As I write this last column of 2019 and as my 10th year as Executive Director of the American College of Surgeons (ACS) concludes, I would like to express my gratitude for all the hard work our surgeon volunteers and the ACS staff have done this and every year. A thorough summary of the developments and transformations that have occurred in 2019 is also included in this issue. Herein, I outline the most significant milestones.
Advocacy and Health Policy
The ACS Health Policy and Advocacy Group identified more than 40 issues that the College’s Division of Advocacy and Health Policy should address this year. Top-ranking issues included: administrative burdens and regulations, including prior authorization; the development of a value-based payment system; the electronic health record, including interoperability; new evaluation and management documentation guidelines; and surprise billing for out-of-network care.
We introduced ACS THRIVE (Transforming Health Care Resources to Increase Value and Efficiency)—developed through a collaboration of the ACS and the Harvard School of Business (HBS) Institute for Strategy and Competitiveness—which may resolve some of these challenges. THRIVE ties together the ACS track record of developing meaningful quality improvement programs with the economic principles that the HBS espouses to offer a blueprint for creating a value-based health care system. Key components of this system include development of integrated practice units, composed of all health care professionals and facilities involved in every stage of patient care; use of a time-driven, activity-based costing system; and bundled payment. Congressional staff and officials at the Centers for Medicare & Medicaid Services have continued to express interest in ACS THRIVE as a means of transforming the U.S. health care system.
To address the unique challenges that private practice surgeons are experiencing, we released ACS Resources for the Practicing Surgeon, Volume II: The Private Practice Surgeon at Clinical Congress 2019. This primer provides an overview of private practice business models, financial management and revenue cycle processes, relevant health care laws and rules, and mechanisms to ensure the ongoing prosperity of private practice.
The second class of the ACS Academy of Master Surgeon Educators was inducted October 4. Academy Members, Associate Members, and new Affiliates are exploring pathways to enhance surgical education and training.
A highlight for this year’s Clinical Congress attendees was the opportunity to participate in The Surgical Metrics Project, which will provide us with useful data about perioperative clinical decision making and its effects on efficiency and efficacy.
We also launched the ACS Certificate Program in Applied Surgical Education Leadership (CASEL) September 26−28. Participants in this program will learn about change management, mentorship, self-management, negotiation, and more.
Clinical Congress 2019 was a success, with approximately 13,700 attendees. A highlight for this year’s attendees was the opportunity to participate in The Surgical Metrics Project, which will provide us with useful data about perioperative clinical decision making and its effects on efficiency and efficacy.
Also at Clinical Congress, the 17th edition of Surgical Education and Self-Assessment Program (SESAP®) was unveiled. New features have been added to increase the program’s impact, and a specialty-focused program, Advanced SESAP 17, will debut in 2020.
Continuous Quality Improvement
For four years, the more than 50 member organizations of the Coalition for Quality in Geriatric Surgery Project, with funding from The John A. Hartford Foundation, have sought to improve care for older patients. The final year of the project recently concluded with many milestones completed, including the finalization of geriatric surgery standards and the launch of the Geriatric Surgery Verification (GSV) program.
The 30 GSV standards, Optimal Resources for Geriatric Care, were released at the 2019 ACS Quality and Safety Conference and can be applied in all U.S. hospitals, regardless of size, location, or teaching status. The program will prepare for the influx of older adults considering surgery with care standards that define the resources hospitals need to have in place to perform operations effectively, efficiently, and safely in this vulnerable population. Hospitals were able to start enrolling in the GSV program at Clinical Congress 2019.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program’s (MBSAQIP’s) second national collaborative initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (ENERGY), ended in summer 2018. The most important finding from this work is that participating centers cut their lengths of stay in half and improved patient outcomes. In addition, MBSAQIP released the third version of its standards, launched a patient-reported outcomes initiative, and unveiled a Bariatric Surgical Risk/Benefit Calculator.
Lastly, we have conducted 12 site visits to develop the “Red Book” (Optimal Resources for Surgical Quality and Safety Manual) verification program and standards. We anticipate that this program will launch next year.
ACS Cancer Programs have accredited more than 1,533 Commission on Cancer (CoC) hospitals, 647 National Accreditation Program for Breast Centers specialty centers, and 13 National Accreditation Program for Rectal Cancer specialty centers.
New standards for the CoC have been drafted, reviewed, and finalized for implementation in 2020. The new standards were discussed at a plenary session at Clinical Congress 2019.
The National Cancer Database continues to curate 1.5 million cancer cases and support 1,000 research projects annually and is moving toward near real-time data acquisition, reporting, and inter-programmatic integration with other ACS databases through the transition to the single database platform.
The Clinical Research Program is completing volumes three and four of the Operative Standards Manual and has transitioned six standards into the new CoC standards for implementation in 2020.
The American Joint Committee on Cancer published the eighth edition of its Cancer Staging Manual, which included structured content and created an application program interface to deliver electronic content to electronic health records vendors and other content users.
Cancer Programs staff performed an assessment of the programs as part of the onboarding of the new leadership. A total of 191 surveys and 604 individual comments were reviewed and discussed in January 2019 at a retreat. Strategic planning to address identified strengths and challenges is under way.
The COT, Stop the Bleed staff, and the Division of Integrated Communications launched a new public-facing website, StoptheBleed.org, to meet the ongoing challenge of bringing information, education, and empowerment to the general public.
With leadership from the ACS Committee on Trauma (COT), representatives from 45 professional medical and injury prevention organizations and the American Bar Association met February 10–11 for a Medical Summit on Firearm Injury Prevention to develop a consensus-based approach to addressing this public health issue. As a next step, the COT convened the ISAVE (Improving Social determinants to Attenuate ViolencE) panel to study the causes of violence and recommend innovative programs to reduce the prevalence of intentional violence.
In its third year, the Stop the Bleed® program has provided bleeding control training to more than 1.2 million people in all 50 states and more than 110 countries. And in October, the COT, Stop the Bleed staff, and the Division of Integrated Communications launched a new public-facing website, StoptheBleed.org, to meet the ongoing challenge of bringing information, education, and empowerment to the general public, while still serving as a clearinghouse for Stop the Bleed products, services, and updates.
The ACS has 84,026 members, including 64,414 Fellows (56,044 U.S., 1,262 Canadian, and 7,108 International), 2,673 Associate Fellows, 11,211 Resident Members, 3,168 Medical Student Members, and 568 Affiliate Members. We welcomed our largest class of Initiates this year: 1,992.
The Division of Member Services—which has purview over the Board of Governors, Chapter Services, the Advisory Councils, the Central Judiciary Committee, the Young Fellows Association, the Resident and Associate Society (RAS), Operation Giving Back, the History and Archives Committee, and the Military Health Services Partnership ACS—continues to develop new programs and services to foster member engagement.
As reports of physician burnout continue to be released, several of these groups have sought to address this issue. RAS, for example, chose Nurturing Wellness and Fostering Resilience as its theme for this year’s August Bulletin. Earlier this year, the Division of Member Services also hosted leaders involved in well-being initiatives at their institutions to discuss areas of focus for future programs. The ACS is working on several initiatives as follow-up to this meeting.
As a leader in global health care, the College has partnered with the College of Surgeons of East, Central and Southern Africa (COSECSA) on several projects. In January, the ACS-COSECSA Surgical Training Collaborative launched an effort to establish a regional surgical training hub in Hawassa, Ethiopia. A total of 13 U.S. academic institutions deployed faculty to Hawassa to provide training and support to local surgical residents and faculty.
The College’s new GSV Program captured national media attention this summer with several news articles on the need for the program and how it will improve outcomes for older surgical patients. Stories were published in the New York Times, Associated Press, Kaiser Health News, AARP.com, Reuter’s Health, Becker’s Healthcare, and Fierce Healthcare.
ACS trauma surgeons appeared on CBS Sunday Morning August 4 to discuss a public health approach to firearm violence on the heels of mass shootings in El Paso, TX, and Dayton, OH. The segment featured a panel of seven surgeons and physicians working with the American Foundation for Firearm Injury Reduction in Medicine.
The ACS launched a new artificial intelligence (AI)-driven version of ACS NewsScope. Disseminated twice weekly to all members of the College, My ACS NewsScope is designed to deliver customized content to each recipient. The AI database curates information from nearly 80 sources of both clinical and nonclinical information. Each issue includes a news brief on an important ACS program and occasional updates from the Washington office. The traditional Thursday-night ACS NewsScope continues to be disseminated to more than 55,000 recipients.
With the January issue, the Journal of the American College of Surgeons (JACS) unveiled a redesigned cover. The issue featured 13 selected papers presented at the Clinical Congress 2018 Scientific Forum. It was the first Scientific Forum-dedicated issue of JACS, and the January 2020 issue will feature highlighted papers from the 2019 meeting.
In October 2018, a multistep process was used to create a Twitter strategy, which was approved and implemented to improve the College’s Twitter effectiveness. Increases occurred in all categories.
As this report indicates, the ACS continues to lead the way in ensuring all patients have access to value-based surgical care. It is my honor and privilege to work with all of you as your ACS Executive Director and to help lead this organization.
If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at email@example.com.