August 2, 2017
The American College of Surgeons (ACS) Board of Governors’ Surgical Care Delivery Workgroup developed the following revised statement, which the ACS Board of Regents approved at its June 2017 meeting in Chicago, IL. The original statement was developed by the Board of Governors and approved by the Board of Regents in 1998 as the Statement on the Use of Proprietary Guidelines by Managed Care Organizations.*
The ACS is committed to protecting the patient’s health and well-being and the physician’s role in delivering efficient, appropriate, and comprehensive health care.
The ACS Board of Governors recognizes new government regulations and alternative payment models are transforming the delivery of care throughout the U.S. To ensure the voice of physicians and surgeons is audible in the new health care landscape, the ACS Board of Governors is proactively putting forth guidelines on the role of the patient, the physician, and the government in health care.
Patients should have the freedom to choose their own physician and engage in shared decision making regarding their care. Patients should be encouraged to choose care that meets the following criteria:
Physicians and surgeons should be involved in the creation, approval, implementation, review, and modification of all guidelines that affect medical care. Physician leaders at hospitals, physician organizations, and individual practitioners should be diligent in the responsible creation, evaluation, and subsequent implementation of guidelines.
Undesirable or unproven guidelines or portions thereof must be rejected and the objections appropriately documented.
Guidelines that are formulated and maintained through this rigorous process should be followed within reason and in good faith, with the patient’s best interest always at the forefront. Exceptional circumstances and variations in patient condition or circumstances should be anticipated and documented. Patterns of exceptions should lead to refinement of the guidelines.
Guidelines for specific disease processes developed by governmental agencies or mandated by legislation should follow nationally accepted evidence-based standards of care, have input from physicians, and always put the safety of the patient first.
Appropriate roles for government are the following:
The ACS believes that the patient has a right to choose a physician and that the physician has a right to freely direct, without interference, the care of the patient. Guidelines may be used to assist the physician, surgeon, and other health care providers in achieving this goal, but should not impede the process or deviate from this purpose.
*American College of Surgeons. Statement on the Use of Proprietary Guidelines by Managed Care Organizations. 1998;83(3):33-34.