The second annual American College of Surgeons Advocacy Summit took place April 14-16, in Washington, DC, in conjunction with the ACS Leadership Conference. The event rallies surgery’s collective grassroots advocacy voice, with more than 200 surgeon attendees learning about such topics as reforming the Medicare physician payment system, protecting the surgical workforce, and funding graduate medical education (GME) before spending a day on Capitol Hill meeting with their representatives and senators and congressional staff.
Understanding the issues
Health care costs continue to rise, particularly as baby boomers age and increase the demand services. The ACS Young Fellows Association (YFA) sponsored a panel at the Summit on the future of health care. Moderated by Scott Coates, MD, FACS, Vice-Co-Chair, the YFA Member Services Work Group, speakers included Gail Wilensky, PhD, senior fellow, Project Hope; Harold Miller, executive director, Center for Healthcare Quality and Payment Reform; and Frank G. Opelka, MD, FACS, Associate Medical Director, ACS Division of Advocacy and Health Policy.
Dr. Wilensky discussed physician payments, the cost of health care, and spending—topics that have recently gained traction. She expressed skepticism about whether programs such as accountable care organizations (ACOs) – designed to provide more coordinated, high quality care to Medicare patients – are the answer to physician payment woes. However, she said bundled payments,1 which encourage efficiency by offering a single payment to multiple providers of services delivered during a single episode of care or over a specific period of time, could result in lower costs.
Advocacy Summit participants
Dr. Miller, however, said that some accountable care arrangements may benefit surgeons and patients while reducing Medicare spending. Under the model he suggested, health care professionals would participate in a flexible, alternative payment and delivery system that best fits their practices and that delivers high-quality, efficient care.
The College has offered another option—the Value-Based Update (VBU), 2 noted Dr. Opelka. The VBU calls for replacing the sustainable growth rate (SGR) formula used to calculate physician payment with a system that improves outcomes, quality, safety and efficiency while reducing the growth in health care spending. Dr. Opelka noted that the VBU would combine the College’s century of experience in quality measurement to improve patient care and reduce costs,
Atul Grover, MD, chief public policy officer, Association of American Medical Colleges; Doug Henley, MD, chief executive officer, and executive vice president, American Academy of Family Physicians; and Samuel Finlayson, MD, MPH, Kessler Director, Center for Surgery and Public Health, Brigham and Women’s Hospital, offered distinct viewpoints on physician workforce issues. Dr. Grover discussed specialty choice among physicians and practice locations, deficit reduction plans, and incentives for surgical practice in rural areas. Dr. Henley provided data on what he believes are probable causes of the current workforce shortage and suggested possible solutions, including appropriately valuing and compensating primary care physicians to address the income gap between primary care and other specialties and reforming GME. Dr. Finlayson believes that increasing the number of surgeons is an "unwise response to the workforce crisis" and that "addressing geographic and specialty distribution is the main challenge."
Maria Ghazal, vice president and counsel of the Business Roundtable, which represents the interests of many of the nation’s largest companies, invited the College to collaborate on many issues, including the development of state insurance exchanges. Greg Gierer, vice president of policy, America’s Health Insurance Plans, agreed that collaboration can effectively address health care reform, particularly cost-containment. Mr. Gierer discussed health care cost and how insurers are leading changes in the marketplace through collaboration with providers and possible means of providing care to vulnerable populations through public-private cooperation. Harlan F. Weisman, MD, chairman and chief executive officer of Coronado Biosciences, Inc., talked about regaining the country’s status as the world leader in the development of pharmaceutical research and advancement.
The price of politics
Bob Woodward, Pulitzer Prize-winning journalist for The Washington Post and author of The Price of Politics, opened the Summit on Sunday evening as the keynote dinner speaker. He focused many of his comments on political investigative reporting, providing examples of events that have had a profound impact on today’s political climate, including President Bill Clinton’s impeachment and Vice-President Al Gore’s unsuccessful run for president. Mr. Woodward discussed his disappointment with the today’s media’s fact-finding methods, asking, "Why isn’t the media doing more?"
Mike Allen, chief White House correspondent for Politico and author of the Politico Playbook was the featured speaker at the Summit’s political luncheon. His talk centered on Barack Obama’s second presidential election bid and how the president’s reelection campaign effectively used technology-driven communications.