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

NewsScope: June 28, 2019

Editor's note: Because of the Fourth of July holiday, ACS NewsScope will not be published next week. Publication will resume July 12. Best wishes to all of our readers for a happy and safe holiday.


ACS Submits Comments on FY 2020 IPPS and Promoting Interoperability Proposed Rule

The American College of Surgeons (ACS) submitted comments June 24 in response to Centers for Medicare & Medicaid Services’ (CMS) fiscal year (FY) 2020 Hospital Inpatient Prospective Payment Systems (IPPS) and Promoting Interoperability Programs Proposed Rule, which was released May 3. Under the provisions proposed in this rule, CMS projects that total Medicare spending on inpatient hospital services will increase by approximately $4.7 billion in FY 2020. The proposed CMS rule updates payments and policies for the inpatient hospital programs and initiatives. It also provides opportunities to provide feedback on the future of quality measures and increased efficiency of Electronic Health Records (EHRs).

The College encouraged CMS to reduce burden on physicians by adopting open-source standards for data exchange and the utilization of cloud platforms as well as aligning quality measures across the various inpatient hospital quality programs. The ACS also strongly urged CMS to retain and use risk-adjusted clinical outcome measures, patient reported outcomes (PROs), and evidence-based standards, such as the protocols in the ACS manual Optimal Resources for Surgical Quality and Safety (also known as the Red Book), to promote a culture of continuous quality improvement and ensure that hospitals have the resources necessary to provide optimal care. 

CMS also sought stakeholder feedback on the agency’s policies to provide additional payment for new medical technologies that demonstrate substantial clinical improvement over existing technologies. The ACS supported such add-on payments for new technologies under IPPS for the purposes of reducing financial barriers to investment and adoption by hospitals. The College encouraged CMS to provide greater clarity on the criteria new technologies must meet to be eligible for additional payment to ensure that ambiguities within the existing criteria do not hinder access to technologies that may significantly enhance the diagnosis and treatment of Medicare beneficiaries.

To read the full text of the comments on this rule, see the letter here. For more information, contact Regulatory@facs.org.

College Leads Congressional Letter to CMS on the Need for Surgery-Specific Quality Measures

Following up on the advocacy efforts of American College of Surgeons (ACS) Fellows at the 2019 Leadership and Advocacy Summit, several key members of Congress are circulating a sign-on letter concerning quality measures under the implementation of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MARCA). Led by Reps. Raul Ruiz, MD (D-CA); George Holding (R-NC); Brian Higgins (D-NY); and Larry Bucshon, MD, FACS (R-IN), the letter encourages the Centers for Medicare & Medicaid Services (CMS) to work with stakeholders to develop and test a quality framework that focuses on high-value processes, clinical outcomes, and patient-reported outcomes or experiences. Under the Merit-based Incentive Payment System (MIPS), most employed surgeons are ranked based on measures in the CMS Web Interface, which evaluates compliance with primary care services, such as immunizations, blood pressure control, diabetes control, and tobacco cessation. These measures may be important to a patient’s overall health, but they are not meaningful to a patient’s episode of surgical care nor do they facilitate surgical quality improvement.

It is important that as many members of Congress as possible sign on this letter. Voice your support and ask your member of Congress to sign this letter through SurgeonsVoice.  

For more information on physician payment reform efforts, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

ACS Continues Fight to Fairly End Unanticipated Medical Billing

The Fellows of the American College of Surgeons (ACS) recently engaged in a grassroots campaign through SurgeonsVoice in support of a congressional sign-on letter to the leadership of the U.S. House of Representatives Committee on Energy and Commerce, Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR). The letter, led by Reps. Ami Bera, MD (D-CA), and Phil Roe, MD (R-TN), expresses concerns with regard to draft legislation developed to address unanticipated (also known as surprise) medical billings, the No Surprises Act. The legislation uses an untenable benchmark payment rate and excludes an independent dispute resolution (IDR) process. The ACS previously has expressed its opposition to the No Surprises Act.

On the Senate side, the Health, Education, Labor, and Pensions Committee reported out legislation that the ACS opposes, the Lower Health Care Costs Act. This legislation covers myriad topics, including the issue of surprise billing, and contains a federally set benchmark payment rate and no IDR process. The next step for the legislation is full U.S. Senate consideration, scheduled for debate in July. The ACS will continue to work to prevent this legislation from gaining final passage in the Senate.

For more information on the issue of surprise billing, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

Learn about Safe Care for Older Surgical Patients at Quality and Safety Conference

Members of the American College of Surgeons (ACS) who provide care to older patients won’t want to miss the roll out of the Geriatric Surgery Verification (GSV) Quality Improvement Program at the 2019 ACS Quality and Safety Conference, July 19−22 in Washington, DC. A Preconference Session will take place Friday, July 19, which will focus on the GSV program’s development, return on investment, implementation, and enrollment. The conference also will include a Geriatric Track with five breakout sessions covering such topics as aligning goals of care, moving the needle on geriatric outcomes, and palliative care. At this time, the final GSV standards (32 total, with two optional) will be released and interested hospitals will be able to obtain more information on how to become involved in the GSV Program.

The GSV was developed through the Coalition for Quality in Geriatric Surgery (CQGS) Project, which the ACS formed in partnership with John A. Hartford Foundation in 2015. The CQGS is an interdisciplinary group of more than 50 stakeholder organizations representing patients, caregivers, nurses and other health care professionals (such as pharmacists and social workers), physicians, payors, and health care regulatory bodies. The vision of the CQGS was to improve the surgical care and outcomes of older adults by establishing a quality improvement program with verifiable standards and data based on best evidence, with a focus on what matters most to the individual patient.

Read more about the new GSV program in the New York Times and in the July issue of the Bulletin, which will be available online July 1. To register for the Quality and Safety Conference, go the meeting web page.

SECOND Trial Announced to Address Resident Wellness

A randomized trial aimed at analyzing and improving general surgery resident wellness began enrolling training programs this week. The Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial seeks to improve the learning environment and resident well-being in 320 participating residency programs. For the first time, programs will receive data on their residents’ well-being.

At present, no data are available to surgical residency programs about how resident well-being and burnout at their program compares with other training programs across the U.S. The SECOND Trial will address this lack of data by providing programs with comparative, confidential, program-specific data for the first time about burnout and the myriad factors that contribute to poor well-being among residents. The Wellness Toolkit includes ready-to-use interventions from the literature, best practice guidelines, and examples from other successful surgical residency programs.

The SECOND Trial comes after the 2016 landmark Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial found that flexible surgical resident work-hour policies were safe for patients and preferred by surgical residents. However, the FIRST Trial also found that 39 percent of U.S. general surgery residents experience burnout symptoms weekly.

“The data from the FIRST Trial demonstrated that resident well-being was getting worse each year, irrespective of the study arm,” said Karl Bilimoria, MD, MS, FACS, SECOND Trial Co-Principal Investigator and the John B. Murphy Professor of Surgery and director, Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern Medicine, Chicago, IL. “We developed the SECOND Trial with the American College of Surgeons (ACS), Accreditation Council for Graduate Medical Education (ACGME), and our other partners to both provide programs with data about how they are doing and also with real initiatives that they can implement to improve resident well-being.” 

“The SECOND Trial represents an important step in understanding resident well-being,” said ACS Executive Director David B. Hoyt, MD, FACS. “The data from this trial will help inform our understanding about trainees’ wellness at surgical residency programs around the country and move a path forward for ensuring that it becomes a priority in the future.”

The SECOND Trial is in partnership with the ACS, ACGME, American Board of Surgery, Association of Program Directors in Surgery, Society of Surgical Chairs, Association of American Medical Colleges, and Northwestern Medicine’s SOQIC.

Join ACS and HBS Leaders July 19 for Unveiling of New THRIVE Initiative

Fellows of the American College of Surgeons (ACS) are well aware of the challenges that stand in the way of expanding access to care and providing innovative treatments to surgical patients—quality, cost, and interoperability. The ACS and the Institute for Strategy and Competitiveness at Harvard Business School (HBS) have collaborated to develop a path forward and will host an exclusive event July 19 in Washington, DC, to introduce THRIVE: Transforming Health care Results by Investing in Value and Excellence. The session will take place 9:30−11:00 am Eastern time at the Walter E. Washington Convention Center prior to the ACS Quality and Safety Conference.

Speakers at the event will describe the ACS and HBS THRIVE approach and specific strategies for introducing a workable plan to shape the nation’s health care system into the model all health care professionals want and their patients deserve—one that emphasizes value over volume.

Leaders of the Preconference Session are as follows:

  • David B. Hoyt, MD, FACS, ACS Executive Director
  • Robert S. Kaplan, senior fellow and Marvin Bower Professor of Leadership Development, emeritus, HBS
  • Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS Division of Research and Optimal Patient Care
  • Frank G. Opelka, MD, FACS, Medical Director, ACS Quality and Health Policy
  • Mary L. Witkowski, MD, MBA, fellow, Institute for Strategy and Competitiveness, HBS

Registration and networking opportunities begin at 8:30 am. To reserve your seat for this important preconference program, e-mail acseducation@facs.org.