American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Dr. Brent Eastman’s Statement on Senate Health Care Reform

Delivered via teleconference


November 4, 2009

Good morning or good afternoon – wherever you are in the country.

Earlier today, on behalf of more than 200,000 surgeons who care for and provide surgical treatment to millions of Americans every year, the American College of Surgeons and 19 other surgical organizations sent a letter to Senate Majority Leader Harry Reid expressing these key points:

First, we reiterated our steadfast support for health care reform that expands coverage, promotes better access to high quality care and reduces costs.

Secondly, we expressed deep concern that Senate health care reform leaders are heading down a legislative path that, if enacted, will pose serious risk to patient access and to surgical quality improvement efforts.

In short, rather than improve access and quality, the policies and provisions that the Senate is currently considering on health care reform will make an already-flawed system -- worse.

We sent this letter today because we believe it is essential for the sake of our patients and for the country that we pass meaningful health care reform this year.

We believe reform is in sight.

But we are seriously concerned with many of the provisions currently under consideration in the Senate.

Despite our deep desire to pass reform this year, if the Senate chooses to ignore our stated concerns, we will have no other choice than to oppose the bill.

First, let me share with you why we support health care reform—and then let me tell you why we oppose the Senate’s provisions.

Surgeons believe Americans should have access to high quality health care. We believe it is achievable and cost-effective. In fact, we know high quality care actually costs less. If we achieved the quality improvements that we know are possible, we as a country could free up resources that could, in turn, be used to expand access.

Over a year ago, when it was clear that health care reform would finally be tackled, we as an organization, along with the 19 other surgical groups who signed this letter to Senate Majority Leader Reid, made the decision to be as thoughtful and disciplined and diligent as possible about how we went about the business of building consensus within our own ranks.

We wanted to make sure we could offer constructive, meaningful solutions that would

  • improve care
  • reduce costs and
  • ensure access to quality surgical care.

The American College of Surgeons developed a core set of principles that our leadership, our membership and surgeons across the country could support because they would have the confidence that any legislation we supported would improve patient access to quality care and the system would be improved:

These core principles are:

  • Quality and patient safety
  • Access enabled through an adequate physician workforce
  • Cost effectiveness achieved through quality improvement and medical liability reform

I share this with you because I believe that undergoing this consensus-building process dramatically increased our ability to bring a diverse set of surgical specialists together, united in our desire to achieve health care reform.

But that’s why we are so concerned about the Senate Health Care Reform Provisions. Too many of the provisions that the Senate Finance Committee considered put patient access and quality improvement at risk, including:

  • The establishment of a Medicare Commission. This would be a small body of unelected people who have no accountability to the public to decide what treatments get covered under Medicare and which treatments are denied. By the way, we aren’t the only one’s who were concerned about this lack of accountability—Rep Richard Neal of Massachusetts led 75 other House members to express collective dismay about this proposal.
  • The mandating of an unsuccessful quality program, PQRI. The Physician Quality Reporting Initiative (PQRI)—is the government’s quality improvement program and by its own admission is seriously flawed.

Before I explain why we are so concerned about this, please let me be clear: we are 100 percent behind quality improvement—it is our heritage and a constant focal point for surgeons—but it is foolhardy to mandate an unsuccessful program.

The government established PQRI as its quality measurement program. They told doctors across the country to send in their “quality data.” Doctors faithfully followed the instructions laid out by the government and sent in the information—only to find out the instructions were wrong. CMS, the government agency, acknowledged that the instructions were wrong, that they had made mistakes and that they would fix the problem and come back to doctors with a clear set of instructions.

That was in 2007—we are now almost to 2010—and we still haven’t heard from them what that clear set of instructions are supposed to be –

And now the Senate wants to mandate that we participate in this program?

That doesn’t make any sense and it certainly won’t improve quality. In fact, we believe it may harm quality efforts because physicians and hospitals tell us they are inundated with so many quality improvement initiatives, it is increasingly difficult to keep up. The last thing they need or want is a flawed quality program imposed upon them.

I’ve just described an unsuccessful quality program—but now let me describe a successful one—The American College of Surgeons National Surgical Quality Improvement Program also known as NSQIP. With NSQIP, patients get better care, have better outcomes and it reduces costs.

In a two-year study, of 118 hospitals, recently published in the Annuals of Surgery, this quality program helped prevent thousands of surgical complications each year, resulting in more than 250 to 500 fewer complications in each hospital each year, reducing annual costs by more than $3 million per hospital. Nine of the top 10 private hospitals in the nation, along with more than 240 additional hospitals, across the country, use ACS NSQIP. The ACS believes that these types of quality programs could save the health care system a minimum of tens of billions of dollars over the next decade.

How is this possible, you might ask? We believe it’s because our quality programs start with the patient. Most quality programs rely on billing data—i.e. the information that insurance companies collect to actually pay claims.

NSQIP doesn’t use billing data but rather starts where it matters most—with the patient. Think about it—a 22 year old track star has a very different health status than a 55-year-old person who has a history of heart disease and diabetes. Our quality programs start with the premise that no two patients are alike—and therefore that the care and treatment for the patient must be specific to the patient—and the quality measurement must be as well.

There is an old adage in medicine—which is “look at the patient.” It’s a simple concept but a powerful one —it is essentially our profession’s reminder that all the new technology, innovations, our own professional expertise, etc. are important—but nothing is as important as looking at the patient.

As surgeons, we strive to keep the patient front and center in our daily lives. We think this is probably good counsel as we consider health care reform, too.

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit


Sally Garneski