American College of Surgery: October 19, 2005

Indiana Governor’s report

Sunday October 16, 2005 was the date of the annual meeting of the Board of Governors held at the Hilton in San Francisco.

Introductory comments were made by Dr. Copeland (Chair, Board of Regents), Dr. Laws (President of the College) and Dr. Russell (Executive Director of the College).

Dr. Andy Warshaw (First Vice President and Chair of the ACSPA-SurgeonsPAC) provided a report on the ACSPA-SurgeonsPAC highlighting the political activities supported on an off election year and the regulatory efforts undertaken. We have made some process in the support of this arm of the college but still are anemic in support when compared to other organizations. This year almost $500 thousand is anticipated to be donated. While only 33% of Governors and 70% of Regents are contributing to the PAC, this is still a significant improvement over last year by almost double and signifies an ever increasing believe in the effort. But consider that if everyone gave just the cost of a hotel room night ($250) with a membership in the 30,000 range, the amount available to support our effort for improvements in tort reform, reimbursement issues, etc. would be in the millions per year. What a difference this could make.

Dr. Robin McLeod presented the current effort in computer Evidence-based Reviews which allow GME credits at home for a series designed to improve our interpretation of the literature. Other courses are being planned.

Ms. Gay Vincent (Comptroller of the College) reported that the College finances are doing well with a 14-50% return on various component of the investment plan. Because of this excellent performance, which has been sustained over the last several years, there is a proposal before the Board of Regents to have a fund of funds in which individuals could participate as a benefit of membership.

Dr. Julie Freischlag (Secretary of the Board, and Chair of the Fiscal Affairs committee) reported on the Long terms dues strategy. The thought is that any change should be based on need and considered annually to avoid large increases at extended time intervals.

Dr. Courtney Townsend (Chair, Board of Governors) acknowledged contributions to the ACS Endowment Funds and the Indiana Chapter was recognized. He discussed the results of the Board of Governors Survey. The major concern this year according to the survey is Professional Liability/Tort Reform, Risk Management/Patient Safety. Comments with suggestions that this must be addressed on the federal level since state legislation is constantly challenged and chipped away over the years. Early retirement, the inability to recruit new surgeons and the inability to keep surgeons are often influenced by the local environment of professional liability. The second topic was Physician Reimbursement/Medicare/Medicaid with comments typical of the last several years. Health Care Reform and its Impact on Practice and Graduate Medical Education come in third and fourth in order. Also presented were efforts by the ACS aimed to address these concerns. We now have a political action group active in Washington. The College is a leader in the Doctors for Medical Liability Reform which is a coalition of medical societies formed to conduct a state-by-state public education effort to promote passage of comprehensive federal medical liability reforms in the U.S. Senate. TV ads have been run to support these efforts. 500 surgeons and physicians traveled to Washington D.C. to rally for medical liability reform. The College is leading the way in the five-year review of the Medicare fee schedule. The ACS in very active in the “pay for performance” efforts being advanced by many and diverse groups. Another three to four pages of activities were presented to extensive for this report, but it was clear to me that the College was taking our concerns and comments seriously.

A report of the Canadian Regents and Governors Meeting was presented by Dr. Reznick.

Dr. George Sheldon introduced the ACS Web Portal Project (e-FACS.org). It will provide a single sign-on service entry point to the College in an organized manner consistent with the specifics of your work (i.e. breast surgery, endocrine, etc.). You will be able to customize, personalize, integrate and have content management control over its specific look to you. Up-to-date literature will automatically be presented for your review. It is to become operational later this year.

Dr. McGinnis reported on the activities of the AMA. We became active in this organization in the mid 1990’s after a 10-15 year hiatus. Dr. Reiling has become a prominent leader in the organization. Currently, the ACS has three delegates, two alternate delegates and one Young Physicians Section delegate.

Dr. Reiling provided a report on the ACS Foundation. It has been able to fund increasing numbers of grants due to the excellent return on investments and philanthropy of the members. Other projects are being considered such a funds for residents to have time for volunteer work during there training.

Dr. Kathleen M. Casey is the director of the ACS Operation Giving Back. She has completed some basic work on the web to provide the members with on-going projects in which they can want to become involved. She has begun the process of outreach to other organizations involved in volunteerism so that each organizations talents can be utilized when an emergency presents. Much work is still in progress.

The afternoon was spent on a program entitled: Accreditation of Hospital Programs and Individuals by the American College of Surgeons. Dr. Russell made the point that surgical safety is not only contingent on the surgeon’s competency but also on the “system of care”. We must demand effective hospital systems based on data, only by measuring can we hope to improve any situation. The same is true of our own practice, “pay for performance” will demand that we keep track of our cases, risks factors affecting the results and the result themselves. This data will be used to improve quality and is already being used to provide a report card on you but with data you have no control over to ensure it is correct. It has been shown that when this happens everyone’s quality is improved (e.g. NSQIP within the VA system). Dr. R. Scott Jones discussed ACS accreditation. This will really be a process of guideline determination leading to clinical trials leading to best evidence which leads to high quality care as determined by outcomes which will start the process over as a method of constantly striving for excellence. Credentialing should be data driven like everything else. The College is going toward Centers of Excellence by providing criteria for such centers including mandated hospital services, a program director, guidelines of care and a method of following outcomes. NSQIP, Centers, the Web Portal, personal IPOD download for case management, the review series are all aimed at this process of continuing improvement in patient care. Dr. Hoyt provided a review of the Trauma Verification Program which is really simply a Center that is well ahead of the rest. Dr. Sachdeva spoke on “Accreditation of Surgical Education Institutes and Verification of Knowledge and Skills of Surgeons”. The College is interested in having regional institutes for surgical training for which the College will then provide credentialing. The will be five levels of credentialing: 1) attendance 2) Course objective 3) verification of knowledge or skills 4) verification of preceptoring 5) verification of results when the trainee is reviewed at a later date. This program is in its infancy.

I tried to only hit the highpoints. As you can see, the College is very active and does try to respond to the needs of the practicing surgeon. Much of the recent effort is to develop a process by which the practicing surgeons can obtain appropriate retraining since it is unlikely that technology will stand still. Respectfully Submitted,

Michael C. Dalsing, M.D.