Looking forward – May 2017

David B. Hoyt

David B. Hoyt, MD, FACS

In the February 2016 issue of the Bulletin, I noted that the American College of Surgeons (ACS) was engaged in an effort with QuintilesIMS to seamlessly link our clinical databases under a single platform and build the ACS registry of the future.* This vision begins coming to fruition with the launch of a reimagined ACS Surgeon Specific Registry (SSR). Although some users had indicated that they were experiencing difficulties with the new system at press time, the ACS leadership anticipates that the next generation SSR will be an invaluable tool for surgeons seeking to comply with regulatory mandates, improve their performance, and provide the highest quality surgical services to their patients. We are working to address any functionality issues and are providing regular updates on enhancements to the system.

Background on the SSR

The SSR originated as the ACS Case Log system under the leadership of Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education, and the late Thomas R. Russell, MD, FACS, Past-Executive Director of the College. The Case Log system was created as a repository for surgeons seeking to maintain an electronic record of their operations. This information could then be transmitted readily to the American Board of Surgery (ABS) to meet requirements for board certification, recertification, and the fledgling Maintenance of Certification (MOC) program.

Key staff involved in development and launch of the new SSR

  • David B. Hoyt, MD, FACS,
    Executive Director, ACS
  • Clifford Y. Ko, MD, MS, MSHS, FACS,
    Director, ACS Division of Research and Optimal Patient Care
  • Amy J. Sachs,
    ACS Registry Operations Senior Manager
  • Ulrike Langenscheidt,
    SSR Program Manager
  • Michael Bencur,
    Continuous Quality Improvement and Measures Project Manager
  • The QuintilesIMS team

The Case Log system evolved into the SSR with guidance from Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS Division of Research and Optimal Patient Care. The SSR has served as an online software application and database that allows surgeons to track their cases and outcomes in a convenient, easy-to-use manner from their computer or mobile devices. The SSR enables surgeons not only to log and track their cases, but also to participate in an increasing number of government regulations facing the individual health care professional.

In recent years, the SSR has supported ABS MOC Part 4 mandates, which call for ongoing participation in a local, regional, or national outcomes registry or quality assessment program. In addition, the ACS has worked closely with the Centers for Medicare & Medicaid Services (CMS) to achieve and maintain recognition of the SSR as both a Qualified Registry and a Qualified Clinical Data Registry for the Physician Quality Reporting System (PQRS), a quality reporting program that provides payment incentives to eligible professionals (EPs) and group practices that report positive outcomes for certain quality metrics. Providers that fail to report or that do not measure up to CMS’ standards face financial penalties.

How it works

The new ACS SSR has many enhanced features. Under the new registry platform, a single data system will house all quality registry data. As a result, users eventually will be able to share relevant quality data across individual ACS Quality Programs, such as the National Surgical Quality Improvement Program (ACS NSQIP®) and the Trauma Quality Improvement Program (TQIP®), and move these data into the SSR. The ability to move the electronic health record (EHR) into the SSR is in development, and, at present, data from an office practice or a clinic can be uploaded into the SSR as well, thereby minimizing the data entry burden for surgeons. The new ACS SSR also features enhanced reporting capabilities, a mobile device-friendly interface, delegate-level access to enter data, and the ability to add custom fields to collect additional variables relevant to a surgeon’s practice efforts to provide quality care.

Changing regulatory challenges

The new SSR has launched at a time when the Medicare physician payment system is undergoing a significant transformation. This year, CMS begins the transition to the Quality Payment Program (QPP) established under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA). Under the QPP, most physicians, at least initially, will be reimbursed for Medicare services through the Merit-based Incentive Payment System (MIPS). MIPS comprises four components: Quality (formerly PQRS), Advancing Care Information (ACI, formerly EHR meaningful use), a new Clinical Practice Improvement Activities (CPIA) component, and Cost (formerly the Value-based Payment Modifier).

Just as the SSR was approved for use with the PQRS, the new ACS SSR has been approved as a QPP MIPS-Qualified Entity for 2017. As a result, surgeons will be able to fulfill the Quality and CPIA MIPS requirements.

Moreover, surgeons may use the SSR to qualify for an ACI registry bonus because of the SSR’s ability to receive clinical data from EHR systems in a manner that is consistent with MIPS requirements. To receive this Public Health and Clinical Data Registry bonus in payment year 2019—based on 2017 reporting—surgeons will need to create an account within the SSR and maintain a record of their registration for at least 10 years in case of audit. Go to CMS’ ACI page to learn more about the ACI performance category.

In addition, the new SSR will make meeting board certification and Part 4 MOC requirements simpler than ever. Reporting functions will allow users to analyze their own data and compare it with ACS NSQIP compiled data.

Improved ability to deliver patient-centered care

The new SSR is designed to help ACS members not only keep pace with changes in the regulatory demands, but also to provide more patient-centered care in an easy-to-use, more fully integrated format.

Because of the new SSR’s enhanced capacity for customization, it is a tool that surgeons eventually will be able to use at the point of care, along with the ACS NSQIP Surgical Risk Calculator and evidence-based guidelines to assist in shared decision making.

Moreover, office staff will be able to upload a surgeon’s records and spreadsheets to your individual registry through a document template provided by the SSR. This will reduce the time you must spend on administrative tasks, so you can spend more time providing care.

In addition, users will be able to track patients through all phases and domains of care, including the preoperative consultation and evaluation, the immediate preoperative, the intraoperative, the postoperative, and the postdischarge stages. For those of you familiar with the College’s history and the contributions to surgical quality of one of the organization’s founders—Ernest Amory Codman, MD, FACS—this functionality represent a major milestone in fulfilling the end result idea.

The College hosted a series of webinars throughout the first half of April to help surgeons prepare for the switch to the new SSR. For those of you who were unable to participate in April, these webinars will continue throughout the summer and as the need arises. Much of the information in these programs is available on the SSR News and Updates page. This site is updated regularly. In addition, the new SSR will be described more completely in an upcoming feature article in the Bulletin.

Accountability is paramount to success

We are at the dawn of an age of accountability. In health care, accountability will be linked with performance data. The ACS recognizes that some surgeons believe that the new expectations associated with MIPS, MOC, and so on add to a laundry list of already overwhelming administrative burdens. The SSR responds to this concern, making data collection relatively painless. We are excited to offer this tool that will enable our members to objectively reflect on their practice patterns and improve the care provided to the surgical patient.

I can’t overstate how important it is that you participate in these efforts to maintain the financial viability of your practice, to improve your ability to offer patient-centered care, and to help surgery maintain its reputation as a profession that polices itself for the good of society. Your thoughts and recommendations on how the ACS leadership can help you satisfy these objectives are always welcome.

*Hoyt DB. Looking forward. Bull Am Coll Surg. 2016;101(2):6-8.

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