This past year, the American College of Surgeons (ACS) has sought to implement many changes that the leadership believes respond to the growing concerns of surgeons in all specialties and at all phases of their career, as well as the evolving needs of surgical patients throughout the world.
Advocacy and Health Policy
The Bipartisan Budget Act of 2018, P.L. 115-123, was enacted in February and addresses many key physician and patient issues, including important technical corrections to the Merit-based Incentive Payment System (MIPS), which was established under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA).
Key provisions in the Bipartisan Budget Act include the following:
- A 10-year funding extension for CHIP
- Language that eases electronic health record (EHR) meaningful use requirements
- Funding to address the opioid epidemic and support the work of the National Institutes of Health (NIH)
- Repeal of the Independent Payment Advisory Board
Frank G. Opelka, MD, FACS, Medical Director, Quality and Health Policy, ACS Division of Advocacy and Health Policy (DAHP), testified July 26 at a U.S. House Committee on Energy and Commerce Health Subcommittee hearing on MACRA and MIPS. Most of Dr. Opelka’s testimony centered on difficulties that have resulted from the Centers for Medicare & Medicaid Services’ (CMS) implementation of the law. Dr. Opelka said CMS needs additional guidance from Congress and stakeholders to ensure the intent of MACRA—to move the physician payment system toward quality and value—is upheld. In addition, the ACS expressed interest in working with CMS to develop quality and cost measures that are relevant to surgery.
The ACS responded to proposals in the 2019 Medicare Physician Fee Schedule proposed rule on changes related to evaluation and management (E/M) codes. The proposals fall into two categories: documentation and payment. The ACS generally supported the documentation changes, the most significant of which would allow clinicians to document E/M using medical decision making or time spent providing services.
The ACS opposed proposals that combined payment for levels 2 through 5 office/outpatient E/M, along with various modifications that CMS put in place to avoid significant changes in payment for the specialties that would have been most affected by this policy. The biggest concerns include a primary care add-on code, a specialty care add-on code that most surgeons cannot use, and a new E/M for podiatry.
The ACS provided feedback on seven significant changes in the 2019 proposed rule pertaining to MIPS: an increase in the overall performance threshold, adjustment of the quality and cost performance category weights, redefinition of the low-volume threshold, the new clinician opt-in proposal, the requirement to use 2015 certified EHR technology, adjustments to the small practice bonus, and the use of facility-based scores for the Quality and Cost performance categories.
The College met twice with Anthem regarding the insurer’s policy to use medical necessity criteria to shift outpatient procedures from hospital-based facilities to ambulatory surgical centers (ASCs) and physician offices. At these meetings, the College made the following requests: an opportunity to review a list of the policy’s applicable Current Procedural Terminology (CPT) codes, information regarding when the policy will be rolled out and enforced, and details about whether and how Anthem intends to rebalance payments for other hospital services.
To combat administrative requirements that impede surgeons’ ability to provide timely, high-quality care, the ACS launched the Stop Overregulating My OR (SOMO) initiative. Through this campaign, the ACS highlights specific regulatory and legislative actions to reduce administrative burdens and enable surgeons to reinvest time and resources in patient care.
With the SOMO initiative, the DAHP has positioned the College at the forefront of regulatory relief, allowing the ACS to provide meaningful feedback to government officials regarding the impact of unnecessary regulations on clinical workflow and surgical care. As a result, the government removed redundant or outdated clinical documentation requirements and initiated efforts to improve the interoperability of EHRs.
The ACS has supported efforts to pass the Mission Zero Act, H.R. 880, which authorizes $15 million in grant funding to help civilian trauma centers that partner with military trauma professionals and creates a pathway to provide patients with excellent trauma care in times of peace and conflict.
Education
The ACS Academy of Master Surgeon Educators inducted its first class of Members and Associate Members October 3. The Academy’s goals are to recognize Master Surgeon Educators, advance the science and practice of surgical education and training, foster innovation and collaboration, support faculty recognition, and underscore the importance of surgical education and training.
Plans are under way to design a Certificate Program in Applied Surgical Education Leadership for surgeon educators who have successfully completed specific faculty development courses and possess sufficient experience in surgical education.
The ACS also has launched a new Comprehensive Faculty Development Program to address national needs through courses and products that are anchored to the four levels of professional accomplishment—Teacher, Master Teacher, Educator, and Master Educator.
The ACS has formed a Steering Committee for Retraining and Retooling of Practicing Surgeons composed of leaders from the surgical specialties and other key stakeholders. The committee’s focus is on defining standards for surgeons to hone their skills and on establishing a national infrastructure to achieve the best outcomes. The ACS-Accredited Education Institutes (ACS-AEIs) will be at the center of this infrastructure.
The Committee on Coaching the Next Generation is charged with engaging senior surgeons who are winding down their clinical practices and want to remain professionally active in the College’s education and training programs. The committee’s focus is on training senior surgeons to use simulation-based teaching methods and engaging senior surgeons in coaching of surgeons and surgical trainees.
An Introduction to Simulation-based Teaching Course for senior surgeons was developed and offered at the ACS-AEI at the University of North Carolina at Chapel Hill. Senior surgeons who participated in the two-day course acquired fundamental knowledge of simulation-based surgical education, participated in hands-on simulation-based experiences, and taught novice learners a number of procedures using simulation.
At the 2018 Annual Surgical Simulation Summit, a Special Session linked course participants with leaders of ACS-AEIs and facilitated involvement of the trained senior surgeons in teaching activities at ACS-AEIs.
The Committee on Emerging Surgical Technology and Education is being reconfigured with a new charge and will continue to play a pivotal role in evaluating new technology, providing guidance regarding the appropriate time for introducing new technology into surgical practice and training in new technology.
The Fundamentals of Laparoscopic Surgery® (FLS) program, now in its 14th year, is a collaborative program between the Society of American Gastrointestinal and Endoscopic Surgeons and the ACS. The American Board of Obstetrics and Gynecology recently announced that completing the FLS will become a requirement for board certification in that specialty.
The ACS continues to be involved in the Component Group on Simulation of the Council of Medical Specialty Societies (CMSS). The four areas of interest for the group are cognitive, clinical, technical, and nontechnical skills. At the Annual CMSS Meeting in November 2017, the leaders of the Continuing Professional Development Directors and the Information Technology (IT) and Informatics Directors were invited to share a forum with leaders of the Simulation Component Group to discuss specific opportunities for collaboration.
The ACS Entering Resident Readiness Assessment (ACS-ERRA), which launched in May, is an online, case-based program to assess the clinical decision-making skills of entering surgery residents focused on cases frequently encountered at the beginning of resident training. The ACS-ERRA measures key skills needed to safely assume new clinical responsibilities.
Another ACS simulation-based program aimed at surgical residents includes 10 Objective Structured Clinical Examination (OSCE) stations focused on patient safety. A comprehensive package, including videos and practical information relating to implementation of the OSCE, is available.
The Mastery in General Surgery Program has evolved from the Transition to Practice (TTP) Program in General Surgery. Experiences from the TTP Program have yielded invaluable information regarding individualized training in diverse locations with different mentors and strategies to provide sufficient autonomy to increase confidence and competence in early-career surgeons. Steps are being taken to build on this foundation with an emphasis on practice management, business skills, negotiation skills, risk management, quality improvement, and organizational leadership, in addition to the core clinical training.
The ACS/Association of Program Directors in Surgery Surgery Resident Skills Curriculum is aimed at the training needs of surgery residents through simulation. Phase I modules focus on basic surgical skills and tasks; these modules have been reviewed and revised in the last three years. Revised modules include enhanced demonstration videos and new assessment tools that permit summative assessment of proficiency. Specifically, skills stations for Objective Structured Assessment of Technical Skills (OSATS) have been added, along with a guide for administering OSATS. Review and revision of the Phase III modules that focus on team-based skills are under way. The Phase II modules on advanced procedures will be addressed next.
At Clinical Congress 2018, the Resident and Associate Society (RAS-ACS), Division of Member Services, and Division of Education offered a two-day joint program focused on preparing residents for practice.
The ACS has partnered with the Association of Surgical Educators (ASE) to develop a Medical Student Simulation-based Surgical Skills Curriculum, which includes 25 simulation-based modules for year-one to year-three medical students. A number of articles describing use of the curriculum have been published, and a presentation at the 2018 Surgical Education Week centered on alignment with Entrustable Professional Activities. An ACS/ASE Medical Student Core Curriculum also is in development, which will focus on the cognitive skills all medical students should develop before graduation.
A new Surgical Professional Home Care Training Course is being designed to ensure a well-trained patient education workforce. Through a new Patient Education Committee of the ACS-AEIs, training programs focusing on complex postoperative outcomes after hospital discharge are being developed. The first pilot launched in October 2018.
Education for Better Recovery is for cancer patients and includes instructional media, skill demonstrations, and checklists. The program meets the National Patient Safety Joint Commission standards and the Commission on Cancer (CoC) accreditation guidelines.
Informed Surgical Prep Brochures and e-learning materials support patients at all levels of literacy using images and conversational language to explain surgical processes, risks, and discharge education. The materials are available in English, Spanish, and Italian.
The Safe and Effective Opioid Use and Pain Control Program offers professional and patient resources, including patient brochures, office signs, and professional courses, which were developed with input from all surgical specialties, health systems, nursing organizations, and patients. The resources are aimed at educating patients and caregivers about informed choice, safety for opioids, and nonopioid alternatives.
The Consortium of ACS-AEIs is working on a new Maintenance of Accreditation model that would involve assessment of outcomes and review of robust annual reports with longer accreditation cycles. This new model has been phased in over the last year.
The ACS CME Accreditation Program ranks as one of the largest within the Accreditation Council for Continuing Medical Education (ACCME) provider system. The CME Accreditation Program encompasses all ACS educational programs that provide CME credits, as well as the Joint Providership Program, which now includes most U.S. surgical societies.
Steps are being taken to support surgeons’ efforts to meet regulatory requirements for Continuing Certification and relicensure. Enhancements have been made to the collection, review, and analysis of Self-Assessment questions and responses as part of CME activities. To support surgeons’ efforts to comply with state requirements, an interactive listing of state mandates has been created as a reference source for practicing surgeons.
A new learning management system (LMS) has been successfully deployed to support many ACS education and training programs. Several programs are being transferred to this new LMS.
Member Services
The ACS has 80,979 members; 64,587 of these individuals are Fellows (56,727 U.S.; 1,263 Canadian; and 6,597 International). The College also has 2,773 Associate Fellows, 10,480 Resident members, 2,689 Medical Student members, and 450 Affiliate members. The ACS welcomed 1,970 Initiates during Convocation at Clinical Congress 2018.
As part of its recruitment strategy, the ACS has revised member benefits brochures and corresponding web pages for each category of membership. Furthermore, the Division of Member Services has developed two campaigns for graduating residents—one to encourage the transition to Associate Fellow membership and one to encourage membership renewal. The division also created a survey for senior and retired Fellows to determine the types of services and resources they need from the College. Projects for 2019 include the development of an ambassador and mentorship program, a new member onboarding process, international member resources, and a specialty member recruitment campaign.
In January, ACS chapters were asked to complete an annual report on their efforts in the following areas: administration and management, member recruitment and retention, communications, finances, advocacy, and educational programming and events. The leadership of each chapter received a report with suggested areas of focus.
The College continues to assist international chapters in implementing and promoting ACS programs through improved communication and analysis of data from the 2017 International Chapter Annual Reports to prioritize and determine next steps, among other efforts.
The ACS has 289 Governors: 158 Governors at-Large, representing each U.S. state and Canadian province; 86 specialty society Governors; and 45 international Governors.
In June, the Board of Governors Executive Committee held its annual Strategic Planning Retreat, during which committee members evaluated the work of the Pillars and Workgroups, developed future plans, and finalized preparations for the Annual Business Meeting at Clinical Congress. The efforts of the Pillars and their Workgroups are summarized in the October Bulletin.
The Advisory Councils continue to work with the Central Judiciary Committee (CJC) to review expert witness testimony, nominate members for boards and specialty review committees, and recommend members to represent the ACS on specialty guidelines authoring and review panels. A new Advisory Council for Oral and Maxillofacial Surgery was approved by the Board of Regents in June.
The Young Fellows Association (YFA) offered new Mentor Program Workshops for young Fellows at the Leadership & Advocacy Summit and Clinical Congress and continues to offer a Speed Mentoring Program at Clinical Congress. The YFA also has created a new speakers bureau and published 12 essays online that address the joy and privilege of patient advocacy.
The RAS-ACS offered 16 webinars for Associate Fellows in 2017–2018 and formed an Associate Fellow Workgroup that created a Becoming an FACS campaign.
Members of the RAS wrote an article on drug shortages that was published in the November Bulletin and an article on EHR for the Journal of the American College of Surgeons (JACS). In addition, more than 20 residents contributed articles on autonomy for the August Bulletin. The RAS collaborated with the Division of Education on a two-day Surgery Resident Program at Clinical Congress, as noted previously, and led a Resident-get-a-Resident Campaign.
The International Relations Committee engaged in multiple efforts to improve the experiences of international members and guest physicians. For example, it implemented a new interview process for International applicants for Fellowship and invited 21 international scholars and travelers to Clinical Congress 2018. Three international scholars participated in the 2018 ACS Quality and Safety Conference, and three attended the Surgical Education: Principles and Practices course at Clinical Congress. The 2018 ACS/American Society of Breast Surgeons (ASBrS) International Scholar attended the annual meeting of the ASBrS and visited the ACS National Accreditation Program for Breast Centers (NAPBC); likewise, the ACS/American Association for the Surgery of Trauma (AAST) International Scholar attended the annual meeting of the AAST and visited the ACS National Trauma Data Bank®.
In the aftermath of Hurricane Maria in September 2017, Operation Giving Back (OGB) has been working with state Departments of Health and local nongovernment organizations to create an infrastructure for the efficient use of volunteers. A new domestic partnership with Health Career Academy—a surgeon-led domestic volunteerism effort—also is under way.
On the international front, OGB has been working to develop an ACS-COSECSA (College of Surgeons of East, Central and Southern Africa) Surgical Training Collaborative. Details about this initiative were published in “Looking forward” in the November issue of the Bulletin.
Five women surgical residents were awarded ACS-COSECSA scholarships in cooperation with the Association of Women Surgeons. This scholarship is intended to promote gender equity in the surgical workforce.
OGB members participated in the 2018 Leadership & Advocacy Summit and met with leadership at Fogarty International at the NIH to discuss grant opportunities. In addition, OGB applied to the World Health Organization to participate as a non-state actor, which would allow the ACS to play a larger role in global surgery advocacy.
OGB’s volunteer database registration continues to grow, comprising 69 registered partner organizations that provide ongoing volunteerism opportunities and 519 registered surgeon volunteers.
The Military Health System Strategic Partnership ACS (MHSSPACS) has convened two meetings of military and civilian participants to discuss and codify best practices for military-civilian partnerships (MCPs) for trauma training and sustainment. Proceedings of the first meeting were published in JACS. The committee has initiated work on a manual to assist in the selection criteria and performance evaluation for MCPs and conducted a mock trauma site visit at Tripler Army Medical Center, HI.
MHSSPACS convened the annual two-day Military Health System/Surgical Quality Consortium, which included Military Treatment Facility Surgeons Champions and Surgical Clinical Reviewers. The consortium also initiated efforts for a site visit to Walter Reed Military Medical Center, Bethesda, MD, based on the ACS Optimal Resources for Surgical Quality and Safety, (also known as the Red Book) and reviewed the dashboard of ACS National Surgical Quality Improvement Program (ACS NSQIP®) data across the entire MHS.
MHSSPACS also has developed two 200-item tests to assess the knowledge points of expeditionary military surgeons. Both tests are being beta tested to develop a passing cut score.
The Excelsior Surgical Society hosted an annual full-day educational program at Clinical Congress. The society is developing social media streams, an ACS Military Community, an online platform for dues collection, and bylaws.
Among its activities, the Women in Surgery Committee (WiSC) administers the Women Surgeons Community, which has more than 5,300 members. This year, WiSC played an important role in developing a revised Statement on Intimate Partner Violence and will be collaborating with the Intimate Partner Violence (IPV) Task Force to develop and disseminate resources to assist surgeons in addressing IPV.
The IPV Task Force was formed in January to raise awareness about IPV in the surgical community; educate surgeons to recognize IPV in themselves and their colleagues; provide resources for survivors; and create resources and curricula in partnership with other national professional and educational organizations.
In addition to working with the WiSC to develop the revised ACS Statement on Intimate Partner Violence, the task force has developed a brief survey that will be deployed to ACS members by the end of 2018 to gauge the level of awareness, incidence, and educational needs of surgeons as they relate to IPV. Details about IPV Task Force activities were published in the October Bulletin.
The Committee on Diversity Issues has updated the ACS Statement on Diversity and is presenting a webinar on cultural competency and unconscious bias as part of the RAS webinar series. In the last year, the committee created resources aimed at needs assessment tools, cultural competency at work, recognition of implicit bias, and development of diverse surgical teams. The committee is working on a project to spotlight ACS Fellows who have overcome obstacles or created or led diversity initiatives at their institutions.
Since 2010, the Society of Surgical Chairs (SSC) has grown from 157 to 189 members. The agenda for the 2018 annual meeting focuses on diversity and inclusiveness in academic surgery.
More than 500 ACS leaders and members attended the Leadership portion of the ACS Leadership & Advocacy Summit May 19–20 in Washington, DC. Details about this program were published in the August Bulletin.
The ACS Archives responded to 169 research requests in 2017–2018, including 13 in-person research visits. The Archives has received 31 new accessions.
The Surgical History Group sponsored the Surgical History Poster Session at Clinical Congress, and the first Archives Fellowship was awarded this year. The recipient received $2,000 and will use the Archives to study how World War I accelerated the transfer of global leadership in Europe to the U.S.
Continuous Quality Improvement
More than 1,800 health care professionals attended the 2018 ACS Quality and Safety Conference July 21–24 in Orlando, FL. The conference theme, Partnering for Improvement, showcased the value of a collaborative approach to quality and safety improvement. Details about the conference were published in the October Bulletin.
More than 825 hospitals participate in ACS NSQIP—705 in ACS NSQIP Adult and 121 in ACS NSQIP Pediatric—representing a growth of 3 percent in the last year. Approximately 70 percent of ACS NSQIP Adult hospitals participate in more than 55 collaboratives; several others are in development.
ACS NSQIP sampling was streamlined and released with the launch of a single platform for all ACS quality databases in 2017. Sites now can select a mix of cases from targeted and specialty areas. A single participation module allows sites to measure outcomes in their clinical areas of choice.
Beginning with the July 2018 Semiannual Report (SAR) cycle, ACS NSQIP Adult, ACS NSQIP Pediatric, and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) are all using the same dual-criteria approach to identify sites that are “Exemplary” or “Need Improvement.”
Since 2014, ACS NSQIP has been working with the American Society for Transplant Surgeons (ASTS) on the TransQIP Pilot Project to capture variables on patients undergoing liver and kidney transplants. No other established database collects comparable data, essentially filling a gap in surveillance and data collection for the transplant community.
The Children’s Surgery Verification (CSV) program launched in January 2017. Consequently, enrollment in ACS NSQIP Pediatric has increased by 12 percent to 121 active sites. Approximately 45 of these centers are in the various stages of verification, and 11 are fully CSV-verified Level I centers.
The ACS NSQIP Pediatric Process Measures Pilot project concluded this fall. The Process Measures Pilot was developed to prompt local cross-disciplinary quality improvement at individual institutions by allowing sites to assess their readiness to deliver care for urgent diagnoses. A comprehensive report has been developed for the 46 participating hospitals.
MBSAQIP has 894 participating sites, 804 of which are fully accredited—a growth of 5.5 percent from last year. From October 2014 through August 2018, surveyors completed 1,186 MBSAQIP site visits.
MBSAQIP’s national enhanced recovery initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (ENERGY) recently concluded. The 36 participating centers measured adherence to the enhanced recovery process measures. Preoperative, immediate postoperative, and long-term postoperative data and patient experience information also were collected. Overarching goals of the ENERGY project were to enhance the patient experience through improved pain management, fewer opioid side effects, decreased readmissions, and quicker return to normal activity.
The new Surgeon Specific Registry (SSR) launched on the new ACS Quality Data Platform in 2017 and continues to evolve. The following reporting options are available through the SSR for surgeons participating in the 2018 MIPS performance year:
- General Surgery Specialty Measures Set (MIPS-Qualified Registry)
- ACS Surgical Phases of Care Measures Set (MIPS-Qualified Clinical Data Registry)
- ACS Trauma Quality Measures (MIPS-Qualified Clinical Data Registry)
Participation in any set of measures allows for the inclusion of reporting Improvement Activities (IA) to CMS. A total of 591 surgeons submitted MIPS 2017 data using the SSR; 396 participated in the General Surgery Specialty Measures Set and 19 in the ACS Surgical Phases of Care Measures Set quality reporting option. Other surgeons reported on the Quality and the IA components; 176 submitted IAs only.
Additionally, the SSR helps surgeons meet regulatory requirements, such as the ABS Continuous Certification program requirements, including the submission of the 12-month case log. More than 1 million cases have been entered in the new SSR, with a user base of approximately 5,000 surgeons.
All ACS clinical data platforms continue to migrate into the single ACS Quality Data Platform to allow a common data entry platform, data warehouse, and advanced reporting and data visualization tools. Another part of the project is designed to improve data quality and reduce the data entry burden through the use of an EHR Adapter, which will allow certified EHRs to communicate directly to the platform to upload surgical case data. The EHR Adapter has successfully been piloted at several ACS NSQIP sites.
Finally, the new platform will incorporate both financial data and patient-reported outcomes (PROs) to give participating hospitals insights into the value of care they are providing as well as the quality of that care. PROs are being piloted within ACS NSQIP and MBSAQIP and used by the SSR.
Strong for Surgery (S4S) released an online toolkit in July 2017. Subsequently, the program grew from 110 sites to 346 sites (300 percent) from July 2017 to August 2018. The four original S4S checklists include nutrition, medication, blood glucose control, and medication. Four new checklists were introduced at Clinical Congress 2018 centered on delirium, prehabilitation, advance directives, and safe and effective pain control.
The Coalition for Quality in Geriatric Surgery (CQGS), a four-year project funded by the John A. Hartford Foundation, aims to improve care for older patients through standards, verification, measures, and education. The third year of the project recently concluded with several milestones reached, including the launch and completion of an eight‐hospital beta pilot, release of the CQGS Beta Pilot Resource Manual, and testing of the verification processes and standards implementation. The Core Development Team conducted eight site visits in June and July to determine the feasibility of implementing the standards.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Surgical Care and Recovery (ISCR) is a collaborative program between the ACS and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, to enhance the recovery of the surgical patient. ISCR is designed to improve clinical outcomes through evidence-based enhanced recovery pathways. A total of 132 hospitals participated in the first colorectal cohort, which began in July 2017. At present, 130 hospitals are focused on the second colorectal surgery cohort, and 119 are focused on the first orthopaedic, with a gynecology cohort set to begin in March 2019. Read more about ISCR on page 16 of this issue of the Bulletin.
The College released the Red Book in July 2017. To date, 9,000 copies have been disseminated, and surgeons in China and Brazil have requested copies translated into their languages. The College is developing adjunctive resource standards aligned with the Red Book to develop a Surgical Quality Verification Program. An initial draft of the standards has been completed, and pilot site visits began this summer.
The College is developing standards for other subspecialties. A steering committee has been appointed to develop standards and a verification program for high-risk gastrointestinal surgery. The College also has begun work with the Society of Vascular Surgeons and the Society of Thoracic Surgeons (STS) to develop verification programs. Workgroups in rural and emergency general surgery have convened and drafted preliminary standards.
The Surgical Research Committee (SRC) continues to contribute to the series “Profiles in surgical research” in the Bulletin. In addition, the SRC selected the recipient of the 2018 Jacobson Promising Investigator Award. The SRC’s 2018 Health Services Research Methods Course will take place December 6–8. Approximately 50 attendees are expected.
At present, the ACS has five Clinical Scholars in Residence. Two scholars are working on the CQGS program, two are focused on ISCR, and the fifth scholar is focusing on quality in complex oncologic and high-risk gastrointestinal surgery.
Cancer
Heidi Nelson, MD, FACS, Mayo Clinic, Rochester, MN, has replaced David P. Winchester, MD, FACS, as Medical Director of ACS Cancer Programs. See the November Bulletin for details.
At present, 1,533 programs have CoC accreditation, 647 are NAPBC accredited, and three are National Accreditation Program for Rectal Cancer (NAPRC) accredited.
The CoC standards are being rewritten to strengthen the focus on improving patient care, eliminate redundancies, retire the commendation criteria and Outstanding Achievement Award, and introduce standards from Operative Standards for Cancer Surgery (OSCS), Volume 1.
The National Cancer Database (NCDB) is being integrated into the ACS single-platform quality registry. To this end, a Rapid Cancer Reporting System (RCRS) has been developed to simplify data submission, decrease the time between diagnosis and reporting to the NCDB, and integrate a platform for data-driven quality measures for CoC, NAPBC, and NAPRC institutions.
The NCDB completed a call for data in 2018. To support launching the RCRS system, this year’s call was a full analytic caseload from 2004 to 2016. More than 16.9 million cancer patient records were submitted; 1.47 million were new cases diagnosed in 2016, representing approximately 70 percent of all newly diagnosed cases in the U.S.
The Participant User File (PUF) program accepted 904 applications from principal investigators affiliated with CoC-accredited hospitals in 2017. To date, approximately 1,200 peer-reviewed publications have cited NCDB PUF data.
The fourth annual Cancer Quality Improvement Program (CQIP) report was released in February. The CQIP report contains 30- and 90-day mortality for six complex operations, risk-adjusted survival, and a facility-specific top 10 disease sites by volume.
The Cancer Liaison Program (CLP) collaborated with DAHP to host a Virtual Hill Day in conjunction with the 2017 Cancer Conference. CLP members also attended an October 2017 meeting of the National Colorectal Cancer Roundtable’s Hospital/Health Systems Advisory Group & Professional Education and Practice Implementation Task Group to develop strategies to increase screening rates; hosted the Fall 2017 Comprehensive Cancer Control National Partners meeting; served as faculty for the American Psychosocial Oncology Society’s project on distress screening; and participated in the Centers for Disease Control and Prevention’s (CDC’s) Cancer Conference.
The ACS Clinical Research Program (CRP) has released OSCS, Volume 2, focused on esophagus, gastric, rectum and thyroid cancer, and melanoma, and members of the CRP interviewed five surgeon researchers for videos that are being posted incrementally on the ACS website.
ACS CRP has submitted a proposal to serve as subcontractor on the Dissemination & Implementation of a Decision Support Tool for Contralateral Prophylactic Mastectomy project. The program also has received approval of three NCI Community Oncology Research Program Cancer Care Delivery Research (CCDR) protocols, two of which are surgery-focused, and has applied for CCDR section for the NCORP grant renewal through the Alliance. Moreover, the ACS CRP has completed work on the Optimizing the Effectiveness of Routine Post-Treatment Surveillance in Prostate Cancer trial.
The standards in the American Joint Committee on Cancer’s Eighth Edition Cancer Staging Manual went into effect January 1. The transition year provided the oncology community the time necessary to properly implement the eighth edition and ensure higher-quality data collection into the NCDB.
Trauma
The Committee on Trauma (COT) celebrated its quadrennial change of leadership. Eileen Bulger, MD, FACS, is COT Chair; Ronald Stewart, MD, FACS, is Medical Director, Trauma Programs; and Patrick Reilly, MD, FACS, is Vice-Chair, COT, and Chair, Regional Committees on Trauma.
The COT embarked on a strategic planning process to define its direction for the next three to five years. Strategic priorities include member engagement, global engagement, education, trauma systems, quality, injury prevention, and advocacy.
A total of 800 hospitals and 15 collaboratives participate in the Trauma Quality Improvement Program (TQIP).
The 2018 TQIP Conference took place November 16–18 in Anaheim, CA. Sessions of note this year focused on TQIP collaboratives, the TQIP Academy, mass casualty incidents in a new era, the halo effect of trauma quality improvement, and the continued integration of ACS trauma programs.
The ACS Firearm Injury Prevention Strategic Workgroup has developed a nine-point action plan on firearm injury prevention. The Firearm Strategy Team workgroup, composed of firearm-owning Fellows, recently released a consensus statement. An ACS membership survey on topics related to firearm injury prevention has been conducted.
The COT has developed Best Practice Guidelines for Imaging in Trauma, which consolidates recommendations from existing guidelines of national organizations and provides concise, evidence-based protocols and practices. In addition, performance indicators have been identified to evaluate imaging services.
The 10th edition of the Advanced Trauma Life Support® (ATLS®) course launched January 22, and the mobile version (mATLS) is being piloted at 36 sites. In addition, an online update course leveraging the ACS LMS platform launched in August; 221 individuals have registered for the course, and 73 have completed the online training. The COT has embarked on a Global Trauma Education Initiative that combines some foundational principles of the ATLS course.
The Advanced Surgical Skills for Exposure in Trauma (ASSET) program has experienced a surge of international growth in the last year, with courses now offered in South Africa, Australia, Finland, and Estonia. Expansion in the U.S. has been pronounced as well, with 14 new course sites added in 18 months.
Basic Endovascular Skills for Trauma has added six course sites in the last year and now has a total of nine sites in the U.S. The Pan-American Trauma Society Congress in August included the second international workshop version of the course. A plan for global dissemination is being developed.
The ACS Stop the Bleed® (STB) program has trained hundreds of thousands of civilians and has nearly 30,000 registered instructors across the U.S. and in 77 other countries. The bleedingcontrol.org website is the primary information repository for both the public and instructors, containing training and informational materials and a course search function. The site also houses a private instructor portal through which the instructor processes are managed, instructor materials are maintained, and courses are managed. The bleedingcontrol.org website had 909,768 page views August 1, 2017, through July 31, 2018.
Integrated Communications
The Division of Integrated Communications (IC) has added new content to the ACS website, including a resource section on opioids, information on the Academy of Master Surgeon Educators, a section on the SOMO campaign, and ACS Case Reviews in Surgery. From August 1, 2017, through July 31, 2018, the ACS website had approximately 10.6 million page views.
In terms of the ACS public profile, the ACS promoted the first National Stop the Bleed Day March 31 with an advance national press release and informational video explaining how this occasion presents an opportunity to take or teach a bleeding control course. This effort garnered 76 media mentions, citing the ACS as a key player in the STB movement, with articles running in the Washington Post, Chicago Tribune, Indianapolis Star, and EMS World Online, as well as mentions on local media outlets.
The College’s Out of the Crucible Capitol Hill Briefing for congressional staffers July 23 brought attention to the importance of the Mission Zero Act, military-civilian partnerships, and the work of MHSSPACS. A press release was distributed on PR Newswire the afternoon of the event on July 23, which was picked up by 216 news outlets and was viewed 2,435 times. Live tweets from the event received a combined total of 19 retweets and 23 likes, and a Facebook post received 25 likes, two shares, and reached 2,147 people.
The work of the CQGS has been highlighted in Kaiser Health News, CNBC, and U.S. News and World Reports. Furthermore, the work the surgical community is doing to limit or eliminate surgical patients’ exposure to opioids has been reported in the Baltimore Sun, ABC News online, and Health Leaders Media.
Other media mentions for the College in the last year include bleeding control training and kit stories in TIME Magazine and Newsweek; a Wall Street Journal article on the need for better screening to detect cancer before gynecological procedures; and a report in San Antonio Express on the COT’s efforts to lead a national consensus-based discussion on firearm injuries. The media team also promoted two articles published online in JACS reporting that many women feel uninformed about their breast cancer treatment options and a new decision-making tool as a potential solution to the problem. More than 40 news outlets covered this story.
Google Analytics data showed that the Bulletin website is widely accessed since its transition to a mostly online publication in January 2017, with the number of hits climbing to 449,121 in 2017 from 361,473 in 2016—a 24.25 percent increase. The total number of page views increased 27.58 percent to 565,563 in 2017 from 443,296 in 2016. In September 2018, the Bulletin website had a total of 72,333 page views and 63,061 unique page views.
Bulletin online readers can now comment on articles. This feature will be useful in determining the content of most interest to readers and will make reading the publication a more interactive experience.
To ensure members can read the publication in the format they prefer, all domestic members may now opt in to receive the Bulletin in print. The total number of print copy recipients exceeds 6,000.
Staff continues to work to streamline and modernize ACS NewsScope. Plans are under way to make ACS NewsScope a biweekly publication, with one issue focused on advocacy and health policy and the other on education, quality, and other programs.
JACS is on track to convert 40 percent of College members to an online-only format in the near future and recently launched a monthly electronic table of contents, which is distributed via e-mail to all ACS members eligible to receive JACS.
In 2018, JACS’ impact factor increased by 10 percent to 4.767, ranking it in the top 10 surgery journals.
The College’s social media presence continues to grow. The 117 ACS Communities continue to attract a range of members. In its first four years, the Communities have become home to more than 5,300 unique discussion contributors who have posted 75,000 messages in 10,376 discussion threads with more than 3.5 million page views.
Furthermore, the ACS continues to see upward trajectories on its Facebook, Twitter, and LinkedIn sites. By August 16, a total of 29,602 individuals had “Liked” our Facebook page. The ACS has 41,552 Twitter followers and now has 13,689 LinkedIn followers.
Demand for IC marketing and design services continues to grow, reflecting the growth and success of the ACS as a whole.
Over the past year, the ACS and Weber Shandwick have been developing the next phase of the Inspiring Quality campaign, which will focus on sharing an insider’s view of surgeons and why they are uniquely qualified to lead.
Weber Shandwick also is supporting ACS and the Health Services Platform Consortium to develop a strategy to address the health care data interoperability challenge by leveraging open-source tools and setting standards.
ACS Foundation
Thanks to the generous support of Fellows and ACS friends, the ACS Foundation experienced a 40 percent increase in individual contributions over the previous year. The Foundation continues to expand its portfolio of new projects and programs to expand its outreach to College Fellows. The Support a Medical Student campaign offers Fellows the opportunity to cover the cost of medical students attending Clinical Congress and provides mentoring opportunities.
Generous philanthropic gifts from Fellows continue to support OGB, international scholarship travel awards, fellowship research awards, as well as providing materials for STB training in rural communities.
Corporate grants secured by the ACS Foundation provided support for Skills Courses at Clinical Congress, Patient Education materials, and the first annual Residents Surgical Skills Competition.
Behind the scenes
The success of many of the programs outlined in this report is attributable not only to the staff and volunteers who work for the respective divisions, but to the individuals who work behind the scenes.
- The Convention and Meetings staff manages the Clinical Congress, internal and external meetings of the ACS, and the business affairs of several surgical associations and ACS chapters.
- The Facilities and Finance staff keeps our offices running and is leading our efforts to remodel and modernize the Chicago headquarters building.
- The Performance Improvement team aims to foster a culture of continuous QI that will catalyze rapid and sustainable change at the College.
- Human Resources ensures that our staff has access to competitive benefits for recruitment and retention of top talent.
- IT is playing an integral role in establishing the LMS, working with our vendor on the development of a single quality registry platform, and upgrading Aptify.
I’d like to thank all of the ACS volunteers and staff for their dedication to improving the care of the surgical patient. Through their hard work and commitment, the ACS continues to lead the way in ensuring all Americans have access to high-quality surgical care.
