The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met June 7–9 at the College’s headquarters in Chicago, IL. The following is a summary of key activities discussed. The information provided was current as of the date of the meeting.
From January 1, 2017, through April 30, 2018, the ACSPA and its political action committee, ACSPA-SurgeonsPAC, collected $760,000 in donation receipts from more than 1,480 ACS members and staff. SurgeonsPAC also disbursed $541,000 to more than 111 congressional candidates, leadership PACs, and political campaign committees. Commensurate with congressional party ratios, 59 percent of the amount given went to Republicans and 41 percent to Democrats.
In addition to reviewing reports from the ACS division directors, the Regents reviewed and approved the following policy statements and recommendations:
- Statement on Recommendations for Surgeons Caring for Patients Who Are Jehovah’s Witnesses
- Statement on Intimate Partner Violence (see upcoming October Bulletin)
- Revised Statement on Patient Safety in the Operating Room: Team Care
Division of Advocacy and Health Policy
The Division of Advocacy and Health Policy (DAHP) reported on its activities related to relieving administrative burdens, developing alternative payment models (APMs), and other issues that lawmakers and policymakers are discussing.
Administrative burdens and regulations
The ACS is collecting examples of administrative burdens and regulations that Fellows are facing. The administration and Congress are open to addressing those issues related to Medicare. The College has launched a Stop Overregulating My OR (SOMO) web page to further combat policies that could continue to overburden surgeons and their practices. SOMO highlights specific regulatory and legislative actions that should be taken to eliminate unnecessary requirements and enable surgeons to reinvest their time and resources in patient care. Under SOMO, feedback is provided to congressional and executive branch leaders on regulatory obstacles that interfere with the clinical workflow and delivery of surgical care.
The ACS-Brandeis Advanced APM is in commercial use with demand to create the logic as a public utility for all specialties. Surgeons using the model receive APM status for Accountable Care Organization activity.
Employed Surgeon Handbook
The ACS General Surgery Coding and Reimbursement Committee is updating the Employed Surgeon Handbook. The revised version is expectedto be published before Clinical Congress 2018.
The College continues to focus on the digital health information for a patient longitudinally rather than solely on electronic health records (EHRs). The ACS and other specialties plan to create open-source apps that can deploy broadly at a scale across all EHRs, as well as separately in patient cloud platforms.
The College has worked at both the state and federal level to ensure that any response to the opioid crisis doesn’t negatively affect surgical patients who need prescription painkillers. The ACS also has worked to ensure that any legislation doesn’t place additional burdens on surgeons. Collaborative efforts continue with the Division of Education on educating both surgeons and surgical patients regarding opioid issues.
The College is involved in 24 state legislative initiatives. Issues are primarily focused on concerns regarding payment for out-of-network services, Maintenance of Certification, trauma, and scope of practice. The division continues to actively partner with ACS chapters on advocacy efforts and activities.
Stop the Bleed
Numerous Stop the Bleed® training events have taken place on Capitol Hill. An introductory meeting with the Department of Energy was recently held to discuss potential promotional efforts of the program.
Division of Education
The Division of Education reported on Clinical Congress, the new Academy of Master Surgeon Educators, and other ACS programs that contribute to the lifelong education of surgeons.
A total of 8,228 physicians attended Clinical Congress 2017 in San Diego, CA; 1,628 were residents and 635 were guest physicians. Other attendees included 513 medical students, 304 allied health professionals, and 113 PhDs. A total of 2,990 individuals claimed 49,876.50 Category 1 Continuing Medical Education (CME) Credits. In addition, 2,330 individuals claimed 26,810 Self-Assessment Credits. Credits also were offered in new domains to address a variety of regulatory mandates, including cultural competence (454), end-of-life care (25), and risk management (232).
The Clinical Congress 2018 Program, approved at Clinical Congress 2017, includes 24 Tracks, 120 Panel Sessions, 15 Didactic Courses, 14 Surgical Skills Courses, 45 Meet-the-Expert Sessions, and 17 Town Hall Meetings. A total of 2,131 scientific abstracts were submitted—the highest number ever received and 19 percent more than in 2017. Additionally, 459 video-based education abstracts were received, just under the all-time high of 463 in 2017. Clinical Congress 2018 will take place October 21–25 in Boston, MA.
Academy of Master Surgeon Educators
The Academy of Master Surgeon Educators, which recognizes and assembles a cadre of Master Surgeon Educators of national and international renown, will induct its inaugural members this October. Members of the Academy will be selected through a rigorous peer-review process and are expected to work with the Division of Education to advance the science and practice of cutting-edge surgical education and training. Starting at Clinical Congress 2019 in San Francisco, CA, the Academy will meet annually and pursue specific projects between meetings. A journal, Proceedings of the ACS Academy of Master Surgeon Educators, will launch in 2020.
Plans are under way to design a Certificate Program in Applied Surgical Education Leadership (CASEL) for surgeon educators who have successfully completed specific faculty development courses and possess sufficient experience in the field of surgical education. The curricular requirements and assessments are in development. The program is expected to launch in July 2019.
Committee on Ethics
The Committee on Ethics, housed in the Division of Education, has developed several activities for Clinical Congress 2018, including the John J. Conley Ethics and Philosophy Lecture, which will be delivered by Michael E. Porter, MBA, PhD, author of Redefining Health Care. This year’s Ethics Colloquium, Money and Modern Surgical Practice: Navigating the Difficult Ethical Terrain, will explore the challenges that surgeons face when financial incentives and constraints influence clinical practice.
The committee also is reviewing applications for the Fellowship in Surgical Ethics, sponsored by the Division of Education and the MacLean Center for Clinical Medical Ethics, University of Chicago, IL, which prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics.
Launched in May, the Entering Resident Readiness Assessment (ERRA) is an innovative online, case-based program to assess clinical decision-making skills of young surgeons entering the field. ERRA provides psychometrically rigorous measures of key skills needed to safely assume new clinical responsibilities. Results can be used to identify strengths, develop learning plans for areas that may need reinforcement or remediation, and support decisions regarding the transition from direct to indirect supervision.
Fundamentals of Surgery Curriculum
Launched in 2005, Fundamentals of Surgery Curriculum® is a simulation-based curriculum for surgery residents featuring 110 case scenarios. More than 1,500 residents from nearly 250 general surgery and a few other specialty training programs are enrolled. Pilot testing is under way for 14 assessment modules to provide program directors with information regarding resident performance. The development of advanced cases for senior residents and practicing surgeons also has commenced.
ACS Multimedia Atlas of Surgery
The ACS Multimedia Atlas of Surgery includes volumes on colorectal surgery, hernia surgery, liver surgery, and pancreatic surgery. Later this year, a volume on bariatric surgery will be introduced. The Atlas contains numerous videos, medical illustrations, didactic presentations, and expert commentaries on specific steps of both laparoscopic and open operations. Each chapter is authored by an expert surgeon and highlights special nuances, including steps that can help reduce surgical errors. Revisions and updates to the colorectal and pancreas volumes are planned.
In its 11th year, Selected Readings in General Surgery (SRGS®) continues to publish evidence-based reviews of the medical literature on a cycle of general surgery topics over 48 months. In 2017, SRGS introduced a new audio offering, further expanding accessibility by allowing subscribers to listen to a recording of each issue’s literature review. SRGS has 2,350 subscribers, including 500 surgery residents.
Now in its 46th year, the Surgical Education and Self-Assessment Program (SESAP®) remains the premier self-assessment and cognitive skills education program for practicing surgeons. The current edition, SESAP 16, was released in October 2016 and continues to be extremely well received by subscribers who extol the quality of content, ease of use, and relevance to practice. An additional web-based resource, the SESAP Sampler, is available within SESAP and contains monthly modules designed to enhance surgical decision making through ongoing self-assessment and review of surgical content.
Surgeons as Leaders: From Operating Room to Boardroom Course
The 14th Annual ACS Surgeons as Leaders Course took place June 24–27 in Durham, NC. This popular course provided the surgeon attendees with a better understanding of leadership at all levels of an organization, as well as with essential skills for effective leadership.
Residents as Teachers and Leaders Course
The 12th Annual Residents as Teachers and Leaders Course took place April 13–15 at the ACS headquarters and garnered participation from 136 residents from 76 programs in the U.S. The course aims to help surgery residents develop essential nonclinical skills to become more effective teachers and leaders.
Division of Member Services
The Board of Regents accepted resignations from 25 Fellows and changed the status from Active or Senior to Retired for 125 Fellows. The Regents also approved the formation of an Advisory Council for Oral and Maxillofacial Surgery.
Division of Research and Optimal Patient Care
The Division of Research and Optimal Patient Care encompasses the areas of Continuous Quality Improvement, including ACS research and the accreditation programs.
Quality and Safety Conference
The 2018 Quality and Safety Conference took place July 21–24 in Orlando, FL. The conference featured sessions and tracks from multiple ACS Quality Programs including the National Surgical Quality Improvement Program (NSQIP®) Adult and Pediatric, Children’s Surgery Verification (CSV), Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), Cancer Programs, and Trauma Programs. In addition, a new track explored concepts and resources from the Optimal Resources for Surgical Quality and Safety, also known as the “red book.” More than 400 abstracts were submitted to the conference.
Optimal Resources for Surgical Quality and Safety
Last year, the College officially released its quality manual, Optimal Resources for Surgical Quality and Safety. The development of adjunctive and integrated resources/standards based on this manual are near completion and will ultimately be used to launch a Surgical Quality Verification Program. The principle areas of focus for the standards are rooted within the foundational elements of the manual and include the domains and phases of surgical care, the Surgical Quality Officer, program and committee infrastructure, peer and case review, disease-based management, and components of data capture and surveillance.
New program development
Multiple surgical specialty organizations and surgeon groups have approached the College to partner in the development of new specialty-specific verification programs. The goals of all new quality programs include setting standards, defining necessary resources, providing data and valuable tools for quality improvement, and supplying meaningful feedback to hospitals on an ongoing basis through the verification process. Preliminary standards and verification program development has started in the following areas: emergency general surgery, high-risk gastrointestinal surgery, rural surgery, thoracic surgery, and vascular surgery.
A total of 802 hospitals participate in ACS NSQIP—688 in the adult option. The pediatric option represents 14 percent of overall participation. An additional 24 hospitals are in various stages of the onboarding process. At present, 88 hospitals outside of the U.S. participate in ACS NSQIP—approximately 11 percent of all participating hospitals. Interest from international sites continues to build, particularly in Asia, Australia, Europe, the Middle East, and South America.
A total of 854 facilities participate in MBSAQIP, and 66 surgeon surveyors were expected to complete 162 site visits between January and June 2018. Work continues on the release of MBSAQIP’s new data registry, which is tentatively scheduled for early 2019. MBSAQIP also is preparing to finalize the third version of its standards, Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient, scheduled for release in April 2019.
Children’s Surgery Verification Program
The College’s Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring that pediatric surgical patients have access to high-quality care. The program has garnered endorsements from multiple specialty societies, including the American Academy of Pediatrics, American Pediatric Surgical Association, and Society of Pediatric Anesthesiology. A total of 10 sites have been verified and 25 are going through the verification process.
The Coalition for Quality in Geriatric Surgery (CQGS) Project, funded by the John A. Hartford Foundation, aims to systematically improve surgical care of patients older than 65 years of age by establishing a verification program in older adult surgery. The project team is conducting a CQGS Beta Pilot at eight hospitals. The CQGS Beta Pilot Resource Manual, which describes in detail the rationale behind each standard, strategies for implementation of each standard, and specifics on how sites can meet each standard, was distributed previously to the participating sites. The team will conduct and complete site visits this year to better understand the feasibility of centers implementing the standards.
The Agency for Healthcare Research and Quality Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the College and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, is under way. The second cohort began in March with 130 hospitals concentrating on colorectal surgery and 119 hospitals focused on orthopaedic surgery (total joint and/or hip fractures).
Strong for Surgery
Strong for Surgery, a joint program between the ACS and the University of Washington, Seattle, is a quality initiative aimed at identifying and evaluating evidence-based practices to optimize the health of patients before surgery. The program empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. The checklists target four areas known to be high determinants of surgical outcomes: nutrition, glycemic control, medication management, and smoking cessation. Four additional checklists covering the areas of delirium, frailty, pain management, and education are in development. The new checklists debuted at the 2018 ACS Quality and Safety Conference. The Strong for Surgery program also offers an online toolkit providing the framework for successful implementation of the program at any site. In addition to the active sites included in the content migration from the University of Washington to the ACS, 276 additional sites have accessed the online toolkit.
The Surgeon Specific Registry (SSR) platform has an active user base of more than 5,300 surgeons. Since its launch a year ago, more than 900,000 records have been entered in the new system. The overarching purpose of the SSR program is to better aid individual surgeons in measuring outcomes and complying with the changing regulatory environment and its requirements. For the 2017 Merit-Based Incentive Payment System (MIPS) performance year (PY), the SSR successfully submitted data to CMS for 600 surgeons. For the 2018 PY, the following MIPS Quality measures reporting options will be offered: the General Surgery Specialty Measures Set, the ACS Surgical Phases of Care Measures, and the newly revised ACS Trauma Specialty Measures Set. The SSR will continue to improve functionality and address enhancement opportunities.
The Commission on Cancer (CoC), National Accreditation Program for Breast Centers (NAPBC), and National Accreditation Program for Rectal Cancer (NAPRC) have successfully integrated into a single team. The primary goal of the integration is to increase efficiency and effectiveness through standardization of processes and the cross-training of team members to support the multiple programs.
- The NAPBC released a revised standards manual in January 2018, and the Survey Application Record was updated to reflect these changes.
- The CoC initiated a review of the current standards, which will introduce standards based on content in Operative Standards for Cancer Surgery Volume I.
- The NAPRC launched in January 2018 by accepting applications for survey from more than 20 rectal programs, training NAPRC surveyors to perform site visits, and accrediting the first rectal cancer program—the John Muir Health Cancer Institute, Walnut Creek, CA.
A total of 783 trauma programs are participating in the Committee on Trauma’s (COT)’s Trauma Quality Improvement Program (TQIP®), and 517 hospitals are participating in ACS Verification.
The 2018 TQIP Annual Scientific Meeting will take place November 16–18 in Anaheim, CA. Featured topics include TQIP Collaboratives, pediatrics, intentional mass casualty incidents, and the continued integration of Verification, TQIP, and the Performance Improvement and Patient Safety program.
The 10th edition of the Advanced Trauma Life Support® traditional course officially launched to all sites earlier this year. The faculty toolkit will be available this summer.
The Bleeding Control program has experienced rapid and unprecedented growth since its inception in January 2017. The program has trained more than 124,000 people in the U.S. and 133,000 in other countries, with more than 30,000 instructors worldwide. As a result of this growth, the COT Executive Committee underwent a committee restructure to support the program. The Stop the Bleed Steering Committee will provide strategic guidance regarding program efforts and oversee the activities of the Education, Outreach and Dissemination, and Advocacy/Policy Workgroups. ♦