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Highlights of the ACSPA Board of Directors and ACS Board of Regents MeetingsJune 10-11, 2005American College of Surgeons Professional Association (ACSPA) The ACSPA-SurgeonsPAC had an excellent start. With a 2005 fundraising goal of $500,000, $343,000 in contributions had already been received by early May. Telephone fundraising has proven successful for the PAC. As of early May, $202,700 had been pledged via telephone. Of 215 US members of the Board of Governors, 70 (33 percent) contributed to the PAC for an average contribution of $362. The names of all leaders who have donated to the PAC in 2005 will be listed at the PAC booth during the Clinical Congress. So far in 2005, the ACSPA-SurgeonsPAC has organized five political fundraising events. Two additional events will be hosted this year. American College of Surgeons (ACS) The Board of Regents approved a Statement on the Prevention of Retained Foreign Bodies After Surgery. The Statement emphasizes patient safety, and urges hospitals and health care organizations to take responsible measures to prevent the retention of foreign bodies in the surgical wound. The new Statement will be posted on the College's Web site once it has been published in the Bulletin of the American College of Surgeons. The Board of Regents also approved a revised Statement on Surgical Technology Training and Certification. Initially developed by the Committee on Perioperative Care (CPC) and approved by the Regents in 2004, the Statement was revised by the CPC to clarify the role of the surgical technologist as a member of the surgical team. The revised Statement will be published in the Bulletin and then posted on the College's Web site. A revised Statement on Health Care Industry Representatives in the Operating Room was approved by the Board of Regents. Developed in 1999 by the Committee on Operating Room Environment (now the CPC) and subsequently approved by the Regents, the Statement was revised by the CPC to reflect various changes in the perioperative setting such as the introduction of the Health Information Portability and Accountability Act (HIPAA), advances in technology, and so forth. The revised Statement will be published in the Bulletin and posted on the ACS Web site. Additionally, the Board of Regents approved a Statement on Blunt Suture Needles. The Statement was developed by the CPC to encourage the universal adoption of blunt suture needles as the first choice for closure of fascia and other structures, in order to minimize the risk of injury to the surgeon, even when the surgeon's glove is punctured. The CPC believes that greater awareness of the benefits of blunt suture needles and a better understanding of barriers to their use will benefit all members of the operative team. The Statement will be published in the Bulletin and then posted on the College's Web site. The Board of Regents approved the funding of a third shared career development award. This award will be co-sponsored by the American Head and Neck Society. The College awards approximately $1.5 million annually in scholarships. The Board of Regents approved a business plan for pilot testing an ACS Accreditation Program for Surgical Education Centers. The primary goals of the program are to enhance the standardization of surgical education at the national level, increase access to education programs, and to support surgeons' efforts in acquiring and maintaining surgical knowledge and skills. The program would also serve the needs of surgical residents, medical students, and members of the surgical team. The purpose of the program is to create a national system of centers accredited by the ACS to offer high quality regional educational activities in surgery. The pilot testing is for the purposes of confirming the level of interest in such accreditation efforts and refining the accreditation process. The Board of Regents approved a proposal by the Committee on Trauma (COT) and the American Burn Association (ABA) on a joint relationship to administer the Burn Verification/ Consultation Program for Hospitals. A memorandum of understanding was developed to shift the oversight of the Burn Verification Program to the administrative office of the ABA. This relationship proposes to maintain quality assessment of the verification program within the COT while shifting administrative responsibilities to the ABA. The Advanced Trauma Life Support ® (ATLS ®) program's Trauma Evaluation Management (TEAM) course has been used for medical students and in areas where it is not feasible to conduct the ATLS course. Materials for this course are being revised and include an instructor manual, student material, and a DVD. The ATLS program will celebrate its 25th anniversary at this year's Clinical Congress. More than 39,000 medical students were trained in ATLS in 2004. Accrual of data for the National Trauma Data Bank (NTDB) is now taking place in preparation for the 2005 Annual Report. More than 100 researchers have used NTDB in their analyses. Articles on various aspects of NTDB data are offered each month in the Bulletin. A new Web feature, NTDB Online, is an interactive tool that allows for quick aggregate data analysis and graphing. The Board of Regents approved the appointment of the following Fellows and one non-Fellow to serve as members of the ACS Foundation Committee on Development: Richard B. Reiling, MD, FACS, Chair; Lynn H. Harrison, Jr., MD, FACS, Vice-Chair; Oliver H. Beahrs, MD, FACS; Robert E. Berry, MD, FACS; John E. DeLauro, MD, FACS; Roger S. Foster, Jr., MD, FACS; Robert E. Hermann, MD, FACS; Norman M. Kenyon, MD, FACS; LaSalle D. Leffall, Jr., MD, FACS; Michael S. McArthur, MD, FACS; Mary H. McGrath, MD, FACS; H. Bryan Neel, III, MD, FACS; Amilu S. Rothhammer, MD, FACS; William F. Sasser, MD, FACS; Hugh H. Trout, III, MD, FACS; Jon A. van Heerden, MD, FACS; H. David Vargas, MD, FACS; and Mr. Leslie J. Armour-Vice-President, Corporate Relations, Ethicon, Inc. The ACS Foundation will officially begin operations on July 1, 2005. During the current fiscal year, the Development Program has received gifts and pledges totaling $1,250,542. Twenty-eight new Life Members are scheduled to be recognized during the up-coming Clinical Congress. All members of the Board of Governors, Board of Regents, and ACS Officers are encouraged to become Life Members. Operation Giving Back Web site capacity and functionality enhancements are underway, via Web site configuration, in collaboration with Newfangled Web Factory in Providence, RI. The target month for launching the enhanced Web site is July 2005. Volunteer agencies such as Project HOPE and Crudem have expressed an interest in being included in the OGB database. Also, through collaboration with staff at Project HOPE, OGB was able to mobilize Fellows in response to the tsunami and subsequent earthquake in Southeast Asia. Surgeons' responses outnumbered the available slots for these missions. Kathleen M. Casey, MD, FACS, Director of Operation Giving Back, spoke to the ACS Committee on Resident Education regarding opportunities and hurdles for surgical residents who are interested in volunteerism. Also, discussions have been ongoing with the Resident and Associate Society (RAS-ACS) regarding the high level of interest among residents and young surgeons in topics related to volunteerism. The Governors' Committee on Socioeconomic Issues solicited the College's membership for nominations for the surgical volunteerism award. The award is offered annually in recognition of Fellows who make significant contributions to surgical care through organized volunteer activities. This year, the committee will give two awards. One award, for volunteer activities in the International arena, will go to Domingo T. Alvear, MD, FACS, of Harrisburg, PA. The other award, for volunteer activities in the Domestic arena, will go to George F. Ellis III, MD, FACS, of Longwood, FL. The Board of Regents approved a business plan to develop a Cancer Programs Online Education Program. To meet the continued demand for training and education on CoC requirements, the CoC will build upon its current foundation of educational offerings by establishing a fee-based online educational resource area offering a library of audio/slide presentations that can be purchased and viewed to earn CME and CE credits. A request for proposals will secure an external vendor with expertise in the construction and management of Webcasting applications. The online program content will be of value to cancer program administrators, cancer committee chairs, cancer liaison physicians, cancer registrars involved in the operations of the cancer program at their respective CoC-approved cancer programs, and to programs working to maintain their CoC approval. The Board of Regents approved funding for the completion of the renovation of the John B. Murphy Auditorium in order to allow the Auditorium to become a meetings and special events venue available to the College and to the public. The Auditorium will become an additional large and modern meeting facility for the College as well as a venue for select public events. Progress continues on e-FACS.org–the ACS Web Portal. Staff is investigating the possibility of hosting the portal technical infrastructure outside the College. Doing so would provide higher Internet bandwidth and would allow around-the-clock customer support to be provided. A beta test of the portal prototype will be conducted sometime in mid-to late-July. Pertinent staff participated in a design workshop with outside portal consultants to ensure that the organizational and user goals for e-FACS.org are reflected in the home page and secondary page designs. Final designs for the portal's home page and secondary pages were developed and approved in April. The portal contains 31 communities of which 12 are specialty communities; eight are subspecialty communities under the category "General Surgery," and the remaining communities are special interest communities. Since February, the College has testified before Congress and federal agencies on various subjects. The College also secured appointments for Fellows on the newly established EMTALA technical advisory group. The College is leading a surgery-wide effort to preserve and improve payments for surgical services in the upcoming five-year review of the Medicare fee schedule. In addition, federal and Congressional policymakers are committed to implementing some type of pay-for-performance system for physicians under Medicare, and the College is actively working to develop proposals that would benefit surgical patients. The Centers for Medicare & Medicaid Services (CMS) informed the Medicare Payment Advisory Commission (MedPAC) that the projected update to the 2006 physician fee schedule would be a negative 4.6 percent. Unless Congress intervenes, the across-the-board payment cuts will occur in 2006 because of how the sustainable growth rate system is used to calculate annual physician payment updates. The College wrote key Congressional committees with jurisdiction over Medicare physician payment issues, urging them to stop the cuts from taking effect, and explaining that the viability of surgical practice and patients' access to surgical services is in jeopardy. The letters pointed out that surgical procedures accounted for a disproportionately small amount of the growth, and that unlike other physicians, surgeons cannot recover lost revenue by increasing volume. CMS issued a final rule on May 4, which updated the list of procedures that Medicare will cover when they are provided in ambulatory surgical centers. Following many of the recommendations made by the College, the agency added 65 procedures to the list that initially contained only 25 proposed new procedures. Also, the agency removed only five procedures from the list of 100 procedures proposed for deletion. On June 18, the 18-month moratorium prohibiting physicians from referring patients to specialty hospitals in which they have an ownership interest expired. The moratorium was put in place in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA also included provisions requiring MedPAC and CMS to analyze, within 15 months, the costs, payment system issues, referral patterns, and quality of care issues associated with specialty hospitals. On March 8, the Senate Finance Committee and the House Ways and Means Health Subcommittee held hearings to seek clarification from MedPAC and CMS regarding their reports. At both hearings, the College submitted testimony for the record supporting efforts to refine the diagnosis related group system to provide more equitable reimbursement for procedures in hospital settings and opposing any efforts to either extend the moratorium or to prohibit physician ownership of specialty hospitals. The College has partnered with the National Aneurysm Alliance (NAA) in order to introduce a Medicare ultrasound screening benefit for the detection of abdominal aortic aneurysms. The NAA has garnered 18 cosponsors to the SAAAVE (Screening Abdominal Aortic Aneurysms Very Efficiently) Act of 2005 (H.R. 827), which was introduced to create this benefit. The legislation also provides screening for women with a positive history of aneurysms. On April 28, the House and Senate passed the Congressional Budget for fiscal year 2006. While much discussion surrounded potential reductions in Medicaid spending, the conference report assumes no reductions in Medicaid spending in 2006. The budget includes a reserve fund for legislation to create a bipartisan commission charged with reviewing Medicaid and making recommendations regarding long-term goals for the program. The College has stated its support for creating a bipartisan commission to review Medicaid. On April 20, approximately 500 surgeons and physicians from nine northeast and Mid-Atlantic States traveled to Washington, DC, to rally for federal medical liability reform. The rally was sponsored by the Coalition for Accessible Physicians, and was also supported by the College. In 2002, CMS fiscal intermediaries began denying–often retroactively through audits–payments for the time residents spent in non-hospital settings where teaching physicians were freely volunteering their time to supervise resident training. The College joined other physician groups to oppose CMS audits and retroactive denial of direct and indirect graduate medical education payments. Last year, CMS set new associated principles for informed consents and operative notes. While most of the conditions of participation and the companion interpretive guidelines apply to hospital staff, this change has a direct effect on surgeons who practice in hospitals certified by the state survey and certification agency. Teaching programs, in particular, have expressed grave concern about these provisions. In response, the College has been leading a coalition effort involving the Association of American Medical Colleges, the American Medical Association, the Society of Thoracic Surgeons, and others to persuade CMS to revise the guidelines. The College hosted a meeting of surgical specialty society leaders in Chicago on March 29 to explore emerging issues regarding the surgical workforce and the future of emergency and trauma care. The College and the surgical specialty groups will continue efforts to highlight these issues and work collaboratively to develop and promote policy solutions to ease the pressure on the nation's emergency care safety net. The College's Committee on Trauma (COT), along with the Coalition for American Trauma Care, commissioned Harris Interactive to conduct a public opinion poll on the public's awareness, knowledge, and perception of the importance of trauma care and methods of trauma care. The College hosted a Congressional briefing on March 2 in Washington to officially release the poll results. Moderated by COT Chair, J. Wayne Meredith, MD, FACS, over 60 Capitol Hill staff members attended the briefing. On March 14, CMS announced the appointment of a new technical advisory group (TAG) that includes three Fellows of the College. The College nominated or endorsed the three Fellows who were appointed to the 19-member TAG. The TAG is charged with reviewing Emergency Medical Treatment and Active Labor Act (EMTALA) regulations that affect hospital and physician responsibilities in treating individuals who come to the hospital seeking treatment for a medical condition. Its goal is to help CMS develop rules that will protect individual rights while minimizing unnecessary burdens on health care providers. Non-physician health professionals continue their state-level legislative efforts to expand their scopes of practice. The College and other medical organizations have participated in an advocacy fly-in as part of a "Surgery by Surgeons" campaign. Representatives met with legislative leaders and the local media to educate policymakers and the public. This effort is ongoing In January, the Hearing Health Accessibility Act (H.R.415) was introduced. If enacted, this legislation would grant an inappropriate expansion in the scope of practice of audiologists. In response to a request from the American Academy of Otolaryngology-Head and Neck Surgery, the College sent a letter to all members of Congress stating its strong opposition to this legislation. The College, along with seven other physician groups, sent a letter to Congress opposing the Medicare Patient Access to Physical Therapists Act. This legislation would provide an inappropriate expansion in the scope of practice of physical therapists. The bill would allow direct access to physical therapists without first consulting a physician. The College has introduced a resolution directing the AMA to convene a work group with the specialties affected by the impending shortage of specialists for emergency and trauma care and those organizations closely involved in physician workforce issues. This group would be charged with developing solutions to the problem of the undersupply of specialist physicians and the future of emergency and trauma care. Also, the AMA Surgical Caucus, now chaired by the College, will feature a panel presentation on pay-for-performance. The College continues to host basic and advanced CPT coding courses. A basic and an advanced course will be held in Chicago on July 14 and 15, respectively. Another set of basic and advanced courses will be held in Dallas on September 15 and 16, respectively. The College continues its sponsorship of practice management teleconferences presented by Economedix. Courses remain on the 2005 schedule through December 14. Journal of the American College of Surgeons (JACS) As of May 2005, the JACS CME-1 Program has provided 70,000 CME-1 credits at no cost to more than 8,200 Fellows of the College. The College's chapters would benefit from a live demonstration during their meetings so that more members would be aware of this excellent program. The Advisory Councils continue to propose educational programming for the Clinical Congress, and are working to formulate programming which would benefit the varied surgical attendance at the Clinical Congress. In addition, the Advisory Councils for Cardiothoracic Surgery and Urology are now proposing postgraduate courses for candidates preparing for their board certification or recertification. A completely new slate of didactic postgraduate courses in general surgery will be offered at the 2005 Clinical Congress. The skills-oriented courses were especially designed to address contemporary topics in surgery such as the core competencies, patient safety, new procedures, and emerging technologies as well as the non-clinical topics relating to the practice of surgery. Major changes have been made in the Abdominal Ultrasound Course, which has also been shortened. The changes should enhance the educational value of the course and also reduce the expenses. The Scientific Exhibit/Poster Program has been enhanced. A moderated Poster Session will be held for the first time on Tuesday, October 18, from 12:00 – 1:30 p.m. The session will be held in the Scientific Exhibit Area and moderated by Barbara L. Bass, MD, FACS. A new video-based education session, "Movie Classics from the Past," will be presented along with an interactive session, "AntiReflux Surgery: Specific Challenges." Also, an additional general surgery session has been included. Two "Surgical Forum Sessions on Quality, Outcomes and Costs," and a separate "Research in Surgical Education Session" will be presented as a result of the increase in abstract submissions in these categories. The Surgical Forum Committee will sponsor two general sessions, "Biomaterials and Biosensors" and "Grant Writing Symposiums for New Investigators." Changes in the Clinical Congress program continue to be made based on principles of contemporary adult education and experiential learning. The Chair of the Program Committee is Barbara L. Bass, MD, FACS. Enrollment in SESAP 11 concluded in October 2004. SESAP 12 consisted of redesigned format, with the content categories made congruent with the content categories of the Recertification Examination of the American Board of Surgery. A new category on ethics and general competencies was added. The CD-ROM for SESAP 12 was enhanced and the CME verification process was streamlined. SESAP 12 was released in October 2004. The audio companion for SESAP 12 has been launched and various parts of the audio companion will continue to be released during the SESAP 12 release period (2004-2007). Development of SESAP 13 has commenced and the process is proceeding well. Web casts of various sessions have been made available from the 2002, 2003, and 2004 Clinical Congresses and the 2004 and 2005 Spring Meetings. Also, Charles D. Mabry, MD, FACS, is the Course Director for two new CD-ROM interactive courses, "Personal Financial Planning and Management for Residents and Young Surgeons" and "Practice Management for Residents and Young Surgeons." A new course, "Surgeons as Effective Communicators," launched in May 2005, includes interactive sessions that focus on the application of principles of effective communication to complex surgical situations. The course offers planned and impromptu opportunities for attendees to participate in standardized scenarios that involve communication challenges in a variety of clinical and non-clinical settings. Each attendee is videotaped and is provided with feedback. Another course, "Surgeons as Leaders," was launched in April 2005, and is designed for surgeons who currently serve in leadership positions or aspire to such positions in university-based environments. The focus of the course is effective leadership to handle clinical and administrative challenges in a variety of surgical settings. The College has designed a Case Log System to support the practice-based learning and improvement activities of individual surgeons. The Case Log System will help surgeons monitor their outcomes and benchmark this information with risk-adjusted outcomes data and best available evidence in order to identify gaps in performance and areas for improvement. The Case Log System is designed to facilitate surgeons' efforts to begin collecting their patient information and outcomes data in an ongoing and systematic fashion. In addition to assisting surgeons in identifying learning needs, the outcomes data would help surgeons meet the requirements of Step IV of the Maintenance of Certification Program of the American Board of Medical Specialties. The Case Log System was demonstrated to the Regents. Entries require less than one minute, can use any language, and import from Excel to eliminate the need to make duplicate entries. It is anticipated that the system will be released during the Clinical Congress. Revised March 8, 2006
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