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

NewsScope: September 7, 2018

ACS Responds to Stark Self-Referral Law Request for Information

The American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) responded August 24 to a request for information from the Centers for Medicare & Medicaid Services (CMS) related to the Physician Self-Referral Law. 

In the letter, the ACS notes the chilling effect on payment model development and participation because of the possibility of running afoul of the regulations.  These rules, commonly referred to as the Stark Law after former Congressman Fortney H. “Pete” Stark, Jr., (D-CA) who originally proposed them, typically prohibit physicians from referring patients for services in facilities in which they have a financial interest. This legislation was intended to remove adverse incentives that were thought to lead to abuses, but in the current environment of value-based payment, the laws are increasingly seen as an impediment to the development of team-based, coordinated payment models that could benefit patients.  

For more information, contact Matthew Coffron, Manager of Policy Development, ACS DAHP, at mcoffron@facs.org with any questions about the Stark Law.   

Senate Passes Health Appropriations Package

Last week, the U.S. Senate passed an $857 billion Labor, Health and Human Services and Related Agencies (LHHS) appropriations bill, H.R. 6157, with a bipartisan vote of 85-7.

The package includes a $2 billion increase for the National Institutes of Health (NIH), including a $190 million increase for the National Cancer Institute (NCI). In addition, the legislation allocates an additional $2 million for cancer registries to assist in tracking pediatric cancer as outlined in the Childhood Cancer Survivorship, Treatment, Access & Research (STAR) Act, P.L. 115-180, which became law in June 2018. The Childhood Cancer STAR Act has been a legislative priority for the American College of Surgeons (ACS) and the Commission on Cancer for a number of years. 

The Senate now has passed nine of the 12 appropriations bills. With government funding expiring September 30, Congress has three weeks to pass the remaining three bills. The Senate LHHS appropriations bill now awaits action in the House of Representatives. The House bill differs from the Senate’s in terms of overall funding levels. If the House passes its version of the legislation, a Conference Committee will convene to negotiate the funding differences.

For more information about the Senate Appropriations Committee, contact Justin Rosen, ACS Congressional Lobbyist, at jrosen@facs.org or 202-672-1528.

Congress Holds Hearing on ACS-Supported Pediatric Legislation

This week, the House Energy and Commerce Health Subcommittee held a hearing on the Advancing Care for Exceptional (ACE) Kids Act, H.R. 3325. This American College of Surgeons (ACS)-supported legislation would create an organized health care delivery system for the more than 2 million children in the U.S. with complex medical needs. Overall, this legislation will play a large role in coordinating care and ensuring optimal outcomes for children with complex medical conditions and covered by Medicaid.

The ACE Kids Act now awaits further action by the House Committee on Energy and Commerce Committee before heading to the full House of Representatives for a vote. The Senate companion of the ACE Kids Act (S. 428) is awaiting action in the Senate Finance Committee.

For more information about pediatric health policy, contact Justin Rosen, ACS Congressional Lobbyist, at jrosen@facs.org or 202-672-1528.

Children’s Hospital GME Legislation Heads to the President’s Desk 

Earlier this week, the Senate passed the Dr. Benjy Frances Brooks Children's Hospital GME (graduate medical education) Support Reauthorization Act of 2018, H.R. 5385. The Children’s Hospital Graduate Medical Education (CHGME) program provides funding to children’s hospitals to assist with the training of pediatric physicians. This legislation funds the CHGME program at $325 million a year for five years. In April 2018, the ACS joined a coalition of other health care organizations by signing on to a support letter for CHGME funding.

The House of Representatives passed the Dr. Benjy Frances Brooks Children's Hospital GME Support Reauthorization Act of 2018, and the bill now heads to the President’s desk for further action.

For more information about pediatric health policy, contact Justin Rosen, ACS Congressional Lobbyist, at jrosen@facs.org or 202-672-1528.

Dr. Heidi Nelson to Join ACS as Medical Director of Cancer Programs

Cancer ProgramsThe American College of Surgeons (ACS) is pleased to announce that Heidi Nelson, MD, FACS, will be joining the ACS Division of Research and Optimal Patient Care as Medical Director, Cancer Programs, replacing David P. Winchester, MD, FACS, as he transitions from the position.

Dr. Nelson is chair, department of surgery, Mayo Clinic, and professor of surgery, Mayo Clinic College of Medicine and Sciences, Rochester, MN. She has master’s faculty privileges in clinical and translation science at the Mayo Clinic Graduate School of Biomedical Sciences and the Mayo Clinic College of Medicine and Science.

Dr. Nelson is the Fred C. Andersen Professor for the Mayo Foundation and a consultant for Mayo Clinic’s division of colon and rectal surgery. She is well-respected for her research in the field of colon and rectal cancer and has been funded by the National Institutes of Health, the American Cancer Society, the American Society of Colorectal Surgeons, and many others. She brings a wealth of experience from leading others and establishing strong results-oriented teams. In addition, Dr. Nelson has mentored trainees and investigators and served as an editor and publisher for high-impact journals.

Dr. Nelson will be starting work with the ACS in September on an initial part-time basis, overlapping with Dr. Winchester to ensure a smooth transition and continuity of leadership. The College is excited about her joining the organization, and we look forward to her expertise and leadership in the cancer community.

Read more about the ACS Cancer Programs.

ACS Releases Guidelines for the Perioperative Management of Antithrombotic Medication

As the number of older people facing surgery increases, so does the accompanying occurrence of prescribing chronic anticoagulation therapy. This change has prompted the American College of Surgeons (ACS) to release new guidelines for the perioperative management of antithrombotic medications. Authors of the guidelines, which included members of the ACS Board of Governors Best Practices Workgroup, noted that the document is intended to update, summarize, and combine previously published guidelines into a clinically rigorous format suitable for a broad surgical readership.

According to the authors, the guidelines are intended to update surgeons in the following areas:

  1. Assess thromboembolic risk if the antithrombotic agent is discontinued perioperatively
  2. Determine the bleeding risk of the surgical procedure and patient factors that modify this risk
  3. Discuss heparin bridging for perioperative thromboembolism prevention in high-risk patients
  4. Develop an evidence-based perioperative antithrombotic medication management strategy for elective surgical patients
  5. Outline perioperative antithrombotic medication management in the non-elective surgical setting

The guidelines are published as an “article in press” on the website of the Journal of the American College of Surgeons ahead of print.

A session on the Perioperative Management of Anticoagulants, which is based on the guidelines, is scheduled for ACS Clinical Congress 2018 in Boston, MA, on October 22. The session is sponsored by the Board of Governors Best Practices Workgroup and the Committee on Trauma and will educate attendees on the multiple facets of anticoagulants in the perioperative period.

ACS-Pfizer 2018 Surgical Volunteerism and Humanitarian Awardees NamedOperation Giving Back

Each year, the American College of Surgeons (ACS) Board of Governors Surgical Volunteerism and Humanitarian Workgroup selects up to five recipients for the ACS/Pfizer Surgical Volunteerism and Humanitarian Awards. This year, five Fellows will be honored at Clinical Congress in October 2018 in three categories (Humanitarian, Volunteerism-Domestic, and Volunteerism-International), acknowledging their tremendous contributions to surgically underserved populations.

  • Nandakumar Menon, MB, BS, FACS, will receive a Surgical Humanitarian Award for his sustained commitment to serving an indigenous population in southern India.
  • Roland Stephens, MD, FACS, will receive a Surgical Humanitarian Award for his dedication to improving surgical care, primarily in Zimbabwe.
  • Barbara Barlow, MD, FACS, will receive a Surgical Volunteerism Award in the Domestic category for her decades of work in promoting injury prevention among children in the Harlem borough of New York, NY, and communities nationwide.
  • Michael Curci, MD, FACS, will receive a Surgical Volunteerism Award in the International category for his more than 40 years of surgical volunteer work  centered on helping to build workforce capacity, mentoring surgeons, and providing surgical care in Haiti and Rwanda.
  • Bruce Steffes, MD, FACS, will receive a Surgical Volunteerism Award in the International category for dedicating much of his career to volunteerism efforts in Africa, Asia, and Central and South America.

More information about the ACS-Pfizer Awards and this year’s awardees can be found in the September issue of the Bulletin.

Second Volume of Operative Standards for Cancer Surgery Manual Now Available

Operative Standards for Cancer Surgery, Volume 2, a collaborative manual from the American College of Surgeons (ACS) and the Alliance for Clinical Trials in Oncology, is now available for print and electronic purchase. This second volume focuses on thyroid cancer, gastric cancer, rectal cancer, esophageal cancer, and melanoma. The goal of the manual is to recommend the steps that need to occur in the operating room, from skin incision to skin closure, that ensure the best oncological outcomes for patients. Recommendations from the first two volumes serve as an initial point of discussion as the ACS Commission on Cancer (CoC) works to revise its accreditation manual and requirements. Preliminary work is being done to incorporate a portion of the recommendations into the new CoC standards for implementation by 2020.

The recommendations in the manual are part of a shift in the way surgeons perform cancer operations to ensure the procedures are guided by the strongest available evidence, according to the leadership of the Alliance/ACS Clinical Research Program (ACS CRP) Cancer Care Standards Development Committee, which led development of both volumes.

Similar to the first volume of the manual, which covered cancer of the breast, colon, lung, and pancreas, this volume breaks down the major cancer operations for each of the five disease sites into the critical steps that teams of experts and stakeholders around the country have identified as having the most significant influence on outcomes.

“We hope that the recommendations become actively used and achieve greater legitimacy,” said Committee Chair Mathew H. G. Katz, MD, FACS.

Operative Standards for Cancer Surgery, Volume 2, is available for purchase on the Wolters Kluwer website. For more information, contact clinicalresearchprogram@facs.org and read the ACS press release.