Revised Statement on the Development and Use of Proprietary Guidelines for Accountable Patient-Centered Care

The American College of Surgeons (ACS) Board of Governors’ Surgical Care Delivery Workgroup developed the following revised statement, which the ACS Board of Regents approved at its June 2017 meeting in Chicago, IL. The original statement was developed by the Board of Governors and approved by the Board of Regents in 1998 as the Statement on the Use of Proprietary Guidelines by Managed Care Organizations.*

The ACS is committed to protecting the patient’s health and well-being and the physician’s role in delivering efficient, appropriate, and comprehensive health care.

The ACS Board of Governors recognizes new government regulations and alternative payment models are transforming the delivery of care throughout the U.S. To ensure the voice of physicians and surgeons is audible in the new health care landscape, the ACS Board of Governors is proactively putting forth guidelines on the role of the patient, the physician, and the government in health care.

General concepts about guidelines

  • Guidelines, like medical care, must be evidence-based, reduce unnecessary variation in care, and always put the safety of patients first.
  • Guidelines should allow for variations in patient condition and provide options to account for severity of illness and comorbidities.
  • Guidelines should allow for local resource and staff considerations, regional differences in community standards of care, and community needs.
  • Guidelines should be formulated to consider the totality of an episode of care. For example, discharge criteria should consider the aftercare resources that are available to the patient, such as convalescent care, home care, hospice care, family availability, and so on.
  • Guidelines should never be used as a basis for disciplinary action or litigation if the physician or surgeon determines that strict adherence to their provisions is not in the patient’s best interest.

Patient role

Patients should have the freedom to choose their own physician and engage in shared decision making regarding their care. Patients should be encouraged to choose care that meets the following criteria:

  • Supported by evidence
  • Doesn’t duplicate tests or procedures already completed
  • Avoids harm
  • Truly necessary

Physician role

Physicians and surgeons should be involved in the creation, approval, implementation, review, and modification of all guidelines that affect medical care. Physician leaders at hospitals, physician organizations, and individual practitioners should be diligent in the responsible creation, evaluation, and subsequent implementation of guidelines.

Undesirable or unproven guidelines or portions thereof must be rejected and the objections appropriately documented.

Guidelines that are formulated and maintained through this rigorous process should be followed within reason and in good faith, with the patient’s best interest always at the forefront. Exceptional circumstances and variations in patient condition or circumstances should be anticipated and documented. Patterns of exceptions should lead to refinement of the guidelines.

Government role

Guidelines for specific disease processes developed by governmental agencies or mandated by legislation should follow nationally accepted evidence-based standards of care, have input from physicians, and always put the safety of the patient first.

Appropriate roles for government are the following:

  • Reaffirm the physician’s responsibility for patient care
  • Ensure patients have access to health care
  • Provide for shared decision making between a patient and physician

The ACS believes that the patient has a right to choose a physician and that the physician has a right to freely direct, without interference, the care of the patient. Guidelines may be used to assist the physician, surgeon, and other health care providers in achieving this goal, but should not impede the process or deviate from this purpose.

*American College of Surgeons. Statement on the Use of Proprietary Guidelines by Managed Care Organizations. 1998;83(3):33-34.

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