Report on ACSPA/ACS activities, June 2020

The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met virtually throughout June 1–6, 2020. The following is a summary of key activities discussed. The information provided was current as of the dates of the meeting.

ACSPA

The ACSPA and its political action committee, ACSPA-SurgeonsPAC, received funds from more than 1,800 individual College members and staff disbursed $850,000 to more than 150 candidates, political campaign committees, and other PACs.

ACS

In addition to reviewing reports from the ACS division directors, the Board of Regents accepted resignations from eight Fellows and changed the status from Active or Senior to Retired for 63 Fellows.

Division of Advocacy and Health Policy

The Division of Advocacy and Health Policy provided an overview of the quality, value, and informatics efforts in federal legislation, rules, and regulations and how the College’s programs support these activities. Key ACS activities such as verification programs and outcomes and patient-reported outcomes undertakings support these quality initiatives.

In 2019, the College partnered with Harvard Business School (HBS) to create ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency), an ambitious new program to measure and improve the value of surgical care. Leveraging the College’s expertise in quality measurement and HBS’ expertise in activity-based cost accounting, the program will help hospitals accurately measure their costs, tie those costs more closely to robust outcome measures, and take steps to improve the value of care.

The College’s informatics and interoperability knowledge management is focused on finding ways to move beyond electronic health records (EHRs) to leverage ACS registries and clinical pathways/guidelines in overall knowledge management. Additional efforts include supporting activities in government agencies to further optimize surgical knowledge at the point of care for the surgeon and the patient, reducing the burden of data management, and supporting structured data capture and optimal registry inputs and outputs into point of care. Key College activities supporting these efforts include ACS National Surgical Quality Improvement Program (NSQIP^®), Optimal Resources for Surgical Quality and Safety (the Red Book), Committee on Cancer programs, and many other quality initiatives.

The College’s current focus in regulatory and legislative areas for knowledge management include the following:

• Supporting meaningful interoperability to avoid burdensome, costly regulations
• Avoiding holding surgeons accountable for EHR vendor mishaps
• Promoting research and grants to optimize data interoperability to and from registries
• Promoting research and grants to aid in standards-based digital interoperability to support clinical decision support in the point of care
• Promoting research and grants to aid in structured data capture and in natural language processing

ACS advocacy efforts focused on the next federal relief package included the following:

• Preventing scheduled Medicare Physician Payment cuts
• Strengthening relief for practices and small businesses
• Specific relief for rural facilities and providers
• Reauthorization of Health Professional Shortage Area Surgical Incentive Payment
• Student loan relief
• Promoting access and reimbursement for telehealth
• Enhanced liability protection
• Mental health
• Prior authorization
• Surgical Care Coalition

The Surgical Care Coalition advocates for access to quality surgical care for all Americans and is comprised of 12 surgical professional associations that represent the more than 150,000 surgeons working across the country with a common goal of improving the quality of care, and quality of life, for all patients. Meeting informally since the 1980s, the coalition’s 12 founding members have a long history of working together to address the most pressing policy issues affecting the surgical profession. In the spring of 2020, the founding 12 surgical professional associations formalized this existing network, establishing the Surgical Care Coalition to provide a shared voice for the surgical profession. The Surgical Care Coalition members include the following:

• American Academy of Ophthalmology
• American Association of Neurological Surgeons
• American College of Osteopathic Surgeons
• American College of Surgeons
• American Society for Surgery of the Hand
• American Society of Colon and Rectal Surgeons
• American Society of Plastic Surgeons
• Congress of Neurological Surgeons
• Society for Vascular Surgery
• Society of American Gastrointestinal and Endoscopic Surgeons
• The American Society of Breast Surgeons
• The Society of Thoracic Surgeons

Division of Education

Academy of Master Surgeon Educators

Established in 2017, the Academy recognizes and assembles a cadre of Master Surgeon Educators of national and international renown to work closely with the Division of Education to advance the science and practice of surgical education and training. Recognizing the unprecedented impact of the coronavirus 2019 (COVID-19) pandemic on surgical practice and surgical education, the Academy has taken steps to identify and embrace innovative strategies to address the challenges relating to surgery residency training during the pandemic and, through these multidimensional efforts, transform surgical training for the future. A special committee was appointed to address these challenges and opportunities via several goals, including the following:

• Identifying major challenges that surgery residency programs, surgery faculty, and surgery residents are facing across all surgical specialties
• Defining opportunities and solutions to address these challenges
• Designing innovative residency training models to help address current complexities and transforming residency training across all surgical specialties in the long-term
• Sharing scarce resources, providing valuable guidance, and disseminating novel educational methods and tools to positively impact all types of surgical residency programs
• Addressing key issues relating to governance of residency training programs and working collaboratively with national regulatory organizations to achieve the best outcomes

ACS Fundamentals of Surgery Curriculum®

Launched in 2005, the ACS Fundamentals of Surgery Curriculum^® (ACS FSC) is a simulation-based curriculum for surgery residents that has established a new standard for cognitive simulation-based education and addresses diagnostic and patient management skills in surgery. A total of 109 peer-reviewed case scenarios are available in 14 essential content areas. During 2019–2020, a total of 1,469 residents from 219 programs were enrolled in ACS FSC. Thirty advanced case scenarios are in development and expected to be ready in 2021, after beta testing.

Ethics Committee

The Committee on Ethics, housed in the Division of Education, is planning several programs at the virtual Clinical Congress 2020, including the John J. Conley Ethics and Philosophy Lecture given by Robert D. Truog, MD, MA. Other events include the 2020 Ethics Colloquium, Contemporary Challenges to Surgical Informed Consent. Panel Sessions include Big Data, Who Owns It?, Ethical Considerations for Surgeons Participating in Clinical Research, and Informed Consent Ruling: Contrary to Ethical Standards or Upholding the Primacy of the Surgeon Patient Interaction? A Meet-the-Expert Session on The Importance of Surgical Ethics: Pathways for Better Patient Outcomes and Career Advancement through Clinical Ethics Training is scheduled, as well as a Town Hall on Surgeons as Advocates: How Wide Is Our Lane?

Clinical Congress

The approved program for Clinical Congress 2020 includes 11 Named Lectures; 122 Panel Sessions; 14 Didactic Courses; 15 Skills Courses; 88 Scientific Forum Sessions, including E-Poster Sessions; 36 Video-Based Education Sessions; 45 Meet-the-Expert Sessions; and 14 Town Halls. Due to the COVID-19 pandemic and concerns about travel and social distancing, plans to convert to a virtual meeting were under way.

General Surgery Training Collaborative

The annual meeting of the General Surgery Training Collaborative was held virtually on May 27, 2020. Discussions focused on specific areas and tangible deliverables related to the following:

• Assessment, feedback, and supervision
• Career-long record keeping
• Community rotations/continuity of care
• Core training/competency-based education and skills assessment
• Faculty development and support
• Public education and federal regulations
• Resident attrition
• Resident selection
• Role of surgeons in the residency accreditation process

National Professional Development Seminar Series for Medical Students

Due to the COVID-19 pandemic, the recent disruption of undergraduate medical education has led medical students to experience difficulties in accessing the requisite guidance needed to chart their professional careers and pursue goals to enter surgical training. The Division of Education organized a special webinar series, National Professional Development Seminar Series for Medical Students, to address these topics, such as how to plan fourth-year rotations, further enhance knowledge and skills, and make decisions about interviews.

Optimal Resources for Surgery Resident Training

A new resource under development, Optimal Resources for Surgery Resident Training, will serve as the authoritative reference for surgical education leaders to ensure educational excellence in the training of general surgery residents. Fifteen chapters are being written by renowned leaders in surgery resident training. The resource will include special emphasis on new technologies, animations, simulations, and virtual environments in training and assessing surgery residents.

SESAP®

The Surgical Education and Self-Assessment Program^® (SESAP), now in its 47th year, remains the premier self-assessment and guided cognitive skills education program for practicing surgeons. SESAP 17 features a redesigned educational model that further reinforces learning and supports mastery of the content. Important new features include the offering of Education Credits of Excellence for those interested in achieving and demonstrating higher levels of cognitive skills. Content also is now available by category, allowing subscribers to purchase all 13 categories or to select only the categories most relevant to their surgical practice and learning needs.

SESAP 17 Advanced will be released later this year featuring additional in-depth content for surgeons seeking further knowledge in specific areas. Modules in abdomen and alimentary tract, breast, endocrine, surgical critical care, and trauma will address clinical problems and areas that are complex and may be ambiguous or still evolving.

Summit on Surgical Training

The Fifth Annual ACS Summit on Surgical Training was held virtually May 27–28 and focused on the impact the COVID-19 pandemic has had on training across the surgical specialties. Representatives from the various certifying boards, review committees, professional societies, and program director organizations presented challenges and opportunities from their respective specialties. Virtual small group discussions focused on how to address the following issues in times of crisis: skills training and assessment, required number of procedures, board and review committee requirements, milestone achievement, formal testing and certification, and resident well-being.

Division of Integrated Communications

The COVID-19 pandemic required the Division of Integrated Communications to pivot from many planned activities to focus on quickly communicating critical information about the virus to the surgical community. In mid-March, the team swiftly mobilized and, in collaboration with College leadership, developed a rapid digital publication to ensure surgeons had the latest information to guide them in navigating the pandemic. The new, twice-weekly digital newsletter, Bulletin: ACS COVID-19 Updates, covered several topics related to the crisis, including clinical guidance, ethical considerations, first-person perspectives, and messages from leadership. The new publication leveraged the legacy of the traditional Bulletin but incorporated new branding to set this new communication vehicle apart.

Other key activities included the following:

• Building a new microsite of facs.org specifically dedicated to COVID-19 content, including a new search function to allow visitors to quickly find critical information
• Significantly increasing the use of video as part of a core communication strategy, including more than 30 videos with a wide range of experts shared across facs.org, newsletter, and social media channels
• Implementing a new social media listening and publishing strategy, including publishing social posts across College channels with the latest surgical COVID-19 information and driving people to facs.org to learn more
• Monitoring social channels and the ACS Communities for discussions related to surgery and COVID-19
• Actively engaging with that content through liking or sharing, and using those discussions to inform future newsletter content
• Soliciting feedback from the surgical community, via College social media channels, ACS Communities, and replies to the e-newsletter, as to what topics they needed more information on, and using that feedback to inform content for future issues
• Partnering with celebrities on social media to issue a public service announcement for the public to appropriately socially distance, as well as implementing animation to deliver similar messaging
• Conducting media outreach to support new College guidance related to COVID-19 and surgery, as well as to support COVID-19 research published in the Journal of the American College of Surgeons (JACS)
• Developing new methods of sharing the latest JACS data, including video author interviews and infographics to visually depict the scientific findings Creating quick-turn analytics reports that demonstrated the impact of College communications and informed future editions

The results of these efforts have been significant, with increases across several metrics:

• 30 percent open rate of Bulletin: ACS COVID-19 Updates
• 4.65 percent click-through rate of Bulletin: ACS COVID-19 Updates
• 106 percent more users to facs.org
• 98 percent more visits to website
• 75M+ people reached via social media
• 750M+ video views of our COVID-19 Content
• 2,900 media articles, with coverage in top-tier outlets such as New York Times, Wall Street Journal, FOX News, and beyond
• More members visiting the ACS Communities in March and April than in any previous month in the last six years
• 30 percent increase in abstract submissions to JACS compared with 2019

Member publications

The COVID-19 crisis presented new challenges and opportunities resulting in a significant overhaul of two key communications vehicles: ACS NewsScope and the Bulletin. In response to concerns about the pandemic’s effects on surgical patient care, the operating room team, hospitals, group practices, and other providers, the ACS decided to pause the twice-weekly My ACS NewsScope and the weekly ACS NewsScope. During the peak of the pandemic, these publications were replaced with Bulletin: ACS COVID-19 Updates.

In May, the Bulletin: ACS COVID-19 Updates was replaced with the Bulletin Brief. The new publication continues to provide updates on COVID-19-related activities, as well as information regarding College activities and events that was previously published in ACS NewsScope. The Bulletin Brief also includes links to time-sensitive information published in the Bulletin, such as Board reports, obituaries, and so on.

The Bulletin resumed quarterly publication in July and will resume more regular publication—monthly or every other month—in January 2021.

Public profile and visibility

Since mid-March, the ACS public profile and visibility team has focused its media outreach efforts on promoting ACS clinical guidance documents issued during the COVID-19 pandemic and disseminating COVID-19 research studies published ahead of print as “articles in press” on the JACS website. Several press releases reporting on safety-first surgical practice approaches and clinical research findings during the pandemic were developed and distributed to journalists worldwide. Short video commentaries from authors and infographics also were developed and released in tandem with JACS press releases to share on social media.

ACS leaders participated in numerous press interviews on COVID-19 issues with journalists from the trade and lay press. A popular topic was postponing and resuming elective operations as the COVID-19 curve of incidence rose and then began to flatten locally.

Division of Research and Optimal Patient Care

The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement (CQI), including ACS research and the accreditation programs.

Quality and Safety Conference

The 2020 ACS QSC was scheduled to take place July 24–27 in Minneapolis, MN. Due to the impact of the COVID-19 pandemic and the ensuing travel restrictions and social distancing guidelines, the in-person conference was canceled. The ACS QSC transitioned to a virtual event focused on timely and important topics related to quality, safety, and the evolving COVID-19 crisis. The 2021 ACS QSC will be held July 10–11 in Denver, CO.

Optimal Resources for Surgical Quality and Safety

The development of adjunctive and integrated resources/standards based on Optimal Resources for Surgical Quality and Safety is near completion. These standards ultimately will be used to launch a Surgical Quality Verification Program. Pilot visits began with a group of targeted hospitals in 2018 and continued into 2020 as the verification elements of the program are further refined. The goal is to refine and revise the set of standards based on the findings from the pilot phase and launch the program either through on-site or virtual site visits in the first quarter of 2021. During the COVID-19 pandemic, several pilot hospitals indicated that the core principles behind the standards were critical to their ability to respond effectively.

ACS NSQIP

A total of 849 hospitals participate in ACS NSQIP—706 in the adult option. The pediatric option represents 17 percent of overall participation. Another 27 hospitals are in various stages of the onboarding process. At present, 136 hospitals outside of the U.S. participate in ACS NSQIP—approximately 16 percent of all participating hospitals.

MBSAQIP

A total of 949 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and 53 applicants are seeking accreditation for the first time. From October 2014 through April 2020, 1,595 site visits have been completed under the MBSAQIP standards. Due to COVID-19 restrictions, a total of 66 surgeon surveyors are expected to perform approximately 150 site visits during 2020.

Children’s Surgery Verification Program

The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring that pediatric surgical patients have access to quality care. In all, 143 centers participate in CSV. All 143 centers also participate in ACS NSQIP Pediatric, an increase of 10 sites since January 2019. Approximately 45 of these centers are in the various stages of verification. A total of 25 active sites are fully verified as Level I children’s surgery centers—a 67 percent increase from the same time in 2019.

Geriatric Surgery Verification Program

The Geriatric Surgery Verification (GSV) Quality Improvement Program was launched in 2019 to ensure that geriatric surgical patients have access to high-quality care. The program defines the resources required to achieve optimal patient outcomes for older adults undergoing inpatient surgery and offers institutional verification to sites that meet the prescribed standards. GSV is developing an education curriculum to prepare hospitals across the U.S. for verification and to reduce the burden of the implementation process.

ISCR Program

The Agency for Healthcare Research and Quality Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the ACS and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, continues to attract hospitals interested in implementing enhanced recovery practices. Approximately 60 percent of enrolled hospitals also participate in ACS NSQIP. The fourth cohort, focused on Emergency General Surgery (EGS), launched in March 2020 with a concentration in appendectomy, cholecystectomy, and laparotomy surgeries. With the launch of EGS in ISCR, the program also is incorporating opioid tracking variables into all ISCR cohorts. Due to some hospitals needing to delay cohort participation due to pandemic concerns, another cohort for all surgery areas (EGS, colorectal, total joint/hip fracture, and gynecology) is planned to launch in September 2020.

Strong for Surgery

Strong for Surgery (S4S), a joint program of the ACS and the University of Washington, Seattle, is a quality initiative aimed at identifying and evaluating evidence-based practices to optimize the health of patients before surgery. The program empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. Since its release in 2017, S4S has more than 700 participating sites. Newly added topics include chronic disease management, mental health, and substance abuse.

SSR

The Surgeon Specific Registry (SSR) allows surgeons to track their cases, measure outcomes, and comply with changing regulatory requirements. The SSR can be used to meet the requirements of the Centers for Medicare & Medicaid Services Quality Payment Program Merit-based Incentive Payment System, as well as the American Board of Surgery Continuous Certification Program requirements. The SSR has an active user base of approximately 6,000 surgeons and more than 2.4 million case records have been entered in the SSR system since its initial release in 2017.

Trauma Programs

Due to the COVID-19 pandemic, the Committee on Trauma (COT) provided support and relief to members and trauma centers as they focused on surge planning and patient care, as well as provided resources to aid trauma centers and trauma systems as they maintained access to care and supported the care of trauma patients.

The 2020 Annual Spring COT Meeting and Advanced Trauma Life Support^® (ATLS^®) Global Symposium, originally scheduled March 11–15, was converted to a virtual meeting to minimize travel and allow members to focus on the preparations at their home institutions. Key activities, such as the Regional Resident Paper Competition and a panel discussion on the Social Determinants of Violence, were deferred to Clinical Congress 2020. The remaining committee meetings and workgroups were successfully converted to webinars or conference calls.

The COT also made accommodations to support trauma centers, including a one-year extension of all trauma center verifications with suspension of verification site visits, a one-year extension of all ATLS certifications, and a delay in the deadlines for data submission for the Trauma Quality Improvement Program.

The COT Disaster Committee and Trauma Systems Committee published a guidance document for trauma medical directors and trauma program managers to support efforts to maintain trauma center access and care during the pandemic.

To help ensure governmental and health care system leaders recognized the importance of preserving the trauma system and the need for regional coordination to support distribution of patients and resources among hospitals, the COT published a statement on the importance of preserving the emergency care system. The COT worked with state and federal advocacy teams to ensure a wide distribution of the statement, especially in major cities across the U.S.

The COT developed a guidance document on how to set up a Regional Medical Operations Center, modeled after experiences in southern Texas and Washington. They have worked closely with the Federal Emergency Management Agency Healthcare Resilience task force to promote this approach and identify sources for funding.

To further understand the impact of COVID-19 on trauma care, and to account for those challenges when conducting risk-adjusted benchmarking, the COT has worked with trauma registry vendors to collect confirmed and suspected COVID-19 cases via ICD-10 diagnosis codes.

Launched at Clinical Congress 2019, the FTL100 Fundraising Campaign was established to generate financial support for 100 Future Trauma Leaders (FTL) to coincide with the 100th Anniversary of the Committee on Trauma (COT) in 2022. FTL’s mission is to help foster the advancement of future leaders in trauma. The FTL aims to recruit, mentor, provide program support, and reimburse travel to various trauma meetings for eight participants annually. Due to the pandemic, fundraising initiative efforts were paused but will be resumed when appropriate.

TQIP will celebrate its tenth anniversary in 2020. The in-person meeting, to be held December 6–8, has been converted to a virtual presentation, with plans to hold an in-person meeting in 2022. The latest TQIP Best Practice Guidelines on Acute Pain Management will launch at the meeting.

National Stop the Bleed Month and Day (NSTBM/D) is one of the nation’s largest public health campaigns providing life-saving training to the general public. The ACS has partnered with national and international agencies to promote and provide support for each event. The 2020 NSTBM/D initiative required a new strategy as a result of COVID-19 and the recommendations to halt all STOP THE BLEED^® (STB) training. As a result, the STB program developed a refocused strategy that fully adhered to the social distancing guidelines of the ACS, government entities, and local communities. This strategy ensured STB remained a focus for the general public while maintaining the current momentum for the initiative and led to an increase in visits to the website.