American College of Surgeons - Newsletter.

Summary of Governors Report

by Dr. Mike Dalsing

Governor Indiana Chapter of ACS

At the next meeting, I will have a multi-page summary of the Governor’s meeting since there are many innovative and exciting projects now underway. However, let me try to hit some of the major points.

This year was “The Year of the Resident” and there has been a major effort to involve residents both at the national and local level. I believe our chapter has been pro-active in this effort for many years but certainly at the national level residents have been incorporated into almost all the major activities of the college.

The upcoming year with be “The Year of Unity.” There will be a major outreach to nurses, anesthesiology and other major organizations such as the American Medical Association. Some of these people are already part of the ACS affiliated medical group. It was interesting that over a thousand two hundred people at last year’s American College of Surgeons meeting were part of the affiliated or associate group. They are interested in being included.

We are currently being issued a report card by several organizations. The problem with this report card, of course, is that the data may or may not be true. Dr. Russell noted that currently congress, business, and insurance companies have the mind set of “paying for performance.” In showing these organizations our performance, we must be able to measure it and the college believes that must stress patient safety, have risk adjustments, and provide the outcome that they desire. The ACS effort to allow accurate collection, interpretation, and then reporting of surgical data comes in the form of the NSQIP. This program consists of 48 pre-operative, operative and post-operative data points which will allow risk stratification, operative specifics, and outcomes to be determined. This seems like an excellent way of controlling date that flows from your institution. You might wish to become one of the hospitals involved with this project.

Volunteerism is to be stressed this year as well. If you are involved in any local, national or international program that is philanthropic or volunteer in nature, the College would like to know. This is to be put on the web in the form of “Operation Giving Back.” The person in charge has been hired and that person is Dr. Kathleen Casey. She can be contacted on the web and you can give her details of your favored volunteer effort. Others may read it and want to become involved as well.

In terms of the financial dealings of the college, there has been a change their management group and with this change has come a 15.8 percent return on investment versus only 4.4 percent last year. In fact, they have earned over 30 million dollars over the last year. The endowment has some directed funds and some undirected funds. The undirected funds amount to approximately 140 million dollars. There is an initiative to use 5 percent of interest for new programs which basically allows the college approximately 6 million dollars a year to fund new projects. Of course, this varies depending upon how the mutual funds perform.

There was a major discussion on how dues are to be formulated. The draft article basically mentions a yearly recommendation by the financial committee, membership input, it must be value based, and most would advocate smaller increments more rapidly rather than large increases at a longer period of time.

There was a Board of Governor’s survey sent out at the beginning of the year. Many of you may remember that I handed out a similar survey at the Indiana Chapter meeting in the spring. From this survey it was found that the four major topics on surgeon’s minds are 1.) Professional liability/Patient safety, 2.)Tort Reform, 3.) Physician Reimbursement, 4.) Medicare. There have been major steps taken by the college to impact these various concerns. The health coalition and liability group is a coalition of 75 organizations of which the chair is from the American College of Surgeons. This effort is generally a legislative effort. They have been effective in having the house support two bills regarding liability. However, such legislation can not get through the senate. Dr. and Senator Frishe has proposed such legislation two times and the maximum number of votes obtained was 49. Obviously 60 votes are needed to pass the bill for it to become law. This will be a major effort of the PAC in the coming years. The college has also been involved with doctors for medical liability reform. This is a public awareness effort such as white coat house calls to inform patients of problems and ads specifically targeting public awareness of patients and business to the plights of some surgeons in certain states. This seems to have been very effective. In terms of reimbursement, the college has been active in changing the medicare payments to allow a 1.5 increase over the last and coming year. They are actively involved in the 5 year RVU review. They have gone to congress many times to support the trauma system bills. Stark Phase 2 laws have been somewhat beneficial and have liberalized physician ownership especially in rural areas, publicly traded securities and mutual funds can be owned by physicians and community wide health information dissemination may become a possibility. A negative impact of Medicare has been a decrease in the payment for drugs provided in physician’s offices. This will have an impact on how one pays nursing care during this administration as well as the IV bags etc. that must be used to deliver drugs. This cannot be taken lightly and will be addressed. The Oncologists have already recouped their loss by bringing it to the CMS and I think that the surgeons must do the same. The college has also been instrumental in supporting residents during their time of training. Currently re-payment has to take place after three years of training if there is a certain debt to income ratio. It is the idea of the college that this ought to be extended to the entire period of training. This is embodied in an economic hardship deferment bill which is being proposed. Also, the College has also been instrumental in helping ophthalmologists and plastic surgeons in their dealings with the VA and the quest for non-physicians to perform certain surgical preventions.

The final topic which I which to stress to the membership is that it is critical for them to support the PAC. The PAC is the only way that we can influence public awareness and have any impact on Congress and their actions. Only 1, 000 out of 40,000 potential contributors have given to the pact for only $387, 000 over the last year. This is severely less than the lawyers who contribute approximately 3 million per year to their PAC. If every member gave even one hundred dollars per year we could have a significant impact on what happens outside our normal sphere of influence. It should be noted that this effort is based upon specific concerns and is not a party issue. The college will support any legislator, irrespective of party affiliation, if they support the concerns of the ACS membership. I believe this is critical and should be considered by all members.