Board of Regents/Governors session examines the evolving role of the ACS in health care

Sunday’s Joint Meeting of the American College of Surgeons (ACS) Board of Regents (B/R) and Board of Governors (B/G) identified the College’s role in the future of health care, described surgeon engagement activities—including a communications strategy update—and provided a summary of ACS health policy initiatives in the areas of surprise billing and Medicare physician payment.

Steven C. Stain, MD, FACS, Chair, ACS B/G, moderated the session and underscored the importance of “bridging the communication gap” between College leaders and members of the organization. “You can have brilliant ideas, but if you can’t get them across, your ideas won’t get you anywhere,” said Dr. Stain quoting Lee Iacocca, the American automobile executive.

James K. Elsey, MD, FACS, Vice-Chair of the B/R, encouraged attendees to consider what will make the ACS relevant to surgeons five to 10 years from now and stressed the importance of “preserving the ACS brand.”

“The ACS is not exempt from the dangers that other organizations face,” Dr. Elsey added. “Our task is to engage in vigilant recognition of these threats,” including remaining relevant in an era of rapid technological evolution.

Mika N. Sinanan, MD, PhD, FACS, B/G Advocacy and Healthy Policy Pillar Lead, highlighted a few key trends that are applicable to the future of the ACS. He said strategy is critical at this time, adding that “strategy without tactics is the slowest route to victory.” The five key trends in health care, according to Dr. Sinanan, are: value-based payment (linking outcomes to cost); digital transformation and transparency; practice consolidation/employment; vertical integration by industry; and consumerism. Dr. Sinanan focused specifically on using digital communication to better equip patients to play an active role in their health care.

“Digital is not devices and it is not apps, but more the facile management of information, more contextualized mapping of the individual patient to the larger datasets,” Dr. Sinanan said. He noted that surgeons and patients need access to “trustworthy, relevant information and appropriate technology to make better-informed decisions about their health care options, both within and outside the clinical setting.”

During a presentation on the future of private practice, ACS Regent Beth H. Sutton, MD, FACS, outlined “the forces of change” affecting private practice, including the expense of maintaining a practice (primarily paying employees a competitive salary), administrative burdens related to electronic health records, and declining case volume.

“The expense of maintaining a practice requires we have the same levels of expertise in our offices that big institutions do,” Dr. Sutton said. Tied to those practice expenses are declining case volumes. “With the commercialization of health care, most patients choose their surgeon based on what their third-party payor will allow,” she noted. “This will not change and the future for private practice surgeons will be very different. The College needs to bring what we do best into the future—the essence of being a surgeon is one-on-one communication, and that is what makes our profession special.”

According to ACS Regent Fabrizio Michelassi, MD, FACS, hospitals are starting to question their investment in ACS Quality Programs. He said administrators are reconsidering their participation in these programs because of factors such as the cost of personnel assigned to the programs, yearly cost for participation, costs related to site visit prep, and the cost of the verification visit itself.

“In view of this questioning—which could undermine the incredible work being done by the College for quality improvement—we elected to form a task force called the Task Force on the Future of the ACS Quality Programs,” Dr. Michelassi said. “I think we need to decrease cost and increase the return on investment (ROI). We could decrease cost by bundling site visits and bundling ACS Quality Programs, and we could increase ROI with good data to negotiate with payors.”

The second half of the Joint Meeting focused on future trends in surgeon engagement. Robert Winfield, MD, FACS, Chair of the Young Fellows Association of the ACS, described the relevance of ACS programs to young surgeons, including tangible benefits such as the opportunity to participate in the Surgeon Specific Registry and ACS Coding Workshops. He also underscored the importance of less tangible benefits for young surgeons, including mentorship. “The relevance to young surgeons is also that emotional pull of being able to come to one place and see people who I trained with, or who I would like to learn from. You can get that from the ACS,” he said.

Closing out the Surgeon Engagement in the Future portion of the meeting, David B. Hoyt, MD, FACS, ACS Executive Director, provided an ACS Communications Strategy Update.

“Communication has transformed as much as anything we do,” Dr. Hoyt said. All associations are struggling to effectively communicate with their members and the public, he said, noting that “information overload/communication clutter” remain the most frequently cited communication challenges facing associations. “We have about 130 programs, and it can be hard to get all that information out,” he said.

Dr. Hoyt called for a “modern content operation” that “accounts for consumer shift to new consumption habits, understands its audiences (where they spend their time and how best to reach them), includes key performance indicators to measure impact, and identifies and mitigates risk.”

Dr. Hoyt announced the hiring of a new Director, ACS Division of Integrated Communications, and a plan to build out social media, revamp the website, and create a public-facing campaign as strategies to enhance ACS communication with ACS Fellows, health care policymakers, and members of the public.

A concurrent session with the International Governors Forum focused on legislative issues. The ACS Division of Advocacy and Health Policy (DAHP) tracked 43 issues in 2019—two of which topped the College’s agenda: surprise medical billing for out-of-network services and Medicare physician payment.

With respect to unanticipated medical bills, the big question is how much a health plan should pay physicians if physicians are barred from balance billing their patients, said Christian Shalgian, Director, ACS DAHP. He noted three proposed solutions, including independent arbitration (which the ACS supports), federal rate setting, and matching out-of-network payment with in-network payments.

With respect to Medicare physician payment, Mr. Shalgian noted that “the big problem is that the proposed increases for office visits do not make corresponding adjustments to the global surgical payments. This will lead to a 4 percent cut for general surgery, a 7 percent cut for thoracic, and on and on.”

Mr. Shalgian described the College’s advocacy-related efforts to challenge the Centers for Medicare & Medicaid Services (CMS) on these issues, including leading a surgical coalition, meetings with CMS staff, and public relations efforts to underscore the value of surgical care.