Looking forward – December 2018

David B. Hoyt, MD, FACS

David B. Hoyt, MD, FACS

In October, I sent all members of the American College of Surgeons (ACS) an e-mail with the annual Executive Director’s report that I presented to the Board of Regents at its meeting in October. An abbreviated version of the report is included in this issue of the Bulletin. As these achievements demonstrate, the ACS has had a very productive year. In this column, I highlight some of the key accomplishments and provide details on what has happened subsequent to the time the report was written.

Addressing payment and funding issues

Payment for the services that surgeons and other physicians provide and funding for health care programs continue to top the list of ACS members’ concerns. The Bipartisan Budget Act of 2018, P.L. 115-123, enacted in February addresses many of these issues, including the following: technical corrections to the Merit-based Incentive Payment System (MIPS), 10-year funding for the Children’s Health Insurance Program (CHIP), language that eases electronic health record (EHR) meaningful use requirements, funding to address the opioid epidemic and support the work of the National Institutes of Health, and repeal of the Independent Payment Advisory Board established in the Affordable Care Act.

To further address concerns about MIPS, the College testified at a July U.S. House Committee on Energy and Commerce Health Subcommittee hearing on the Medicare Access and CHIP Reauthorization Act (MACRA) and MIPS. The testimony emphasized that Congress and other stakeholders need to offer more guidance to the Centers for Medicare & Medicaid Services (CMS) as the agency works to implement MACRA and MIPS.

To combat administrative requirements that take time away from the operating room (OR) and patient care, the ACS launched the Stop Overregulating My OR (also known as SOMO) initiative. Through this campaign, the ACS highlights specific regulatory and legislative actions that would improve clinical workflow and surgical care. As a result, CMS removed redundant or outdated clinical documentation requirements and initiated efforts to improve EHR interoperability.

Addressing the opioid crisis

The ACS has actively advocated for a patient and provider education-focused approach to address the opioid epidemic and for averting one-size-fits-all legislative mandates on prescribers. The ACS’ advocacy efforts have included responding to congressional requests for information, submitting letters to key congressional committees, and including opioid talking points in meetings with the offices of members of Congress during the 2018 Leadership & Advocacy Summit in May.

These efforts paid off October 24 when the President signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, P. L. 115-271. The SUPPORT for Patients and Communities Act includes provisions that focus on treatment and prevention for opioid abuse and misuse, safe disposal of opioids, electronic prescribing for controlled substances under Medicare Part D, and enhancement and development of Prescription Drug Monitoring Programs. The law also calls for studying the effects of state and federal legislation that limits the prescription of opioids, creating standards for electronic prior authorization in Medicare Part D, and addressing the flow of illegal opioids into the U.S. Also significant is what the law does not contain—federal mandates on physicians.

To educate providers and patients on opioids and their alternatives, the ACS Opioid-Sparing Workgroup developed a brochure, “Safe and Effective Pain Control After Surgery,” which can be accessed on the ACS website.

Addressing the needs of practicing surgeons

The ACS recently published ACS Resources for the Practicing Surgeon, Volume I: The Employed Surgeon in response to requests from Fellows for more help in navigating institutional employment, understanding compensation, negotiating contracts, and addressing other related issues. The booklet provides detailed information about various employment types and environments, an overview of the contractual parameters of a surgeon’s medical practice, a description of the mechanisms used to determine how surgeons are paid by their employers, and tips for evaluating and finalizing the terms of an employment agreement. This publication is the first in a series of resources the ACS is working to produce for practicing surgeons.

To assist surgeons who prefer to remain in private practice, the College has been engaging in regular discussions with members who want to sustain this model. The Board of Regents, Officers, Board of Governors, and the Executive Leadership Team are committed to identifying and addressing the challenges these surgeons face.

The ACS also has formed a Steering Committee for Retraining and Retooling Practicing Surgeons, which is focused on defining standards for surgeons to hone their skills and stay current on the latest surgical technology and techniques.

Addressing the needs of surgeon educators

The ACS Academy of Master Surgeon Educators inducted its first class of Members and Associate Members October 3 to recognize Master Surgeon Educators, advance the science and practice of surgical education and training, foster innovation and collaboration, and underscore the importance of surgical education and training. In addition, the ACS has launched a Comprehensive Faculty Development Program to address national needs through courses and products that are anchored to four levels of professional accomplishment.

Addressing concerns about autonomy

The Mastery in General Surgery Program launched this year, building upon the Transition to Practice (TTP) Program in General Surgery. The new program emphasizes individualized training in diverse locations with different mentors and strategies to provide sufficient autonomy to increase confidence and competence in early-career surgeons.

The Resident and Associate Society of the ACS (RAS-ACS) published seven articles on resident autonomy in the August issue of the Bulletin and collaborated with the Division of Education and the Division of Member Services to present the two-day Surgery Resident Program: Essential Skills for Surgery Residents at Clinical Congress 2018 in Boston, MA. The RAS-ACS and the Young Fellows Association also offered mentoring programs, pairing residents with young surgeons and young surgeons with seasoned surgeons.

Addressing global surgery needs

With leadership from Operation Giving Back (OGB), the ACS and the College of Surgeons of East, Central, and Southern Africa have developed a Surgical Training Hub Collaborative at Hawassa University in Ethiopia. This collaborative is the first ACS-sponsored, OGB-implemented global health program of its kind, and we anticipate it will give root to similar programs in other underserved countries seeking to develop a sustainable surgical workforce.

Addressing violence

The ACS formed an Intimate Partner Violence (IPV) Task Force to develop and disseminate resources to assist surgeons in addressing IPV. In addition to working with the Women in Surgery Committee to develop the revised ACS Statement on Intimate Partner Violence, the task force has released a host of new resources to support ACS members who may be the victim of, or have a family member, friend, colleague, or patient who is experiencing, IPV. The Task Force continues to develop new materials that will benefit ACS members’ understanding and response to this issue.

Furthermore, the ACS Firearm Injury Prevention Strategic Workgroup has developed a nine-point action plan on firearm injury prevention, and the Firearm Strategy Team, composed of several firearm-owning Fellows, has finalized consensus recommendations, which have been published in the Journal of the American College of Surgeons.

Improving quality improvement

Participation in the College’s programs aimed at improving quality of surgical care—including the ACS National Surgical Quality Improvement Program (Adult and Pediatric), the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, and the Trauma Quality Improvement Program—continues to grow. We also are making progress in developing standards for geriatric care, expanding the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery program, and creating checklists to ensure that patients are Strong for Surgery.

In addition, we recruited Heidi Nelson, MD, FACS, of the Mayo Clinic, Rochester, MN, to succeed David P. Winchester, MD, FACS, as Medical Director of ACS Cancer Programs, and the Clinical Research Program released Operative Standards for Cancer Surgery, Volume 2.

Communicating more effectively

The ACS has engaged in a strategic planning process to improve navigation of the ACS website and to more effectively and regularly communicate with the membership through ACS NewsScope, as well as expand its social media presence.

Looking ahead

I anticipate that in the coming year, the more than 80,000 members of the ACS will see more growth and innovation within our organization. The dedicated staff and volunteers work tirelessly to respond to the members’ evolving needs, and I cannot thank them enough for all that they do for our profession and our patients.

If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.

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