With a new administration and Congress in place, as well as many exciting internal changes, the American College of Surgeons (ACS) is looking forward to an exciting year ahead.
Making certain that surgeons have the tools they need to measure and evaluate their performance is a key mission of the College. To this end, we have initiated the database integration system, which will bring together under a single platform the ACS National Surgical Quality Improvement Program (ACS NSQIP®), National Cancer Database, National Trauma Data Bank, and Surgeon Specific Registry (SSRTM). This project, which is being implemented incrementally, will make it easier for surgeons to meet American Board of Surgery (ABS) Maintenance of Certification requirements and Medicare payment mandates.
Furthermore, the College intends to publish an ACS quality manual this year. This comprehensive guidebook will outline strategies and resources needed to ensure the delivery of optimal surgical care.
The Medicare Access and CHIP Reauthorization Act (MACRA), enacted in 2015, repealed the flawed sustainable growth rate (SGR) methodology that was used for many years to calculate Medicare physician reimbursement. Replacing the SGR is the Quality Payment Program (QPP), which advances a longstanding policy goal of basing payment on value rather than on volume.
Surgeons can participate in the QPP through one of two pathways—the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). MIPS is the default QPP pathway most physicians will use initially. The College has taken a number of steps to ensure that surgeons are able to comply with MIPS’ reporting requirements and performance measures. For example, we have created an online Resource Center () for surgeons seeking information about the QPP. In addition, we are working with health policy experts at Brandeis University, Waltham, MA, and Brigham and Women’s Hospital, Boston, to propose surgical APMs.
We anticipate that the new presidential administration and Republican-controlled Congress will leave QPP untouched—at least for a while. However, we also speculate that they will attempt to repeal at least some provisions in the Affordable Care Act (ACA). The ACS intends to play an active role in what is certain to be a highly charged debate—just as we did when the ACA was under consideration. As we enter this discussion, we will advocate for the policies that we believe will have the greatest benefit toward ensuring that all surgical patients have access to necessary services. We will not be swayed by politics but rather, will promote our enduring principles for health care reform: quality improvement and patient safety, patient access to surgical care, reduction of health care costs, and medical liability reform.
Surgical education and training have been at the heart of the College’s mission since the organization’s inception. We believe the ACS’ education and training programs are the cornerstones of excellence, transform possibilities into realities, and instill the joy of lifelong learning.
Of particular concern in recent years have been reports that a significant percentage of general surgeon residency graduates leave training feeling insecure about their ability to perform advanced procedures and to manage a practice. In response, the College launched the Transition to Practice in General Surgery program, which provides opportunities for recently graduated residents to engage in a period of mentored practice.
In addition, the College has been working with other stakeholders, including the ABS, the Accreditation Council for Graduate Medical Education, the Association of Program Directors in Surgery, and the Residency Review Committee for Surgery, to develop a road map to secure the future of general surgery. Concepts discussed in these meetings include the following:
- Medical student boot camps
- Further training after five years of general surgery residency
- Modification to duty-hour requirements
- Competency-based education and skills assessment
- Guidelines for self-assessment during residency
- A faculty development requirement
- Career-long record keeping, starting in medical school
Today’s residents are tomorrow’s surgeons. Given the aging population that will be seeking their services, it is imperative that the House of Surgery take responsibility for ensuring that graduates of general surgery training programs have the full range of skills and the confidence necessary to care for these vulnerable patients.
Member services and communication
Our Member Services area continues to develop programs that are designed to encourage surgeon engagement and well-being.
The 2017 Leadership & Advocacy Summit, May 6-9 in Washington, DC, will address such topics as team building, managing critical situations, burnout, common mistakes in leadership, and domestic volunteerism. During the advocacy portion of the meeting, members will have opportunities to flex their leadership muscle and advocate on their patients’ behalf.
The College recognizes that surgeons need to be mentally, emotionally, and physically healthy to provide optimal care to their patients. With this thought in mind, the ACS invites all active, dues-paying members to use the Physician Well-Being Index. This validated screening tool provides an opportunity for surgeons to better understand their overall well-being and identify areas of risk compared to physicians across the nation. Access to local and national resources will also be targeted to surgeons based on their results. Access the ACS Surgeon Well-Being page to learn more about the tool.
Furthermore, the College has continued to make its communications vehicles more interactive and user-friendly. The ACS Communities are thriving, allowing members to share their common concerns and interests in a protected environment. We also are working to have all of our major publications, including the Bulletin and the Journal of the American College of Surgeons, moved to fully digital platforms.
I am proud of the strides the College is making and look forward to an exciting and productive year. As always, please let us know how we can better serve you and your patients.
Dr. Hoyt is the Executive Director of the American College of Surgeons.