American College of Surgeons Professional Association (ACSPA)

As of November 30, 2005 (end of election cycle), the ACSPA-SurgeonsPAC raised $516,000.  Also, $291,000 had been pledged to the PAC via the telephone fundraising campaign. 

Of 215 US members of the Board of Governors, 138, or 64 percent, contributed to the PAC (for an average contribution of $381).  The number of contributors represents a 16 percent increase over the October report. 

In the 2005/2006 election cycle, which ends November 30, 2006, contributions have been made to 103 candidate and leadership PAC committees.  The ACSPA-SurgeonsPAC has organized nine political fundraiser events. 

In 2005, Doctors for Medical Liability Reform (DMLR) launched a nationwide grassroots recruitment and advocacy campaign called “Getting the Nation Behind Us.”  DMLR’s focus in 2005 was to identify, educate, and recruit likely supporters.  This year, some of the highlights of the coalition’s efforts include:

• Radio interviews with DMLR physicians and surgeons, which were broadcasted 960 times on 813 stations and heard by more than 23 million people
• A mailing from the DMLR to approximately 83,000 physicians (including all Fellows), patients, and concerned citizens, educating them about the medical liability crisis and encouraging their support
• Compilation of an E-mail list of 84,000 people as part of an ongoing online recruitment, education, and mobilization effort
• New Web site http://www.protectpatientsnow.org/ redesigned as a user-friendly source of pertinent information and up-to-date news
• A series of clever animations was created and distributed via the Internet
• Online ads were displayed 16 million times
• A mini-documentary was produced for the Web on the medical liability crisis and its threat to patient access to care. 

The DMLR’s Executive Committee met in February to make plans for continuing this campaign.  Once the plans are finalized, the ACSPA will decide its level of participation in the coalition. 

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American College of Surgeons (ACS) 

Proposed Statement

The Board of Regents (B/R) reviewed a statement on sharps safety, which was prepared by the Committee on Perioperative Care (CPC).  The statement was drafted in a follow-up to the Statement on Blunt Suture Needles (http://www.facs.org/fellows_info/statements/st-52.html), which was also prepared by the CPC and was approved by the B/R at its June 2005 meeting.  The CPC subsequently determined that a broader statement on sharps safety was needed; thus, it drafted the statement on sharps safety.  After reviewing the proposed statement, the B/R requested that members of the Board of Governors (B/G) review it.  B/G comments will be brought back to the B/R at its next meeting (June 2006).

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ACS Standing Committees

The Board of Regents approved the addition of Associate Fellows, Resident Members, and Affiliate Members of the College as official categories of membership on the standing committees of the College.  It is the Regents’ desire to have their formal involvement in the College, as well as belief that their participation will complement the activities of the College. 

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e-FACS.org

The College’s Web portal, e-FACS.org, was officially launched on January 10, for all members of the College.  The availability of this new members-only benefit was announced through E-mail, the Bulletin, and Surgery News.  The portal contains 38 communities, of which 12 are specialty communities, 10 are subspecialty communities under the category of “General Surgery,” and the remainder consists of special interest communities. 

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HealtheCareers (Job bank)

As of January 19, 2006, there were 787 active jobs listed on the site and 46 posted résumés.  The site, a valuable membership tool, registered approximately 30,000 hits in 2005 with an average of 82 hits per day.

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Board of Governors

The Board of Governors, at its adjourned meeting on Wednesday, October 19, 2005, requested a discounted fee for Residents to enroll in the postgraduate courses at the Clinical Congress.  As a result of this request, the Division of Education will develop a tiered fee schedule. 

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Resident and Associate Society (RAS)

An anonymous donation has enabled RAS to award two scholarships for 2006 to defray costs associated with conference registration, travel, and participation.  These scholarships will allow young surgeons to develop skills required to become leaders of the future in surgery.  The scholarships will be awarded competitively. 

As its primary focus for 2006, RAS has been working to develop new programs, engage medical students, and expand membership.  An outline for the Residents as Managers course has been completed.  The course is slated to debut in the upcoming year. 

Michael J. Sutherland, MD, Chair of the Resident and Associate Society, will moderate a general session at the Clinical Congress titled, “Emerging Technology in Surgical Education.”  RAS will also host Residents’ Day during the Spring Meeting, and focus on resident-presented papers, interesting cases, and the ever-popular Surgical Jeopardy. 

In an effort to increase interaction with medical students, RAS is developing a recruiting flyer to distribute to all second year medical students in the US.  The goal is to increase awareness of the new Medical Student membership category. 

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Operation Giving Back (OGB)

A strategic planning session was held in December to review and prioritize the five programmatic goals of OGB: domestic volunteer programs, international volunteer programs, disaster response, resident involvement, and retiree involvement.  In late December, OGB received notification from Pfizer Medical Humanities Initiative (PMHI) of the approved proposal of support of OGB.  The contributions of PMHI in support of OGB are acknowledged and appreciated.

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Advisory Councils for the Surgical Specialties

An open forum for rural surgeons continues to be held during the Clinical Congress.  Sponsored by the Advisory Council for General Surgery Subcommittee on Rural Surgery, the forum continues to address concerns voiced by members who serve a rural or small-town patient base. 

The Advisory Council for Neurological Surgery has focused on the issue of emergency care.  The Executive Committee of the American Association of Neurological Surgeons (AANS) is opposed to the concept of delegating neurosurgical care of trauma patients.  The Advisory Council is serving as a liaison between the AANS and the ACS regarding this issue. 

The Advisory Councils continue to develop specialty-sponsored programming presented at the Clinical Congress.  In addition, the Advisory Council for General Surgery continues to propose timely topics for the Spring Meeting.

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Advocacy

Members of the Board of Regents were informed about the broad range of activities taking place in Washington, DC, that hold implications for the way surgical services are delivered and reimbursed under federal, state, and private sector programs.  Activities in these areas have placed increasing demands on College resources.  Following are some of the areas in which the College has focused on maintaining a leadership role.

• The AMA Consortium for Performance Improvement, comprised entirely of physician organizations, has assumed the role of developing performance measures.  R. Scott Jones, MD, FACS, co-chairs the Consortium’s perioperative care workgroup, which is in the final stages of developing the group’s first performance measure for surgery.  The College has placed other measures corresponding to the Surgical Care Improvement Project target areas on the Consortium’s agenda for the spring.
• The National Quality Forum (NQF), a multi-stakeholder group that includes physicians, hospitals, health plans, government agencies, employers, and consumer organizations, has the role of validating measures developed by other organizations, with special emphasis on measures that are useful for public reporting.  The College is a member of NQF, but its involvement has been very task-focused.  No staff or surgeons are permanently assigned to actively participate in NQF proceedings.
• Ambulatory Care Quality Alliance is a second multi-stakeholder group organized by internists, family physicians, and health insurance plans.  Consumer groups and employers also sit at the table.  The College and the Society of Thoracic Surgeons are the first surgical groups appointed to this steering committee.
• As a step toward providing the leadership that surgical specialty societies are hoping for, the College formed an ad hoc internal task force of surgeons to review and refine potential broad-based measures of surgical performance.  The measures were shared with the specialty societies, pared down, and then further refined.  A joint letter was prepared for the Centers for Medicare & Medicaid Services in an effort to expand–and correct–the Physician Voluntary Reporting Program measures applicable to surgery. 

In yet another advocacy area, the Patient Safety and Professional Liability Committee (PSPLC) collected and reviewed approximately 461 surgical claims that closed in 2003-2004 with payment or loss (defense) expenses greater than $25,000.  The next step will be to move into a formal closed claims program.  In the meantime, the PSPLC will review the database information, after which it will submit a report with options and recommendations. 

Dr. Thomas R. Russell, MD, FACS, ACS Executive Director and the Washington office hosted a Health Policy Summit, in Washington, DC, to share perspectives and develop collaborative efforts among surgical specialty society leaders, 2005 winners of the health policy scholarship, and the Health Policy Steering Committee (HPSC).  Issues on the agenda included value-based purchasing and Medicare physician payment.  A joint meeting of the HPSC and health policy scholars was held the following day to review conclusions reached during the Summit. 

The College has organized the surgical specialty societies into a “surgical quality alliance” to help coordinate efforts and strategies with respect to various organizations involved in the development, validation, and selection of performance measures to be used in implementing value-based purchasing programs in the public and private sectors. 

To enhance surgery’s input into the Medicare policymaking process, the College collaborated with surgical specialty societies and others to support the nomination of Dr. Karen R. Borman, ACS Governor, to the Medicare Payment Advisory Commission (MedPAC).  In addition, 31 members of Congress co-signed a letter supporting the appointment of a surgeon to the commission.  The letter also highlighted the fact that only two surgeons have served on MedPAC since it inception in 1997. 

Also of interest, John R. Clarke, MD, FACS, ACS Governor, was appointed as the College’s representative to the NQF’s Patient Safety Taxonomy Consensus Standards Maintenance Committee. 

The College informed the governor and the Chamber of Commerce in the State of Georgia that it would not hold meetings in the state until the state recognizes general surgery as a unique specialty in its certificate-of-need (CON) statute.  Under the current statute, general surgery is defined as a “multispecialty,” and as such is ineligible for an exemption that single specialties have from obtaining a CON when building ambulatory surgery centers. 

Frank G. Opelka, MD, FACS, testified on behalf of the College before the House Energy and Commerce Health Subcommittee.  Dr. Opelka expressed the College’s concern that cuts in reimbursement payments will have negative effects on surgeons’ ability to practice and on Medicare patients’ access to needed surgical care.  He further demonstrated how the current Medicare payment system fails to recognize the nature of surgery and how the current sustainable growth rate system disproportionately impacts surgical reimbursement.  He also highlighted the College’s support for quality improvement programs and the success of its own programs as possible models for surgical value-based purchasing programs. 

The College organized two briefings for MedPAC staff, in which several surgical members of the American Medical Association (AMA)/Specialty Society Relative Value Update Committee (RUC) participated, to provide them with its analysis of the relativity of the Medicare fee schedule and to describe the development of more data-driven methods that the surgical societies are using in the RUC process to evaluate changes in work.  As a follow-up to its initial meeting with MedPAC staff, the College sent a letter reiterating points that it had made during the meeting. 

Representatives from the College, the Coalition for American Trauma Care, and the American Trauma Society met with Laura Ott, Health and Human Services (HHS) Deputy Assistant Secretary for Legislation, to discuss the importance of the Health Resources and Services Administration's (HRSA) Trauma-EMS Program.  The main purpose of the meeting was to convince HHS and the Bush Administration to include the program in their FY 2007 budget.  Ms. Ott was very enthused about the program and assisted the College in setting up a meeting with the HRSA administrator for further discussion. 

The College participated in a meeting to explore the formation of a congressional caucus in support of Emergency Medical Services (EMS) issues.  In addition to discussing the role and formation of a caucus, the meeting participants worked toward identifying common ground on some of the leading issues confronting EMS.  The next step is to meet again to develop a more detailed agenda and identify congressional champions in the House and Senate. 

The College’s Committee on Trauma Subcommittee on Emergency Services-Prehospital was invited to participate in the Institute of Medicine project, The Future of Emergency Care in the United States Health System.  The focus of this project is pediatric and pre-hospital EMS issues, as well as hospital-based emergency department issues.  The Committee on Trauma (COT) continues to work with other trauma organizations and the Washington office in support of funding for trauma systems.  The COT continues to emphasize the importance of trauma systems in our country, especially in response to disaster and mass casualty events. 

The College is an active member of One Voice Against Cancer (OVAC), a coalition that continues to lobby Congress to ensure that funding for federal cancer research and programs remains a national priority.  OVAC has begun taking steps to position the cancer community at the forefront of the budget and appropriations processes for next year. 

Dr. Russell assembled an Emergency Workforce Task Force with the goal of developing consensus among the surgical specialty societies on solutions to the impending emergency workforce crisis.  This task force followed up on previous meetings on the issue.  At the March 2005 meeting hosted by the College, the specialties discussed the workforce crisis in emergency departments and trauma centers.  Creative solutions that were brought to the table for review included regionalization of care, on-call stipends, development of a new “acute care surgeon” subspecialty, providing additional residency training positions, and continued federal efforts to address the liability and physician reimbursement problems. 

In 2005, every state saw some type of allied health professional scope of practice bill introduced, and many states were successful in defeating such legislation.  The College has joined with several other groups to monitor and fight these attempts.  So far, the coalition has been successful in stopping all attempts to restrict a surgeon’s ability to offer such services as MRIs, CT scans, PET scans, and ultrasound.  Another strategy being employed to restrict surgeons’ ability to offer imaging services is to approach the private sector (health insurers) to implement guidelines developed by radiology.  Insurers see this as a way to limit the growth in imaging services. 

Also in 2005, several states attempted to introduce a new tax on physician services–specifically on elective cosmetic surgery–in response to the massive budget shortfalls many of them are facing.  Although none of the states were successful in passing this type of tax, the idea is expected to be proposed in other states in 2006.  The College has joined with other national specialty societies to fight physician taxes, and in late 2005, the coalition unveiled a Web site to help educate and monitor these attempts. 

A series of conference calls was held with State Advocacy Representatives (StARs) as a kick-off to the 2006 state legislative season.  These calls gave StARs the opportunity to discuss potential state issues, prepare for advocacy efforts in their states, and consider strategies for engaging Fellows in state-level advocacy.  State affairs staff members continue to solicit the names of interested surgeons to participate in the program. 

The College’s General Surgery Coding and Reimbursement Committee (GSCRC) is engaged in a major multifaceted effort to address the five-year review of relative work value units.  The GSCRC is working on two fronts: reviewing general surgery codes that it considers misvalued and uniting the surgical specialty societies in the RUC to contest the medical specialists’ claim that the evaluation and management codes are currently undervalued.  The surgical coalition that the College is leading continues to provide in-depth analysis of numerous sources of data to demonstrate that the increases being sought are unfounded and threaten the relativity of the entire Medicare fee schedule. 

In November 2005, the College’s delegation in the AMA House of Delegates attended the interim meeting of the AMA in Dallas.  The ACS delegation represented surgery’s perspective on a host of issues and policy decisions.  At the top of the agenda was pay-for-performance/ value-based purchasing.  The delegation also took a strong stand on payment for EMTALA-mandated emergency care. 

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Accreditation

The Board of Regents approved a business plan for the ACS Bariatric Surgery Center Network (ACS BSCN).  The mission of the ACS BSCN program is to improve the quality of surgical care for bariatric patients throughout the US, through the accreditation of bariatric centers that maintain certain physical resources, human resources, standards of care, and documentation of outcomes. 

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Education

The Clinical Congress program was strengthened further.  The 2005 program was designed to address contemporary topics in surgery relating to the core competencies, patient safety, new procedures, emerging technologies, and non-clinical topics relating to the practice of surgery. 

It was very well received by the attendees, and was rated excellent or very good by 91.5 percent of the respondents.  In addition, 97.6 percent of the respondents stated they would use the newly acquired knowledge and skills in their practices. 

The 2006 Clinical Congress program will include 110 general sessions, 8 multidisciplinary sessions, 29 specialty sessions, 14 didactic postgraduate courses, and 21 skills-oriented postgraduate courses.  Major steps have been taken to move the processes of submission of proposals for the Clinical Congress to an electronic platform.  Online systems have been developed to accept submissions of abstracts for the paper presentation sessions, scientific exhibits/posters, and video-based education sessions. 

Since its release, SESAP 12 has experienced a continuous growth in enrollment.  An Audio companion for SESAP 12 was also released simultaneously. 

The Editorial Board of the Video Library has established a model to systematically review videotapes in the ACS Video Library.  An ACS Online Video Journal has been launched and has generated considerable interest.

A new CD-ROM, Professionalism in Surgery: Challenges and Choices, has been released. 

The program is highly interactive with 12 video-based scenes demonstrating challenges in professionalism.  Background readings are provided, and the program includes a post-test with opportunities to review specific content areas if a wrong answer is selected.  Online Category 1 CME credits may be earned through participation in this program. 

The Personal Digital Assistant and Internet-based Case Log System, designed to support practice-based learning and improvement, was released in October.  As of mid-January, over 6,500 cases have been entered into the system by approximately 100 surgeons. 

Evidence Based Reviews in Surgery, an Internet-based program, was launched in October.  The program is designed to enhance skills in critical analyses and evidence-based surgery, and offers participants the opportunity to access online clinical and methodologic articles from the current surgical literature.  The program was developed by the Canadian Association of General Surgeons.  Participants who complete the multiple-choice questions are eligible for Maintenance of Certification credits from the Royal College of Physicians and Surgeons of Canada and Category 1 CME credits from the ACS.

Surgical M+M and Patient Safety was recently launched.  The Internet-based program was developed to highlight new approaches to designing and conducting morbidity and mortality conferences in surgery.  The goal of the program is to address patient safety and focus on systems and individuals within the context of adverse events, errors, and near misses. 

The College recently released a new publication, Successfully Navigating the First Year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents.  The publication includes two sections; the first addresses the areas of knowledge and skills that surgical residents should possess when they enter their first year of residency, and the second lists the areas of knowledge and skills expected of residents at the completion of their first year.  The publication is geared toward medical students interested in surgery, surgical clerkship directors, surgical residents, and surgical residency program directors. 

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Journal of the American College of Surgeons (JACS)

As of January 17, 2006, JACS has provided Fellows and subscribers with nearly 80,000 CME-1 credits as a benefit of membership.  Dr. Frank R. Lewis Jr., Secretary-Treasurer of the American Board of Surgery (ABS), reviewed the JACS CME program, and will promote it as a preferred way for continuous learning activity as part of the ABS maintenance of certification.

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College News

Board of Regents