American College of Surgeons Professional Association (ACSPA)

As of November 30, 2006, the end of PAC fundraising cycle, the ACSPA-SurgeonsPAC raised $954,344.  In addition, $581,817 had been pledged to the PAC via the telephone fundraising campaign.  Of the 216 US members of the Board of Governors, 134 (62 percent) contributed to the PAC.

In the 2005/2006 election cycle, contributions were made to 172 candidates, leadership PACs, and party committees.  In 2007, the PAC will continue to support congressional leaders and other members of Congress who support surgery's legislative agenda.

2006 was a busy and productive year for Doctors for Medical Liability Reform (DMLR).  The coalition recruited, educated, and mobilized a significant national grassroots network in support of medical liability reform.  In addition, a database of over 500,000 physicians, patients, and concerned citizens has been built.

The ACSPA Board of Directors approved a permanent position for ACS Resident and Associate Society (RAS-ACS) representation on the PAC Board with a two-year renewable term and full voting privileges.  Ross F. Goldberg, MD, Boston, MA, was appointed to the PAC Board as the RAS-ACS representative for 2007-08.

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American College of Surgeons Foundation

The Board of Regents approved a slate of Directors and Officers for two-year terms of service on the ACS Foundation Board of Directors and Officers.  In addition, the Board also approved the appointment of Robert W. Hobson II, MD, FACS, Governor-at-Large for New Jersey, to the Committee on Development.

The Foundation completed its second year of operation in February 2007.  Contribution and pledge income for the fiscal year ending June 30, 2006 totaled $1,842,997.

The Foundation Web pages have been updated and now feature a program that allows individuals to calculate the impact of various gifting options.  Individual contributions continue to provide the bulk of gifts to the Foundation. 

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American College of Surgeons 20 F Street NW

The Board of Regents received an update on undeveloped property located at 20 F Street NW in Washington, DC.  The property has been on the College's radar for some time as the need for expansion of the Washington office has grown, along with an increasing demand for surgery to be more visible in Washington on the legislative front.  The Regents received a presentation from representatives of Boston Properties, followed by a question and answer session.  After all questions were asked and sufficiently answered, the Board of Regents voted to approve the purchase and development of the 20 F Street property.

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Statements

The Board of Regents approved a revised Statement on Laser Surgery.  The original statement published in 1991, was previously revised in 1995.  In light of growing medical board involvement in problems/issues arising from the delegation of laser procedures to non-physicians (eg, hair removal and other cosmetic procedures), the College was asked to serve as a clearing-house of proposed and existing regulations on the delegation of laser and other procedures, and to develop a consensus national position on behalf of all of the surgical specialties.  The task was accomplished by the staff of the Division of Advocacy and Health Policy.  The revised statement will be published in the April issue of the Bulletin and posted on the College's Web site.

The Board of Regents reviewed a proposed Statement on Emergency Surgical Care.  The statement was drafted by the Advisory Council for General Surgery, and reviewed by all of the Advisory Councils for the Surgical Specialties.  After much discussion and several suggested changes to the statement, the Board approved the statement contingent upon incorporation of the recommended changes proposed by Dr. Barbara L. Bass.  The statement will be published in the May 2007 issue of the Bulletin and posted on the College's Web site.

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Scholarships

The Board of Regents approved a new shared health policy scholarship.  The scholarship will be jointly sponsored with the American Association for the Surgery of Trauma and will be in effect for the years 2008 through 2010.

The awardee for the Nizar N. Oweida, MD, FACS, Scholarship of the American College of Surgeons was selected for 2007.  The Oweida Scholarship supports attendance at the Clinical Congress by a Fellow or Associate Fellow under the age of 45 who is a surgeon serving a rural US community of approximately 15,000 or less.  One scholar is selected each year.  This year's scholar is Michael C. Gynn, MD, of Dublin, CA.

Ten complete applications were filed for the 2008 Traveling Fellowship.  One Traveling Fellow and one Alternate are selected each year.  Two applicants were notified of their selection following the Board meeting.  Fiemu E. Nwariaku, MD, FACS, Dallas, TX, was selected as the Traveling Fellow.  Richard J. Bold, MD, FACS, Sacramento, CA, was selected as the Alternate.

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Operation Giving Back (OGB)

Following, are some of the OGB activities since the October 2006 meeting of the Board of Regents.

• Traffic on the OGB Web site has increased by approximately 20 percent and the site is now averaging 120,000 hits per month.
• Applications for the 2007 Surgical Volunteerism Award were accepted through February 28.
• An OGB Advisory Committee was formed.
• In collaboration with the Division of Advocacy and Health Policy, relevant legal and regulatory issues related to domestic volunteerism have been compiled for each US state and added to the OGB Web site.
• Two Fellows have been identified as Web Portal Community Editors for the Portal’s Volunteerism Community.

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Public Profile and Visibility

The Board of Regents approved a proposal for enhancing the public profile and visibility of the College.  Estimates regarding the number of new physicians who are likely to enter the profession of surgery continue to fall; ongoing cuts by health care providers and payors continue to negatively affect the ability of surgeons to provide optimal patient care; and skyrocketing medical malpractice premiums continue to erode the surgical community's morale, practice environment, and livelihood.  Internal surveys of the ACS leadership and the Board of Governors reflect growing frustration with this practice environment and their collective concern about the future of the surgical profession.

The College intends to launch a communications plan designed to create a more positive climate that will be receptive to the changes necessary to improve the care of the surgical patient and safeguard the standards of care in an optimal and ethical practice environment.  The plan will focus on reaching key audiences:

• Health Care/Policy Influencers – hospitals, health plans, policy makers, and other influential health care leaders
• The Broader Community – opinion-leading news media, health care trade media, patient advocacy organizations, and leading health consumers
• The Surgical Community – current College members and leaders, and prospective members

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e-FACS.org

Statistics for the College's Web portal continue to show increased usage and greater adoption by its members.  Since the portal's launch, there have been more than 360,000 page views.  During its first year, e-FACS.org was visited by approximately 13,000 individual members of the College.

A highlight has been the collaboration with the Division of Education in developing the CME tracking and logging tool on the My Page area of the portal.  Fellows attending the Clinical Congress were able to use the portal to log CME credits earned by attending scientific sessions.  Nearly 1,600 people entered their CME credits through the portal during the week of the meeting.  Also, the My CME area of the portal gives Fellows the option of tracking credits for educational activities not sponsored by the College.

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Centennial History of the American College of Surgeons

The Board of Regents approved a proposal to develop a Centennial History of the American College of Surgeons.  During the summer of 2006, preliminary discussions occurred regarding the desirability of writing a history of the College for its 100^th anniversary in 2013.

Producing a scholarly, readable history of the organization, using the extensive material available in the Archives, will take approximately five years.  The project would be initiated in the summer of 2007.  The target for completion of the book would be 2012.  The goal of the project is to celebrate the founding of the American College of Surgeons.

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Board of Governors

The following points were presented in a report to the Board of Regents on behalf of the Board of Governors.  The Regents received the report and commented that the College needs more members involved in its advocacy efforts.  In addition, Dr. Rusch highlighted the Governors' comments regarding OGB.

• It was the sentiment of the Executive Committee and the full Board that Operation Giving Back (OGB) not be sacrificed.  The Executive Committee further recommended that OGB be expanded.  Still in the development stage, OGB has surpassed its goals, realizing greater than expected growth on every front, and the Governors are very pleased with the program.  It is the consensus of the Governors that OGB adds great value to the portfolio of the College through its work and the message it sends about who surgeons are and what matters to them.  The Governors felt that the College needed visible programs like OGB and also recommended the use of OGB as a marketing/ branding tool for the College as it is a jewel for the College and for the public.
• The Canadian Regents and Governors forum was held on Saturday, October 7, 2006.  The Board of Governors concurred with the recommendation from the group that the College review and revise, if possible, the dates of future Clinical Congresses that are in direct conflict with the Canadian Thanksgiving holiday.  It was stated that there was tremendous sensitivity to issues related to this conflict.
• The Board of Governors approved a request from its Committee on Socioeconomic Issues to develop criteria for a Humanitarian Award, in addition to the Surgical Volunteerism Award already initiated.  The Board then recommended that the College allow its Development Office to procure funding for this additional award. 
• The Board of Governors approved the report of its Committee on Surgical Practice in Hospitals and Ambulatory Settings regarding the matter of sentinel events, which include OR errors such as wrong-site surgery and retained foreign bodies.  It was brought to the committee's attention that despite the efforts of the Joint Commission and the College to promulgate patient safety procedures such as the time-out, these events still remain a problem.  The Board reiterated the committee's recommendations that the College should:  continue to expand its leadership in OR patient safety and be recognized as the main patient advocate on this issue; develop systems and team training programs and courses on patient safety in the OR, and develop a database on OR errors to be used as a monitoring and research tool for patient safety programs.  The Board also reiterated the committee's recommendations that the College:  promote patient safety CME credits; include patient safety programs in the Clinical Congress offerings, and designate these programs as being meant to fulfill patient safety and medical liability CME requirements.  In addition, the Board approved and reiterated the recommendation that the College continue to support practice guidelines, outcomes research, and innovative programs as it has the unique opportunity to promote this culture among surgeons of patient safety and to emphasize the teamwork that is involved.  Finally, the committee received a letter from a physician concerned that regional insurance companies are deciding that only board-certified cardiologists, neurologists, vascular surgeons, or radiologists can provide vascular ultrasound services.  The Board concurred with the committee's recommendation that the College's position should continue to be that of a provider who has the knowledge, skill, and training that has been acknowledged by recognized certifying bodies should be able to provide those services and be reimbursed for them.

During the Clinical Congress week, the Governors attended various sessions, lectures, and courses.  At the adjourned meeting of the Board of Governors, numerous members of the Board expressed their concerns to the leadership regarding the following issues.

• Surgeons are losing moral high ground with the public, legislators, and payors regarding the issue of emergency responses to surgical calls.
• The P4P issue needs significant consideration and discussion before "Excellence in Surgery" is pursued too zealously.
• The College should continue its focus on improving surgery and healthcare more
•  widely rather than trying to develop the centripetal force in surgery.
• The College should continue its efforts related to education, but also needs to be involved in advocacy.
• The College needs to get the word out to its members through all communications that New Orleans is ready for and can handle the 2007 Clinical Congress, and that members should not abandon New Orleans but instead show up in force.

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Advocacy

F. Dean Griffen, MD, FACS, immediate past chair of the Patient Safety and Professional Liability Committee, was invited to share his views on the feasibility of using the results of the College's closed claims pilot project as the basis for a new educational program on liability risk reduction that the College could export to its chapters.  Under the proposal, arrangements would be made with major liability insurers to provide premium reductions for those Fellows who participate in this educational program.  The Division of Advocacy and Health Policy will conduct a survey of physician-owned liability insurance companies to determine how many of them already offer discounts in exchange for attending risk reduction education sessions.

In December, Congress passed legislation linking a 1.5 percent physician payment update to reporting of quality measures through the Centers for Medicare & Medicaid Services' (CMS's) Physician Voluntary Reporting Program.  There are still many questions to be answered by CMS regarding this program because much of the language in the legislation is vague and requires interpretation.  The College continues to watch this topic closely and will implement an education campaign for Fellows as more details on the program become available.  In addition, the legislation allows for reporting using registry systems.  While this option will not be available for use in 2007, the College has already begun talks with CMS to explore the use of the ACS case log system in data collection efforts for 2008.

In December, a small group of Fellows and staff met in Detroit to learn about the current National Surgical Quality Improvement Program (NSQIP) pilot in Michigan and to examine possibilities for other surgical demonstration projects related to quality improvement.  There are currently six approved pilot sites, all related to primary care services.  US Department of Health and Human Services Secretary Leavitt asked that the pilots be expanded quickly to meet the growing demand for health care quality improvement.  The ACS exploratory committee examined possible structures, challenges, and benefits of the surgical pilot.  The preliminary proposal includes the collection of data related to both the physician and facility, including data on the ACS Perioperative Measure Set, Surgical Care Improvement Project, NSQIP, and patient satisfaction surveys.  The next steps will be to identify other health care stake holders that would be interested in this project, including a consumer group, large purchasers, and health insurers, as well as physicians and hospitals in the pilot community.

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Education

The College continues to provide Category 1 CME credits for all of its educational programs and continues to support the efforts of its faculty and staff to ensure compliance with all requirements of the Accreditation Council for Continuing Medical Education (ACCME).  The College was reviewed by the ACCME for re-accreditation as a CME provider, and granted full four-year accreditation in November 2006.  The process included a comprehensive review of extensive materials and documents.  The College was found compliant in all Essential Areas & Elements for accreditation, and received Exemplary Compliance for Element 2.2: Needs Assessment regarding the use of needs assessment data from multiple sources to plan CME activities.

The vision of the College's Division of Education for the next five years has been defined, and strategic goals to achieve this vision were presented to the Board of Regents.  These goals will support delivery of surgical care of the highest quality and promote patient safety, and will help in comprehensively addressing the current and future needs of various constituencies of the College.  Achievement of these goals will help surgeons in their professional endeavors and keep the College on the forefront of surgical education well into the future.

Journal of the American College of Surgeons (JACS)

To date, the JACS Online CME-1 Program has provided 108,727 free CME-1 credits for ACS Fellows since the Program's inception in January 2001.  This total is up 28,000 since the same time last year.

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