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June 16, 2008
Current Priorities and ACS Ventures:
Under the able leadership of its Executive Director, Dr. Tom Russell, the American College of Surgeons continues to increase its visibility and its influence among the policy-makers in Washington, D.C. He has built partnerships with other specialties not only of surgery but also of medicine as a whole. We have an expanded presence in D.C. which will be even more prominent after the 20F St building opens in 2010. The groundbreaking ceremony occurred May 8. The ACS partners with multiple other groups studying needed changes in the healthcare system, including the National Coalition on Healthcare, the National Quality Forum, and the Surgical Quality Alliance (formed and led by ACS). The D.C. office has been working hard to prevent cuts in Medicare reimbursement. Although this was an uphill battle with the current economic climate and the ongoing Iraq war, the ACS was successful in preventing the 10.5% cut and achieving a 0.5% temporary increase in Dec, 2007. The 3,000 letters, emails, and phone calls of surgeons to their elected congressional representatives were key to this effort. Last week the Baucus bill (S. 3101) failed to achieve the 60 votes needed to invoke cloture, but the Senate leadership has assured the ACS leaders that the 10.6% cut due to take effect in July will be stopped, with a 1.8% increase for 2009. The Washington office of the ACS keeps members, the Regents, and the Governors informed through email communications and Webinars of the need to mobilize additional phone calls as the remainder of the legislative year progresses. The ACS and the American Osteopathic Association joined forces to propose separate expenditure targets and conversion factors for physician services in the Medicare fee schedule that would replace the sustainable growth rate system. This did not pass Congress this year but will be on the table again.
At the ACS Clinical Congress in Oct, 2007, the Board of Governors meeting was very spirited, to say the least. The Governors spoke up about their frustration with regard to declining reimbursement, mandated emergency room coverage, increased cost of liability insurance, and the hassle factor with regard to practicing surgery. As an outgrowth of that meeting, the Regents and the Executive Committee of the Board of Governors have developed better means of communication with other Governors and Fellows with regard to what the College is really doing and how much members do get for their dues contribution. Dues-supported programs of the College are actually $107 per member more than the $440 dues and ACS dues are among the lowest of all medical and surgical specialty societies.
On Fri, June 13, at the Board of Regents meeting, the Executive Director, Chairman of the Board of Regents, and President spoke with the Board of Governors by a streaming video conference and addressed the major areas of concern of the Board of Governors and Fellows, on which the leaders are working:
1) Tort Reform and Liability Insurance – Some progress at the state level is being made; at the federal level, this issue is “dead”. Dr. Healy (President) is dialoguing with two malpractice insurers to set up steep discounts (up to 40%) for surgeons who have no unfavorable judgments for 10 years and who participate in programs that decrease litigation risk.
2) Improve effectiveness of local surgeons and Chapters in achieving more equitable working conditions (e.g. pay from the hospital for ER call) and advocating for reforms at the State level through establishment of regional Chapter coordinators.
3) Establish programs that allow all Fellows to meet the Maintenance of Certification (MOC)requirements that have been mandated by the American Board of Surgery and are being increasingly required by state licensing boards. NSQIP and the ACS Case Log System will be made more nimble and versatile to achieve this goal and allow surgeons and hospitals to look at their outcomes and embark on meaningful quality improvement programs that address bot h MOC Part 4 and increasing demands of insurers and the public. ACS Division of Research and Optimal Patient Care worked with Brett Sheppard, for example, to develop a grant that has been submitted to NIH to establish a consortium of small hospitals in Oregon to participate in NSQIP.
Activities of Each Division in the College:
Division of Education
Activities of this division support products designed to meet the needs of practicing surgeons as well as surgeons-in-training. With the American Board of Medical Specialties decision to require more components for MOC than just an every-ten-year exam, the ACS is developing education institutes all over the US as well as many products , including continuation of the ever-popular SESAP, the Web Portal System including the Case Log System, special courses in communication skills, leadership, and team training, CD-ROMS in several areas of surgical competency, an online multimedia Atlas of Surgery, and increased collaboration with regional surgical societies to sponsor courses.
Division of Research and Optimal Patient Care
ACS sponsors the Commissions on Cancer (COC) and Traum (COT), both of which have national databases. ACOSOG is a sponsor of several clinical trials that individual surgeons can participate in. The COT sponsors consultation and verification for hospital trauma systems, the Disaster and Mass Casualty Management Course, and will be sponsoring the Advanced Trauma Operative Management Course for residents and practicing surgeons.
Division of Advocacy and Health Policy
In addition to the new building at 20F St in D.C., the ACS has launched the Health Policy Research Institute with George Sheldon as the first director.
Division of Member Services
A current priority of the ACS is to provide enhanced support for chapters in performing their activities. Plans are under way to provide chapters with information and skills in dealing with their respective legislative bodies regarding local issues.
The Surgeons Asset Management LLC (SAM) is attracting investment from individual ACS members as well as regional societies and hospitals. The marketing strategy is the same as that of the ACS endowment, which has consistently outperformed the leading mutual fund indices and has shown modest but still POSITIVE return even in the current unfavorable Wall Street trends. You can access information on this great investment opportunity at www.surgeonsfund.com.
To hear what is going on at the ACS contemporaneously, sign up so that you receive the ACS Newscope weekly. The email address is acsnewscope@facs.org. I also urge everyone to stay informed by reading the Bulletin of the ACS every month.
It has been a privilege to represent Oregon on the Board of Governors in this, my last year.
Karen Deveney, M.D., F.A.C.S.
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