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Highlights of the ACSPA Board of Directors and the ACS Board of Regents MeetingsJune 8-9, 2007American College of Surgeons Professional Association (ACSPA) As of May 11, the ACSPA-SurgeonsPAC raised $204,366 for the current election cycle. Telephone fundraising continues to be a major component of the PAC’s fundraising efforts. Contributions have been made to 35 candidates, leadership PACs, and party committees. Of the 216 US members of the Board of Governors, 43 (20 percent) made contributions averaging $413. The names of all leaders who contributed to the PAC, and those who donated $1,000 or more in 2007, will be listed at the PAC booth during the 2007 Clinical Congress. The Board of Regents voted to continue membership for another year in Doctors for Medical Liability Reform (DMLR). Continued membership in DMLR beyond the year is contingent upon credible liability reform. It was noted that with a Democrat-controlled House and Senate, any liability reform will most likely not be substantial. From January 1 through May 15, 2007, the Foundation received 740 gifts totaling $589,873. This compares favorably with the same period last year. American College of Surgeons (ACS) Surgical Education and Self-Assessment Program (SESAP) The Board of Regents approved the continuation of SESAP for another three-year cycle with the development of SESAP 14. SESAP has been a premier surgical education resource for practicing surgeons and surgical residents for 36 years. During the SESAP 13 cycle concerted efforts were made to implement several major changes. Additional enhancements will be incorporated into SESAP 14 to make it even more useful as a self-assessment and review program. The Board of Regents approved an ACS Policy Statement on the Surgical Workforce. The Policy Statement notes the College’s concern that access to surgical care is eroding in many US communities, and the erosion is most evident and widespread in rural areas, trauma centers, emergency departments, and increasingly in urban and suburban communities. Although policymakers have devoted considerable discussion to developing solutions for a predicted shortage of generalists, little attention has been devoted to surgical workforce limitations. The ACS supports measures it believes the federal government should take in order to ensure access to surgical specialty care. The Policy Statement will be published in the September edition of the Bulletin of the American College of Surgeons and subsequently posted on the ACS Web site. The Board of Regents approved a Statement on Sharps Safety. The statement will be published in a future edition of the Bulletin and posted on the ACS Web site. The Board of Regents approved a name change for the Committee on Women’s Issues from its current name to the Women in Surgery Committee. The Board also approved a revised mission statement for the committee.
The Board of Regents approved three new shared health policy scholarships. The scholarships will be cosponsored with the American Society of Breast Surgeons, the American Surgical Association, and the American Pediatric Surgical Association for the years 2008 through 2010. Physician Quality Reporting Initiative (PQRI) In December 2006, Congress passed legislation linking a 1.5 percent Medicare physician payment bonus to reporting Medicare quality data through the Physician’s Quality Review Initiative (PQRI). Physicians will voluntarily report on relevant quality measures for services provided between July 1 to December 31, 2007. Seventy-four physician performance measures are available for use in PQRI, all of which were developed with physician involvement. A resource section on PQRI for practicing surgeons now appears on the ACS Web site. The College has recruited 34 surgical practices to participate in a project that will collect information on the practices’ experiences under PQRI. The purpose of the program is to improve the College’s effort to educate its Fellows about PQRI requirements and operations. Surgical Quality Alliance (SQA) The SQA convened a group of interested surgical specialty organizations in a Patient Experience Workgroup to examine current patient satisfaction surveys for their relevance to surgical care and to determine the parameters of a surgical survey. The workgroup concluded that there is a need for a surgery-focused patient experience survey and that any instrument developed should be applicable across all surgical specialties and settings. A request for proposals for developing a surgical patient satisfaction survey instrument was released in May with plans to award a contract by July. The project will be completed by January 1, 2008. The College will serve as the project leader for this endeavor, but all surgical and anesthesia specialty organizations are being encouraged to participate, and financial support is being sought from private health insurance plans. After the survey is developed, it will be submitted to the Agency for Healthcare Research and Quality (AHRQ) for endorsement as an official Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Upon approval, it will be the only CAHPS survey instrument for surgical care and will be made available publicly. CAHPS surveys are not proprietary and can be used by anyone interested in measuring patient experience. Medicare Physician Payment Issues The Medicare Trustees annual report issued on April 23 estimated that Medicare fee schedule payments will be reduced across the board by 9.9 percent on January 1, 2008, unless Congress intervenes. Projected cuts of between 4.8 and 5.4 percent will occur annually through 2016. The Medicare Payment Advisory Commission (MedPAC) released two reports with implications for Medicare physician payment policy. In its annual report to Congress, MedPAC recommended an increase in 2008 Medicare payments based on practice cost inflation minus productivity growth. This would produce an estimated 1.7 percent increase in the Medicare fee schedule conversion factor, rather than the estimated 9.9 percent cut that is scheduled to take effect. The second report was mandated under the Deficit Reduction Act of 2005 and examined possible options for replacing the sustainable growth rate (SGR) system. The College hosted a briefing for press and congressional staff about the challenges surgeons and their patients are already facing under Medicare and the potential impact of MedPac's recommendations on surgical care in the future. The briefing also outlined an alternative proposal endorsed by the College and the American Osteopathic Association in which service-specific expenditure targets could replace the current SGR system if Congress is unwilling to provide the estimated $265 billion that would be required to eliminate expenditure targets entirely. Surgical Practice in Hospitals Revised hospital conditions of participation (CoP), effective June 1, 2004, raised havoc in teaching hospitals by requiring the surgical informed consent to include the name of any residents (or non-physician staff) participating in a surgical procedure and describe precisely what portions of the procedure they would personally perform. The College, accompanied by the Association of American Medical Colleges, the American Medical Association, and the American Hospital Association, pointed out the realities of working with residents. On April 13, 2007, a further revision of the CoP created an exception for operations in which residents perform parts of the procedure. The Centers for Medicare & Medicaid Services (CMS) outlined its plans to comply with a Congressional mandate to select at least two high-volume or high-cost complications occurring in hospitals that could increase Medicare hospital payment through higher diagnosis-related group (DRG) assignment or outlier payments and to establish procedures under which those increased payments would not be made. The College reviewed the proposal and submitted its official comment. The revised payment policy, which pertains to hospital payments only, will take effect on October 1, 2008. Ambulatory Surgery Centers (ASCs) The College supported HR 1823, the Ambulatory Surgical Center Payment Modernization Act of 2007, which would provide a more equitable payment system for ASCs and follows a MedPAC recommendation to modify the ASC procedures list. In a proposed rule issued by CMS, payments would be made to ASCs at only 62 percent of the 2008 Hospital Outpatient Prospective Payment System (HOPPS) proposed rate. HR 1823 would provide a payment rate of 75 percent of the HOPPS. The House passed HR 727, the Trauma Care Systems Planning and Development Act of 2007, with the Senate following suit. President Bush signed the bill into law and it is now Public Law (PL) 110-23. This legislation reauthorizes the Health Resources and Service Administration (HRSA) Trauma-EMS program through FY 2012 with an authorization level of $12 million for FY 2008, $10 million for FY 2009, and $8 million for FY 2010 through 2012. The President’s FY 2008 budget was released on February 5. As in the past two years, no funding was proposed for most trauma-related programs, including HRSA’s Trauma-EMS program. The College, along with several other organizations, sent letters to the House and Senate appropriations committees supporting $12 million for the HRSA Trauma-EMS Program. The College sent a letter to the chair of the House Defense Appropriations Subcommittee in support of the US Army Institute of Surgical Research to increase scientific knowledge related to trauma, burns, and all aspects of trauma research. The knowledge and information amassed through the National Trauma Institute, coupled with the new therapies that have been developed, will benefit military personnel and have powerful far-reaching benefits for trauma care in civilian settings. The College, along with the American Association of Neurological Surgeons and the American Academy of Orthopaedic Surgeons, developed a legislative agenda to address the ongoing surgical workforce crisis in emergency departments across the nation. The College is approaching other surgical specialty societies for input and support, and will then enlist a member of Congress to sponsor this agenda. The College supports HR 1233, Mitigating the Impact of Uncompensated Service and Time Act of 2007. Introduced to help alleviate the financial burden placed on physicians who are federally mandated to provide emergency care, this legislation would amend the IRS code of 1986 to allow them to partially offset the cost of providing uncompensated care that is required under the Emergency Medical Treatment and Labor Act (EMTALA). Board-certified physicians providing these services could take a tax deduction equal to the Medicare fee schedule payment. MedPAC heard testimony in April regarding the “future workforce of physicians and clinical practitioners.” Following that testimony, J. Wayne Meredith, MD, FACS, and staff met with MedPAC staff to present information on trends in surgical workforce issues, generally, and on the growing problem of specialty emergency call coverage, in particular. One Voice Against Cancer (OVAC) As a member of OVAC, the College continues to call for increased funding for cancer research and programs through the National Institutes of Health (NIH), National Cancer Institute (NCI), and Centers for Disease Control and Prevention (CDC). The FY 2008 funding process started with President Bush submitting a budget that again calls for cuts in federal funding for medical research–calling for flat funding for the NIH and CDC along with cuts to NCI of over $11 million. The College will continue to call for increased funding for cancer research and programs. The College opposes HR 1665, the Medicare Hearing Health Care Enhancement Act of 2007. If enacted, this legislation would grant an inappropriate expansion in the scope of practice of audiologists. As written, it would provide Medicare beneficiaries direct access to audiologists 'without regard to any requirement that the individual . . . be under the care of (or referred by) a physician.' The College sent a letter to members of the House stating its strong opposition to this legislation. The letter stated, 'While we agree that all Medicare beneficiaries deserve timely access to health care professionals and their services, this legislation would remove the physician from the most crucial segment of any patient consultation—initial evaluation and diagnosis.' The House passed HR 710, the Living Kidney Organ Donation Clarification Act. HR 710 was introduced to clarify existing law regarding paired kidney donations. Paired donations enable a kidney transplant candidate and an incompatible living donor to be matched with another incompatible pair; the paired donation enables two living kidney transplants that otherwise would not have occurred. The College sent letters of support for HR 710 to the House Energy and Commerce Committee. The bill also has the support of the American Society of Transplant Surgeons and the American Society of Transplantation. Practice Management and Coding The 2007 series of basic and advanced coding workshops has been scheduled. Two workshops—one basic and one advanced—were scheduled for May, July, and September in Baltimore, Chicago, and St. Louis, respectively. The availability of the free Coding Hotline for Fellows has previously been highlighted at all ACS coding workshops and practice management courses and in a number of issues of ACS NewsScope. For the first part of 2007, the Hotline has averaged close to 500 calls a month from Fellows and their office staff members. The College continues its sponsorship of practice management teleconferences presented by Economedix. The teleconferences are scheduled through December 12, 2007. The College has made a significant impact at the national level through its new and innovative educational programs, products, and resources. These have served the needs of the members well. The College is now poised to build on these achievements to stay ahead of the national trends and mandates. The educational needs of practicing surgeons, surgical residents, medical students, members of the surgical team, and surgical patients will continue to be addressed through comprehensive educational approaches that are based on principles of contemporary surgical education and state-of-the-art technology. Efforts will continue to address the educational needs of the College’s members, to help them provide the highest quality of surgical care and to support their efforts to remain competitive in the ever-changing milieu of surgical care. Journal of the American College of Surgeons (JACS) Online and fax CME submissions to JACS currently exceed 122,700 credits as a member benefit. Hits to the JACS site average 81,492 a month. Continuous Quality Improvement (CQI) Scheduled educational activities in the area of CQI include:
National Surgical Quality Improvement Program (NSQIP) NSQIP program statistics as of June 2007 included:
In April 2006, the multispecialty model became available to all ACS NSQIP hospitals interested in collecting data from the following ten subspecialties: general, vascular, urology, neurosurgery, orthopaedics, otolaryngology, plastic, thoracic, gynecology, and cardiac. The NSQIP-SCIP module has been developed and is currently being tested with CMS. CMS approved the ACS NSQIP multispecialty model’s sampling methodology as an appropriate sample of cases to meet the CMS SCIP requirement. Hospitals participating in the multispecialty model may use the SCIP module to collect and report their SCIP data through the ACS NSQIP Web site. Once testing is finalized, the module will become available to participating sites. NSQIP continues to work with surgical specialty societies to develop additional modules. The pediatric NSQIP planning committee has made significant progress in the development of a pediatric NSQIP module that will include general, vascular, and subspecialty surgeries. The module will also include neonates and trauma patients. The Joint Commission has agreed to acknowledge hospitals that participate in the ACS NSQIP program on their Quality Check Web site through the awarding of a Special Quality Award Merit Badge. The Merit Badges, of which the ACS NSQIP is now a recipient, recognize achievements by health care organizations that go above and beyond accreditation, are national in scope, and relate to the delivery of high quality health care. American College of Surgeons Bariatric Surgery Center Network (ACS-BSCN) The ACS-BSCN Accreditation Program is entering into its third year. The College recognizes and commends those facilities that implement defined standards of care, document their outcomes, and participate in periodic reviews and verifications of their programs in bariatric surgery. The Online Education Center for Cancer Programs debuted in May 2006 with ten programs. An additional nine new topics were added in February 2007 to include:
In June 2007, the Commission launched a new Web conference program aimed at presenting focused education to CoC constituents on new and emerging projects and activities that impact approved cancer programs. A calendar of programs is in development with six topics scheduled for presentation with repeat sessions planned for alternate time zones. These one-hour programs will include 45 minutes of didactic presentation followed by 15 minutes of Q & A. The sessions are free of charge. This year’s recipient of the Arthur Ellenberger Award is Andrew L. Warshaw, MD, FACS. Dr. Warshaw has spent much of his surgical career advocating for patients and for the surgical profession, and was instrumental in creating and expanding the ACSPA-SurgeonsPAC. In conjunction with Operation Giving Back, the Board of Governors Committee on Socioeconomic Issues solicited the College's membership for nominations for the American College of Surgeons/Pfizer Medical Humanities Initiative (ACS/PMHI) Surgical Volunteerism Award. The committee, and subsequently the Executive Committee of the Board of Governors, selected Sylvia D. Campbell, MD, FACS, Tampa, FL; Van C. Knowles, MD, FACS, Albany, GA; and Thomas G. Crabtree, MD, FACS, Kailua, HI, to receive awards. Traffic to the OGB Web site has surpassed 2.3 million hits. In addition, the number of surgeons who have contributed to the demographic compilation of surgical volunteers has reached 689, an increase of 50 percent over a four-month period. Continued outreach to volunteer agencies offering opportunities for surgeons has resulted in the growth of the database to include 84 partner agencies—39 domestic and 45 international. A distinguished group of professionals representing expertise in domestic and international volunteerism, medical philanthropy, surgical academia, and socially responsible industry have accepted invitations to join an advisory group that will help guide the strategic direction of the OGB initiative. Plans are underway to coordinate an opportunity for the College and participants at the 2007 Clinical Congress to contribute to the renewal of the medical infrastructure of New Orleans. Â 'ACS Project New Orleans' will be conducted in partnership with the New Orleans Chapter of Habitat for Humanity and incorporated into the Clinical Congress social program. Details will be made available on the College's Web site and via other communication tools related to the Clinical Congress. Resident and Associate Society (RAS-ACS) Gregory S. Cherr, MD, Chair of the College's Resident and Associate Society, outlined RAS's recent accomplishments. Four recipients were selected to receive the second annual RAS-ACS Leadership Award. Recipients of the award will attend an ACS course of their choosing. The courses are intended to engage young surgeons and enhance skills in leadership, communication, education, or research. The selected recipients are Neal R. Barshes, MD, Houston, TX; Awori J.W. Hayanga, MD, Baltimore, MD; Gerald S. Lipshutz, MD, Los Angeles, CA; and Arezou T. Yaghoubian, Woodland Hills, CA. RAS conducted a survey of the College’s younger members relative to the future of the College and strategic planning. The survey revealed medical malpractice, patient safety, and reimbursement as the topic of concern. It was noted that there is still the perception that the College is not responsive to its younger members. It was suggested that the College develop mentorship programs that focus on recruitment and retention. Other accomplishments include:
As of May 16, there were 785 active jobs listed on the site with 88 posted resumes. This valuable service to all College members is complimentary to the resident members. Committee on Young Surgeons (CYS) Under the leadership of Juan Paramo, MD, FACS, the CYS has re-instituted its newsletter that is sent to all of the College's Fellows who are 45 or younger. The CYS E-News will be distributed electronically each quarter. The CYS has been working on the Initiates Program for the 2008 Clinical Congress. The proposed title for the program is, “The Wards to Wall Street: What Every Surgeon Should Know About Financial Planning and Asset Management.” The 2007 Chapter Officers and Young Surgeons Leadership Conference was held in Washington, DC, for the fifth consecutive year. The conference yielded record attendance. Advisory Councils for the Surgical Specialties As of May 16, half of the 12 Advisory Councils for the Surgical Specialties had held their interim meetings. Several Advisory Councils will conduct mailings to program directors highlighting the ACS membership benefits available to resident members, and encouraging 100 percent participation from all programs as well as participation from the residents in each program. The Advisory Council for General Surgery will increase its educational program proposals for future Clinical Congresses. All of the Advisory Councils continue to propose educational programming for the Clinical Congress, and are working to formulate programming that will benefit the varied surgical attendance at the Clinical Congress. Traffic to the College's Web portal continues to grow. The constant addition of new content, resources, and tools, as well as changes made to the portal as the direct result of user feedback are major reasons for its growing success. To highlight a few changes, in an effort to help visitors find information and electronic tools more quickly, the portal’s home page has been redesigned and a Google TM search engine has been added. A 'Quick Links' box has been added to the home page to provide direct access to pages that are viewed frequently, ie: Clinical Congress information, the case log system.
Revised October 25, 2007
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