similar to the B/G’s. At their spring meetings, the Advisory Councils provided feedback on Optimal Resources for Children’s Surgical Care in the United States and the Statement on Peak Performance in Surgery through Recognition and Mitigation of the Impact on Fatigue. The Advisory Council for Rural Surgery sponsored a successful symposium at ACS headquarters in May, and all Advisory Councils contributed suggestions regarding reasons their colleagues should join the ACS.
The United Arab Emirates and Bolivia formed ACS chapters in the first half of 2014, and a Guam Chapter was approved at the Regents’ October meeting. Jordan and Nigeria also plan to form chapters and have applied to have Governors appointed.
Domestic chapter revitalization continues. For example, the Alaska, Georgia, and Utah chapters are creating strong meetings and increasing membership among young surgeons, and the western states are planning a super-regional meeting for 2016.
A panel presentation and networking reception will be offered at the Clinical Congress for all chapter officers and administrators, sponsored by both the Governors Chapter Activities Workgroup and the International Workgroup. International Chapter Presidents also will have opportunities to meet by region.
More than 425 ACS leaders, chapter officers, and young surgeons participated in the 2014 Leadership & Advocacy Summit. In addition to providing information on best practices for running a chapter, mentoring, and other general topics of interest, the Leadership Summit focused on the importance of emotional intelligence (EI) and its relevance to surgical leadership. Next year’s event is scheduled for April 18–21 in Washington, DC.
The Resident and Associate Society (RAS-ACS) continues to offer opportunities for trainees and early-career surgeons to engage in ACS activities, aided by the launch of an online Community. At this year’s Clinical Congress, the RAS-ACS hosted several sessions, including Surgical Jeopardy and Spectacular Cases. At the RAS Symposium, essay contest winners and other speakers shared their perspectives on Five-Year General Surgery Residency: Reform or Revolution? The Surgical Jeopardy Tool Kit is being piloted at several chapter meetings, and the RAS continues to expand its representation on ACS committees.
The Young Fellows Association (YFA), which has been expanding its representation on College committees and Advisory Councils, presented its annual meeting and Initiates program at Clinical Congress. The YFA Mentorship Program continues to grow, with 22 mentor/mentee pairs participating this year. In addition, the YFA has formed a joint task force with RAS to develop membership recruitment and retention strategies and increase involvement in advocacy efforts. The YFA also launched an online Community.
The role of the International Relations Committee (IRC) has been expanded to better serve as the primary home for international activities and outreach within the College. A new subcommittee structure has been put in place, which is now fully operational. The IRC has prepared metrics on International members and a proposed dues structure.
The Women in Surgery Committee is working with the Program Committee to offer a Women’s Health Day curriculum at the 2015 Clinical Congress and has implemented a Mentorship Program that matched 37 pairs. In addition to launching a new Community, this committee has started a series of podcasts exploring opportunities for leadership within the College.
In 2014, the Central Judiciary Committee (CJC) reviewed 13 new cases. Those cases involved questionable expert witness testimony, physician impairment, felony conviction, negligence, alteration or failure to maintain medical records, and unprofessional conduct. This year, the CJC recommended that six Fellows be charged with Bylaws violations.
Over the course of this last year, the Scholarships Committee presented 33 domestic awards (mostly research-oriented) and 32 international awards (mostly travel/observation). The total amount awarded was $1,527,500.
The Society of Surgical Chairs, which the College manages, has increased its membership to 175 dues-paying members in the U.S. and Canada. It continues to hold its annual meeting during Clinical Congress and has added a mentorship program and tri-annual newsletter as member benefits.
A new Archivist, Adam Carey, has been hired to develop a strategic plan to make the Archives more accessible to Fellows. He is creating a Web-based Master Finding Aid that lists all ACS archival holdings. Specific archival records are being digitized and will be made instantly accessible to Fellows in the near future. Finally, the ACS Surgical History Group continues to generate enthusiasm regarding College history and has proposed several outreach opportunities for next year’s Clinical Congress.
The Division of Integrated Communication is responsible for producing the ACS website and online Communities, member publications, marketing initiatives, and social media.
On August 5, the ACS launched its new public website, facs.org. The site was completely redeveloped based on member input and through significant effort on the part of staff throughout the College. The site is organized as a member would naturally search for information—around the College’s core pillars: Member Services, Quality Programs, Education, and Advocacy. The site’s responsive design allows users to access all components easily on a desktop, tablet, or smartphone. Furthermore, all College-related business is easily handled through password-protected areas of the new website.
The ACS Web Oversight Group met for the first time in August. The group comprises staff from major ACS program groups and is charged with ensuring that ACS website content remains up-to-date and relevant.
ACS Communities launched in July. As of mid-September, the platform had grown to 27 communities covering a variety of member surgeon interests. More communities will be available soon.
The total number of JACS submissions has almost doubled since 2013. Accepted but not yet typeset manuscripts are posted on the JACS website and are fully citable within two weeks of acceptance. The impact factor has remained stable over the past three years at approximately 4.5, currently ranking JACS ninth out of 202 surgery journals. To further develop JACS’ online presence, a Social Media Editor was hired, and to increase the quality of published CME content, have hired a CME Editor. A new “responsive design” for desktop, smartphone, and tablet formats, developed by the Information Technology (IT) area at ACS, will enable greater access to featured CME activities online.
Strategic planning for moving more content and driving readers to the Bulletin microsite will begin after Clinical Congress. As a first step in this process, the division plans to survey the membership to determine their preferred format for reading the Bulletin.
The ACS Inspiring Quality tour visited six more regions/states in 2014: Northern California, January 14; North Carolina, February 19; Ohio, March 28; South Carolina, April 1; Iowa, June 27; and Utah, October 3.
The ACS enjoyed prominent news coverage in 2014. Major media outlets and ACS-related stories they covered are as follows:
- CBS San Francisco, “Health leaders discuss lessons learned from Asiana crash response”
- Los Angeles Times, “Report criticizes LA County spending on emergency medical services”
- Boston Globe, “How to reform the Medicare physician payment system”
- USA Today, “Marathon bombing prompts police to carry tourniquets”
- Yahoo! Health, “No surgery required for children’s appendicitis”
- U.S. News & World Report, “10 changes in surgery in 25 years”
- Boston Globe, “Honoring a once scorned voice for medical openness”
- FierceHealthcare, “Tennessee hospital quality program cuts complications 20%, saves 533 lives”
- Wall Street Journal, “Programs aim to standardize surgical care for children”
One of the College’s marketing initiatives centered on bundling ACS Quality Programs together to build awareness of all related ACS programs and the College’s role as a leader in this arena. In addition, the marketing area was instrumental in developing the Show Your Pride campaign.
The College has made progress in expanding its social media presence, as the table below demonstrates.
ACS Social Media Presence
|Social media site||2010 October||2011 October||2012 August||2013 December||2014 September|
214 have in circles
312 have in circles
The centerpiece of the Foundation’s activities in the last year has been the 1913 Legacy Campaign, which launched in conjunction with the ACS Centennial. At press time, Fellows, friends, and corporations had donated more than $2.4 million through the 1913 Legacy Campaign. Nearly half of the ACS Fellows who donated gave $5,000 in honor of the Centennial. The ACS Regents and Officers, Governors, Past-Presidents, Chapters, and committee members have participated as donors and, in some cases, as peer-to-peer volunteers seeking campaign gifts. Through the campaign, the Foundation has secured financial support to advance the College’s priorities, increased unrestricted gifts, boosted the number of planned gifts, and enhanced member engagement.
The 1913 Legacy Campaign benefits the surgeon, the profession, and the societal good. In collaboration with ACS divisions, the Foundation informs donors about the programs to which they direct gifts, including new initiatives, such as the Rural Surgery Fund and the Codman Quality and Safety Fund.
Nine donors became members of the Mayne Heritage Society in FY 2014, and the 1913 Legacy Campaign has encouraged at least six bequest commitments of $25,000 or more since June 2013.
The 1913 Legacy Campaign established a National Steering Committee of 30 to 35 Fellows to engage their peers in philanthropy. Their contributions of time and effort have allowed for broader implementation of a peer-to-peer campaign promotion. In addition, the Foundation has developed and implemented a strategy to encourage “home-grown” philanthropic champions in each ACS chapter. These Fellows convey key messages and serve as points of contact during their chapter meetings.
The annual gift appeal program has experienced an overall increase of 60 percent in donor response. This fund provides yearly income to nonrevenue programs.
To better communicate the impact of donations, the Foundation partnered with the Bulletin to articulate how ACS Resident Research and Faculty Research Scholars develop innovative methods of providing quality care to surgical patients and point to ACS funding as a start to their research. Additionally, former International Guest Scholars were interviewed and described how they have used the knowledge and skills gained through their ACS-funded travel awards to improve patient care in their countries.
The Convention and Meetings area has continued to generate revenue through exhibit sales at the Clinical Congress and other internal and external client meetings. Association Management Service (AMS) celebrates its 10th anniversary this year. In FY 2014, AMS added two clients, the Society of University Otolaryngologists–Head and Neck Surgeons and the Association of Academic Department Otolaryngologists–Head and Neck Surgeons, for a total of 18. In addition, the John B. Murphy Memorial Auditorium continues to attract events and recently hosted a NASCAR media event and 20th Century Fox TV filming. Social media has played an important role in attracting new clients.
The Performance Improvement (PI) team is tracking 265 projects; 90 are under way, and 106 have been completed. In addition, over the course of this year, the team began 10 new projects; two have been completed, and six are in process.
PI has trained 96 staff members in the Change Acceleration Process (CAP) and designated seven Master Change Agents (MCAs), who participate in training, revising PI curricula, and facilitating projects. CAP/PI sharing sessions are being offered, as are CAP tool refreshers for Change Agents. PI staff have created an ACS Branded Curriculum for CAPS and other resources, which will be rolled out to the next wave of scheduled PI volunteer training courses.
We are designing a curriculum to train all staff in leadership skills. It includes a two-hour innovation orientation and longer engagements, including exercises to encourage innovation. Almost all staff have completed the DiSC and EI training courses.
An Employee Engagement survey was conducted, and each division was provided with their scores in relation to the overall ACS results. Each division has identified at least one focus area to improve staff engagement.
In addition, PI is assisting Member Services in streamlining the member application process, researching the e-publication models available, and assisting Human Resources (HR) in a review of the employee recognition program.
HR hired 69 new employees and promoted or transferred 15 employees in 2013. As of mid-September, the ACS had filled 55 positions in 2014.
The performance review format has been updated to incorporate ACS values and employee self-appraisal.
Monthly UConnect sessions are offered to all supervisors, and values training is offered to new hires. Meanwhile, Executive staff engaged in four two-day sessions focused on development in the following areas: Values, Individual Development Plans, EI, Building High-Performing Teams with DiSC Assessment, Coaching, Conflict Resolution, and Fostering Innovation. ULead II provided one day of training for each staff member, the focus of which was EI and DiSC. More than 300 staff members attended.
Information technology (IT) played an active role in the launch of the new ACS website and Communities. IT also assisted in the creation of a unified billing process for the College, rollout of the MBSAQIP accreditation system, My CME upgrades, data registry vendor evaluation, and upgrading the CoC accreditation system for new standards. Other IT projects include:
- Rollout of new video conferencing and collaboration software
- Development of AEI accreditation management system
- Integration of meeting planning system with meeting app
A few other highlights from this past year include the introduction of an operational oversight system. This system has allowed us to improve internal communication and overall awareness of the accomplishments of the staff across the College.
In addition, at Clinical Congress, the College finalized an agreement to form a strategic partnership with the DoD and the military health care system. This alliance will add an exciting new dimension to the work of both the College and the military.
It also should be noted that several ACS employees have enjoyed recognition by external peer groups for their work on behalf of the College, including:
- Clifford Y. Ko, MD, MS, MSHS, FACS, Director of the ACS Division of Research and Optimal Patient Care, was appointed to the National Quality Forum’s Surgery Standing Committee.
- Michelle McGovern, Director of HR, was elected vice-chairman of the board at HRMAC.
- Dr. Sachdeva was elected vice-president of the Society for Academic Continuing Medical Education.
- Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, was elected to the American Medical Association Foundation.
- Gay Vincent, CPA, Chief Financial Officer, has been nominated for chief financial officer of the year by the Chicago Chapter of Financial Executives International.
Finally, we were all saddened to learn that Thomas R. Russell, MD, FACS, former Executive Director of the ACS, passed away this summer. At this year’s Clinical Congress, we presented the ACS Lifetime Achievement Award posthumously to Dr. Russell and hosted a “Celebration of Life” service in his memory.
The College continues to grow in size and influence because of the dedicated staff and volunteers of this organization. I want to thank each of you for your hard work and commitment to the surgical profession and patient.