December 2001 Volume 86, Number 12

______FEATURES Stephen J. Regnier Editor A review of the Presidential Address: Medicine, government, and capitalism 8 Linn Meyer Director of The ACS chapters: Where do we go from here? 10 Communications Robert M. Quinlan, MD, FACS Diane S. Schneidman Senior Editor Federal programs providing health insurance to children: A review 14 Erin LaFlair Tina Woelke Graphic Design Specialist

Double-digit premium hikes: Alden H. Harken, The latest crisis in professional liability 19 MD, FACS Barry M. Manuel, MD, FACS Charles D. Mabry, MD, FACS Clinical Congress 2001: Highlights 21 Jack W. McAninch, MD, FACS Editorial Advisors Report of the Chair of the Board of Regents 30 C. James Carrico, MD, FACS Tina Woelke Front cover design Report of the Chair of the Board of Governors 32 Barbara L. Bass, MD, FACS Tina Woelke Back cover design Report of the Executive Director 34 Thomas R. Russell, MD, FACS About the cover... ACS Officers and Regents 35 This month’s cover depicts highlights of the 2001 Clinical Congress, including (clockwise from upper left): presentation of the Distinguished Service Award; the Presidential Address deliv- DEPARTMENTS ered by R. Scott Jones, MD, FACS; a special session on terror- ism; the presentation of the Na- From my perspective tional Safety Council’s Surgeons Editorial by Thomas R. Russell, MD, FACS, ACS Executive Director 3 Award for Service to Safety and the College’s Distinguished Phi- lanthropist Award; the carrying FYI: STAT 5 of the Great Mace during the Convocation; the dedication of the Owen H. Wangensteen Surgi- Dateline: Washington 6 cal Forum; and Dr. Jones’s instal- Division of Advocacy and Health Policy lation as President (center). De- tails about these and other events during the Clinical Congress are offered on page 21. (Photos by Chuck Giorno Photography.) Keeping current 39 Bulletin of the American What’s new in ACS Surgery: Principles and Practice? College of Surgeons (ISSN Richard Lindsey 0002-8045) is published monthly by the American Col- lege of Surgeons, 633 N. Saint Socioeconomic tips of the month 40 Clair St., Chicago, IL 60611. It Filing for Medicare services is distributed without charge to Fellows, to Associate Fellows, to participants in the Candi- The Journal page 58 date Group of the American Seymour I. Schwartz, MD, FACS College of Surgeons, and to medical libraries. Periodicals postage paid at Chicago, IL, and additional mailing offices. POSTMASTER: Send ad- dress changes to Bulletin of the NEWS American College of Surgeons, 633 N. Saint Clair St., Chicago, Dr. Collicott named to ACS executive staff 42 IL 60611-3211. The American College of Take a look at the activities of the ACS Insurance Program 43 Surgeons’ headquarters is lo- Gay L. Vincent, CPA cated at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. 312/202-5000, fax: 312/202- Working in the dark 45 5001; e-mail: postmaster@ Wu Shaotung facs.org; Web site: www.facs.org. Washington, DC, office is lo- cated at 1640 Wisconsin Ave., Clowes research award given 46 NW, Washington, DC 20007; tel. 202/337-2701, fax 202/ 337-4271. 2003 Travelling Fellowship available 46 Unless specifically stated otherwise, the opinions ex- pressed and statements Contributions to the 2002 Surgical Forum are requested 48 made in this publication re- flect the authors’ personal Scientific contributions sought for 2002 Clinical Congress 50 observations and do not im- ply endorsement by nor offi- cial policy of the American Fellows and facts 53 College of Surgeons.

©2001 by the American Col- Chapter news 54 lege of Surgeons, all rights re- Rhonda Peebles served. Contents may not be re- produced, stored in a retrieval system, or transmitted in any Bulletin index 59 form by any means without prior written permission of the publisher. Library of Congress number 45-49454. Printed in the USA. Publications Agreement No. 1564382. Officers and staff of the American College of Surgeons

Steven W. Guyton, MD, FACS, Seattle, WA Officers Rene Lafreniere, MD, FACS, Calgary, AB Courtney M. Townsend, Jr., MD, FACS, Galveston, TX R. Scott Jones, MD, FACS, Charlottesville, VA President Kathryn D. Anderson, MD, FACS, Los Angeles, CA Advisory Council to the Board of Regents First Vice-President (Past-Presidents) Claude H. Organ, Jr., MD, FACS, Oakland, CA Second Vice-President W. Gerald Austen, MD, FACS, Boston, MA John O. Gage, MD, FACS, Pensacola, FL Henry T. Bahnson, MD, FACS, Pittsburgh, PA Secretary Oliver H. Beahrs, MD, FACS, Rochester, MN John L. Cameron, MD, FACS, Baltimore, MD John M. Beal, MD, FACS, Valdosta, GA Treasurer Harvey W. Bender, Jr., MD, FACS, Nashville, TN Thomas R. Russell, MD, FACS, Chicago, IL George R. Dunlop, MD, FACS, Worcester, MA Executive Director C. Rollins Hanlon, MD, FACS, Chicago,IL Gay L. Vincent, CPA, Chicago, IL James D. Hardy, MD, FACS, Madison, MS Comptroller M. J. Jurkiewicz, MD, FACS, Atlanta, GA LaSalle D. Leffall, Jr., MD, FACS, Washington, DC William P. Longmire, Jr., MD, FACS, Los Angeles, CA Officers-Elect (take office October 2002) Lloyd D. MacLean, MD, FACS, Montreal, PQ William H. Muller, Jr., MD, FACS, Charlottesville, VA C. James Carrico, MD, FACS, Dallas, TX David G. Murray, MD, FACS, Syracuse, NY President Jonathan E. Rhoads, MD, FACS, Philadelphia, PA Richard R. Sabo, MD, FACS, Bozeman, MT David C. Sabiston, Jr., MD, FACS, Durham, NC First Vice-President Seymour I. Schwartz, MD, FACS, Rochester, NY Amilu S. Rothhammer, MD, FACS, Colorado Springs, CO George F. Sheldon, MD, FACS, Chapel Hill, NC Second Vice-President G. Tom Shires, MD, FACS, Las Vegas, NV Frank C. Spencer, MD, FACS, New York, NY Board of Regents Ralph A. Straffon, MD, FACS, Shaker Heights, OH James C. Thompson, MD, FACS, Galveston, TX Edward R. Laws, Jr., MD, FACS, Charlottesville, VA Chair* Executive Staff Jonathan L. Meakins, MD, FACS, Montreal, PQ Vice-Chair* Executive Director: Thomas R. Russell, MD, FACS Barbara L. Bass, MD, FACS, Baltimore, MD Division of Advocacy and Health Policy: L. D. Britt, MD, FACS, Norfolk, VA Cynthia A. Brown, Director William H. Coles, MD, FACS, New Orleans, LA American College of Surgeons Oncology Group: Paul E. Collicott, MD, FACS, Chicago, IL Samuel A. Wells, Jr., MD, FACS, Group Chair Edward M. Copeland III, MD, FACS, Gainesville, FL Communications: Linn Meyer, Director A. Brent Eastman, MD, FACS, La Jolla, CA Division of Education: Richard J. Finley, MD, FACS, Vancouver, BC Ajit K. Sachdeva, MD, FACS, FRCSC, Director Josef E. Fischer, MD, FACS, Boston, MA Executive Services: Barbara L. Dean, Director Alden H. Harken, MD, FACS, Denver, CO* Finance and Facilities: Gay L. Vincent, CPA, Director Gerald B. Healy, MD, FACS, Boston, MA* Human Resources: Jean DeYoung, Director R. Scott Jones, MD, FACS, Charlottesville, VA* Information Services: Howard Tanzman, Director Margaret F. Longo, MD, FACS, Hot Springs, AR Journal of the American College of Surgeons: Jack W. McAninch, MD, FACS, San Francisco, CA* Wendy Cowles Husser, Executive Editor Mary H. McGrath, MD, FACS, Maywood, IL Division of Member Services: John T. Preskitt, MD, FACS, Dallas, TX Paul E. Collicott, MD, FACS, Director Ronald E. Rosenthal, MD, FACS, Wayland, MA Organization: John P. Lynch, Director Maurice J. Webb, MD, FACS, Rochester, MN Division of Research and Optimal Patient Care: *Executive Committee Cancer: David P. Winchester, MD, FACS, Medical Director Board of Governors/Executive Committee JoAnne Sylvester, Associate Director Office of Evidence-Based Surgery: J. Patrick O’Leary, MD, FACS, New Orleans, LA Margaret Mooney, MD, Interim Director Chair Trauma: Sylvia D. Campbell, MD, FACS, Tampa, FL Gerald O. Strauch, MD, FACS, Director Vice-Chair Executive Consultants: Timothy C. Fabian, MD, FACS, Memphis, TN C. Rollins Hanlon, MD, FACS Secretary Olga Jonasson, MD, FACS 2 Julie A. Freischlag, MD, FACS, Los Angeles, CA

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS From my perspective

n October 23, I met with Tom Scully in his offices at the U.S. Department of Health and Human Services. As you Oprobably know, Mr. Scully is the new Administrator of the Centers for Medicare & Med- icaid Services (CMS), previously known as the Health Care Financing Administration. With me was Cindy Brown, Director of the College’s Division of Advo- cacy and Health Policy. Ken Simon, MD, FACS, a general surgeon who works for the CMS, was also in attendance. Our conversation centered largely on the steep reductions in Medicare payment all physicians are likely to face in January 2002 and on the regulatory burdens they are dealing with. The College has joined a I found Mr. Scully to be very knowledgeable with coalition of more than 50 respect to the controversies surrounding the issue ‘‘ of physician reimbursement. He clearly under- stands the overriding problem, which is a flaw in medical organizations to the law that established the current basis for set- ting the conversion factor that determines Medi- vehemently protest the care payment. We noted that these Medicare reductions are oc- reduction in a conversion curring at the same time that surgeons and other physicians are encountering heightened regulatory factor that is based on and legal burdens. We explained to Mr. Scully that new laws and rules dealing with compliance, emer- unsound legislation... gency room coverage, and so on, place increasing pressures on a surgeon’s practice and responsibil- ’’ ity. Rising liability costs add further financial ing the work values for more than 240 surgical strains. These factors, coupled with falling reim- services. This effort would have culminated in sig- bursement, are simply making practice untenable nificant increases in reimbursement for many pro- for many surgeons and other physicians. Mr. Scully cedures. Unfortunately, much of their achievement recognizes that our concerns are very real, having will be undone by CMS’s recent announcement witnessed the experience of a close friend who is a that there will be a 5.4 percent reduction in the fee surgeon and who retired from practice at age 51 schedule conversion factor for 2002, bringing pay- for all of these reasons. ment per relative value unit down from $38.26 to One meeting with the CMS Administrator, how- $36.19. This reduction will become effective Janu- ever, is obviously not going to be enough to stem ary 1, 2002, unless Congress intervenes. the tide of financial burdens that are likely to wash As Mr. Scully correctly points out, the CMS re- over surgeons’ practices during the coming duced the conversion factor because of legislation months. The entire surgical and medical commu- passed during the previous Administration. The nity must be involved in efforts to achieve some law is flawed because it bases the annual conver- relief. I’d like to take this opportunity to inform sion factor update on a “sustainable growth rate” all of you about the potential problems and to sug- that is tied to the business cycle rather than to gest some approaches to preventing them. health care costs. This formula creates overall re- strictions on aggregate Medicare spending and Inequities of the system continues to apply faulty 1998 and 1999 data that As I have communicated previously, our General have unfairly removed billions of dollars from the Surgery Coding and Reimbursement Committee permitted spending target. Recognizing the prob- really made significant strides this year in increas- lem, Congress passed and former President Clinton 3

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS signed legislation in 1999 that attempted to suture would legislate a negative 0.9 percent payment some of the cuts in payment but did not change update for the 2002 fee schedule conversion fac- most of the inherent flaws in the sustainable tor, setting aside the scheduled 4.8 percent reduc- growth rate formula. As a result, we now face this tion tied to physician spending under the sustain- 5.4 percent reduction in Medicare payment for able growth rate. 2002. • We will continue to point out to the legisla- Congress has attempted to build allowances for tors that a major and unacceptable flaw in the sys- technological improvements into other payment tem is that the target is tied to the business cycle systems; however, the target for physicians and and not to the need of patients. other health care practitioners is not adjusted for • We will continue to assert to the legislators technological improvements. At the same time, that it is unfair to have the physician portion of Medicare Part B spending increased the past year Part B compete with the rapidly escalating costs by approximately 13 percent, largely due to the of the pharmaceutical and the medical device in- introduction of new drugs and medical devices, dustries. Under this system, when the target is many of which are very costly. As spending for these exceeded, physicians and other providers must items consumes more Part B dollars, physicians absorb the increase in expenditure. and other health care professionals are expected • As many surgeons as possible need to to accept a corresponding reduction in their pay- contact their legislators via telephone and ments. I pointed out to Mr. Scully that this policy e-mail to express their concerns about the is unfair to surgeons and other health care provid- egregiousness of the 5.4 percent reduction ers who are in the “trenches” delivering care, espe- in the conversion factor. (Access the College’s cially given the regulatory burdens mentioned pre- Legislative Action Center at http://capwiz. viously and a Medicare reimbursement formula that com/facs/issues/alert/?alertid=63328 to e- is based on a skewed conversion factor. mail a letter to Capitol Hill or contact your legislator through the Capitol Hill switch- What we can do board at 202/224-3121.) This decrease not only What can the American College of Surgeons and will affect the financial viability of physicians’ and you as individual surgeons do to resolve, or at least surgeons’ practices—it will adversely affect access curtail, these problems? First, the entire surgical to care for Medicare patients and further slash the and medical community must come together and safety net for the uninsured. Furthermore, con- speak with a unified voice. To that end, the Col- tinued cuts in reimbursement and regulations lead- lege has joined a coalition of more than 50 medical ing to increased office expenses will simply lead to organizations to vehemently protest the reduction early retirement for many surgeons and will defi- in a conversion factor that is based on unsound nitely make it more difficult for the profession to legislation and that ties the target to economic in- attract surgeons in the future. dicators. As a large coalition, we will be forceful in This is a time when we all need to come together expressing our dismay and concern with the fourth as organizations and as individuals to vociferously major reduction in reimbursement for physicians and effectively state our case. Your support and ac- and surgeons in the last 10 years. Specific actions tion, as well as suggestions, are needed at this time. we are taking and in which I encourage each of you to participate are as follows: • We are urging Congress to pass the Medicare Physician Payment Fairness Act of 2001, which was introduced on November 8, 2001, by Sens. Jim Jeffords (I-VT) and John Breaux (D-LA). If passed by Congress before the end of the year, this legisla- tion would significantly reduce the negative 5.4 Thomas R. Russell, MD, FACS percent Medicare physician payment update sched- If you have comments or suggestions about this or uled to take effect January 1, 2002, under next other issues, please send them to Dr. Russell at 4 year’s Medicare physician fee schedule. The bill [email protected].

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS FYI: STAT

his column provides brief reports on important items of interest Tto members of the College. It will appear in the Bulletin when there is “hot news” to report. In-depth coverage of activities announced here will appear in columns and features published in the Bulletin and in the College’s weekly electronic newsletter, ACS NewsScope. ❖ On October 23, ACS Executive Director Thomas R. Russell, MD, FACS, and Cynthia Brown, Director of the College’s Division of Advocacy and Health Policy, met with key individuals at the Centers for Medicare & Medicaid Services (CMS), the National Committee for Qual- ity Assurance (NCQA), and the Leapfrog Group. During the meet- ing with CMS Administrator Tom Scully, Dr. Russell outlined the College’s concerns about the significant negative payment update for physician services included in next year’s Medicare fee schedule. At the NCQA meeting with President Peggy O’Kane, Dr. Russell provided an overview of the College’s long record, strong leadership, and current endeavors in promoting quality surgical care. Finally, Dr. Russell and Ms. Brown met with Suzanne Delblanco, PhD, Executive Director of the Leapfrog Group—a consortium of Fortune 500 companies and other large health care purchasers that was formed to mobilize employer purchasing power to improve patient safety and health care quality. Dr. Russell informed Dr. Delblanco about the College’s concerns re- garding different aspects and quality assumptions of regionalized care— a pillar of the Leapfrog Group’s efforts for improving patient care. ❖ The 11th Surgical Education and Self-Assessment Program (SESAP 11), the all-new version of the College’s classic home-study course, is now available. Since 1971, SESAP has helped surgeons to maintain and improve surgical proficiency, stay abreast of the latest cognitive and technological advances, and prepare for certification or recertification. SESAP consists of 650 multiple choice items in 17 sub- ject categories with discussions and references. Materials are provided in both book and CD-ROM formats, and participants are eligible to earn up to 60 hours of Category 1 CME credit. To order, call 800/251- 3775, fax 312/202-5005, or e-mail [email protected]. ❖ According to the Journal Citation Reports for the year 2000, the Jour- nal of the American College of Surgeons now ranks 11th of 136 in the category of surgery journals; in 1995, it ranked 34th. Its “impact factor”—the number of times a journal is cited by authors published in other journals—rose from 0.735 in 1995 to 2.805 in 2000. ❖ A CD-ROM containing select postgraduate course syllabi from the 2001 Clinical Congress is now available for purchase through the College’s Web site at: https://secure.telusys.net/commerce/ current.html, or by calling ACS Customer Service at 312/202-5474. The CD-ROM contains syllabi from 20 postgraduate courses and is avail- able for $35, with an additional charge of $12 for shipping and han- dling for international orders. For further information, contact [email protected]. 5

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS DatelineWashington

prepared by the Division of Advocacy and Health Policy

The Centers for Medicare & Medicaid Services (CMS) published the CMS publishes rule final rule for the 2002 Medicare physician fee schedule on November 1. on 2002 Medicare The regulation includes a 5.4 percent across-the-board cut in payments for all physician services next year—lowering the dollar conversion fac- fee schedule tor from its current level of $38.26 down to $36.20. The majority of the reduction for next year—4.8 percentage points— is the result of a congressionally mandated expenditure target formula for physician services known as the sustainable growth rate (SGR). This formula sets a target rate of spending growth for physician expen- ditures that is tied to a number of factors, including growth in the gross domestic product. CMS cites the slowing economy and a relatively high growth rate in physician spending under Medicare as the cause of the negative payment update. In addition, the agency has incorporated a -0.6 percent reduction into next year’s update to offset increased physician work values resulting from the second five-year review of this fee schedule component. Also factored into this number is a slight reduction to account for a “behavorial offset”—an anticipated increase in volume and intensity of physician services to offset losses due to the final year of the imple- mentation of the new resource-based practice expense values. CMS is mandated to make these annual adjustments to the conversion factor in the event that policy or Medicare coverage decisions would increase aggregate spending for physician services under the fee schedule by more than $20 million.

Breakdown of 5.4 percent payment cut

2001 conversion factor $38.26 2002 update resulting from SGR -4.8 percent Budget neutrality adjustment to account for increased work values from the 5-year review -.46 percent Budget neutrality adjustment to account for anticipated increase in services due to practice expense transition -.18 percent Total percentage reduction - 5.44 percent 2002 conversion factor $36.20

While a small increase has been factored into the 2002 values for physi- cian work for a number of general surgery codes, many of these gains were, unfortunately, offset by the 5.4 percent reduction to next year’s conversion factor. As a result, payments for many general surgery pro- cedures will remain flat for 2002. Finally, the proposed rule on the 2002 fee schedule addressed a con- troversial issue revolving around inclusion of critical care in the valua- tion of certain procedure codes (in which critical care is a routine part of the postoperative care). CMS questioned whether Medicare might be making duplicate payments for critical care—once to the surgeon and once to another physician assigned to the intensive care unit. The agency made clear that it will not change Medicare’s critical care payment policy in 2002, but asked for comments on various changes that could be made 6 for 2003. The College objected strongly to all the proposed changes be-

VOLUME 86, NUMBER 10,12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS cause they would violate the College’s ethical standards on postoperative care, as well as Medicare’s own global surgery policy. In the final rule, CMS noted the concerns of the College and numerous other health care groups and has indicated that it will carefully review these comments as it determines whether to make a future proposal on this issue. At press time, Sens. Jim Jeffords (I-VT) and John Breaux (D-LA) had introduced the Medicare Physician Payment Fairness Act of 2001. If passed by Congress before the end of the year, this legislation would significantly reduce the negative 5.4 percent Medicare physician pay- ment update scheduled to take effect January 1, 2002, under next year’s Medicare physician fee schedule. The bill would legislate a negative 0.9 percent payment update for the 2002 fee schedule conversion factor, setting aside the scheduled 4.8 percent reduction tied to physician spend- ing under the SGR. The Jeffords/Breaux proposal also mandates that the Medicare Payment Advisory Commission (MedPAC) conduct a study on replacing the SGR as a factor used to determine the physician pay- ment update. The results of this study and MedPAC’s recommenda- tions for a substitute update formula would be presented to Congress by March 1, 2002.

On October 31, the House Energy and Commerce Committee ap- House committee proved H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and approves Education Reform Act (Medicare RACER Act). Similar legislation was approved by the House Ways and Means Committee on October 11. regulatory Both bills address a number of serious problems with the claims audit- reform bill ing and overpayment recovery process. For example, both bills enhance physician due process rights, limit the use of extrapolation by Medi- care contractors, and call for increased physician education on the part of Medicare contractors. The Medicare RACER Act also includes re- quirements not found in the Ways and Means bill, such as mandates that contractors provide general written guidance to physicians regard- ing billing and coding questions. Currently, the College is working with the American Medical Association and other physician groups to gen- erate support for the strongest reform package possible.

Department of Health and Human Services Secretary Tommy College awarded Thompson announced on October 11 that the Agency for Healthcare AHRQ patient Research and Quality (AHRQ) released $50 million to fund 94 new re- search grants, contracts, and other projects to reduce medical errors safety grants and improve patient safety. The College was awarded three grants as part of this initiative. The first of these grants will fund a collaboration between the Veterans Administration (VA) and the College to evaluate the VA’s National Surgical Quality Improvement Program as a report- ing system to improve patient safety in surgery in both VA and non- federal hospitals. The second grant is for research to study the impact that a variety of factors could have on the safety of surgical care, in- cluding stress, organizational culture, teamwork, and working hours. The final grant will allow the College to modify existing educational programs to emphasize patient safety and initiatives to reduce surgical errors. 7

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS he surgical profession has continuously A review of the evolved, and the changes that have oc- curred over the last few decades, in par- Presidential Address ticular, have produced “significant tension for our profession. That is not surprising, because Tprogress and improvement will not occur without conflict,” R. Scott Jones, MD, FACS, the newly in- stalled President of the College, said during his Medicine, Presidential Address at the 2001 Clinical Congress. Dr. Jones explained how the internal and exter- government, nal conflicts between members of the medical pro- fession and the government, insurers, and other and capitalism stakeholders in the system have emerged and what surgeons can do to enhance patient care in the fu- ture. He began with a brief overview of the socio- economic and political history of surgery and or- ganized medicine in the U.S. During the seventeen century, “medical practi- tioners were either self-taught or learned through apprenticeship. There were no medical schools, medical societies, hospitals, or medical licensure,” Dr. Jones said. However, the first law concerning the practice of medicine in the English Colonies was enacted in the Virginia Assembly in 1639. Ironically, given the current concerns about reim- bursement, the purpose of that legislation was to control costs by regulating physicians’ fees. Virginia, New York, and New Jersey went on to pass licensing laws during the eighteenth century. Also during the 1700s, the first medical societies were formed, the first colonial hospital was opened, Editor’s note: The following is a summary of and the first U.S. medical school was established, Dr. Jones said. the Presidential Address delivered by newly in- After the Civil War, all states began to address stalled ACS President R. Scott Jones, MD, FACS. the issues of licensure and medical education. Ad- Dr. Jones’ address was presented during the Con- ditionally, tremendous scientific advances in pa- thology, drug development, radiology, anesthesia, vocation ceremonies at the 2001 Clinical Congress and surgical practice occurred in the nineteenth in New Orleans, LA, to an audience of approxi- century. “Despite these changes, doctors, among mately 2,000 meeting attendees—including Ini- those with education, generally had low status, low earnings, and little power,” Dr. Jones said. To re- tiates, other Fellows, College Officers, and College spond to these problems and to increase physicians’ staff. strength, the American Medical Association (AMA) The text of Dr. Jones’ Presidential Address will and specialty societies surfaced. Nonetheless, the greatest advances in organized appear in its entirety in the February 2002 issue medicine occurred during the twentieth century, of the Journal of the American College of Sur- largely because the provision of health care and payment for related services had grown increas- geons. ingly complicated. The first private health insur- 8 ance program was initiated in 1929 at Baylor Uni-

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS versity Hospital in Dallas, TX, and despite firm areas of concern: (1) responsiveness to all stake- opposition from the AMA, prepaid health plans holders in the health system, including nonsurgeon similar to today’s health maintenance organiza- practitioners, the government, the health insur- tion (HMOs) started in the early 1940s. ance industry, and purchasers of care; (2) contin- “Following World War II, the federal government ued dissemination of information through meet- again turned attention to health care when the ings, the Journal of the American College of Sur- Truman Administration advocated national health geons, and electronic means; (3) expanded support insurance,” Dr. Jones said. Further, the federal of clinical trials and other methods that will help government supported medicine with large infu- to contribute to evidence-based practice; and (4) sions of money and program support that continue the facilitation of quality control. today, Dr. Jones said, pointing to funding for medi- Guiding all these efforts should be a firm com- cal research, mental health programs, the Veter- mitment to ethics. “The simmering of medicine, ans Administration, and community hospital con- government, and the corporate sector in the broth struction. “Perhaps the most significant event in of the trillion-dollar [health care] economy at some health care in the United States occurred on July point will involve discussions of self-interest ver- 30, 1965, when President Lyndon Johnson signed sus the interests of others, or altruism,” Dr. Jones into law the legislation to introduce Medicare and said. Medicaid,” Dr. Jones added. Quoting from medical ethicist Albert Jonson, Dr. The cost of health care continued to rise signifi- Jones defined self-interest as promoting “for one- cantly throughout the 1960s, though, and in 1971, self the values of preservation, growth, and happi- President Richard Nixon imposed wage and price ness” and altruism as promoting “the preserva- controls, limiting increases in physicians’ fees and tion, growth, and happiness of other persons even hospital charges, Dr. Jones said. Caps on payment to the detriment of one’s own interest.” He added increases would continue throughout the remain- that “altruism and self-interest coexist in all moral der of the twentieth century with the development lives. They have a reciprocal relationship that var- of prospective payment systems and managed care. ies from time to time and from circumstance to As we embark upon the twenty-first century, Dr. circumstance.” Those individuals entering the sur- Jones observed, “Certainly cost remains the point gical profession “would be well-served by a better of focus, particularly for government, the corpo- than average endowment of altruism,” Dr. Jones rate sector, the public, and the medical profession, said. but the quality of health care demands additional The ability to look beyond one’s self-interest will attention.” be a particularly important attribute to have as Dr. Jones noted that the Institute of Medicine’s the profession readies itself for the ongoing debates Committee on Quality of Health Care in America over quality and the health care system in general. recently published a report, Crossing the Quality “When we engage in dialog with payors, govern- Chasm: A New Health System for the 21st Century. ment workers, corporate representatives, manag- He said the report lists four underlying reasons ers, [and so on] about patient-related matters, we for inadequate quality of care: (1) the growing com- must support the interests of the patient.” Dr. plexity of science and technology; (2) the increase Jones said. “Medicine is an occupation that strives in chronic conditions experienced by a population to maintain trust. In the heart of every patient that is living longer; (3) a health care system that there must dwell the questions: Can I trust this is “generally fragmented, poorly organized, and doctor? Is he/she committed to excellence? Does he/ uncoordinated”; and (4) constraints on the revo- she care about me?” lution in information technology. The report as- Dr. Jones noted that while change is a constant, serts that “health care should be safe, effective, “some things do not change: the medical patient-centered, timely, efficient, and equitable,” profession’s mission of service. The medical pro- Dr. Jones added. fession has served the interests of societies and Dr. Jones said surgeons can actively respond to patients since hundreds of years before Christ,” these points, particularly if organizations such as he added. “We must never forget that we are here the American College of Surgeons emphasize four to serve.” ⍀ 9

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS The ACS chapters: Where do we go from here?

by Robert M. Quinlan, MD, FACS, Worcester, MA

ased on the course of surgical leadership 50 years ago as an organization rich in surgical discussions over of the past few years and history and spawned from other collaborative so- the findings generated through the cieties, such as the prestigious Boston Surgical BAmerican College of Surgeons’s (ACS’s) Society and the New England Surgical Society. strategic planning process, it appears that the Currently, more than 1,700 Fellows of the College ACS/chapter relationship is at a crossroads. Hav- (1,264 active FACS) are based in Massachusetts, ing attended the 2001 Chapter Leadership Con- yet the chapter has only 593 active members (47% ference, I have the sense that the ACS and its chap- of the market share). In fact, in the past 10 years, ters have a less-than symbiotic relationship. Dr. active chapter membership has decreased 27 per- Russell’s column in the July 2001 Bulletin con- cent, while senior (non-dues paying) membership firms this belief when he states, “I do not believe has increased 45 percent. that the chapters can continue to function in their This trend tells us not only that our member- current manner,” and “I believe the College must ship population is aging, but that the members of not only maintain but strengthen its chapters.” our next generation of surgical leaders are not So, where do we go from here? joiners—or, at least, they certainly aren’t inclined to participate in the chapter. Membership attri- The Massachusetts experience tion is now directly affecting the financial stabil- Please allow me to share with you a little bit ity of the Massachusetts Chapter as total dues in- about the Massachusetts experience. The Massa- come ($150 per Fellow) just covers our adminis- 10 chusetts Chapter of the ACS was chartered nearly trative management, four Council meetings per

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS year, and two semiannual newsletters. The surgi- a very popular “Meet the Professors” breakfast cal leaders throughout the Commonwealth are as part of our annual meeting. These programs very much engaged, yet there remains a discon- all have been aimed at mentoring the future sur- nect with our rank-and-file members. Respondents gical leaders within the Commonwealth, and it to membership surveys consistently ask the ques- appears that while camaraderie is less important tion, “What does the chapter do for me?” to our younger generation, young surgeons appre- ciate our mentoring efforts. Benefits of membership • Education. The Massachusetts Chapter has The tenet of my presidential year was answer- offered an annual meeting for 47 years. For 24 of ing the question, “What are the benefits of chap- those years, we have also offered a spring meet- ter membership?” My research, statistics, and ing. Frankly, with all of the educational opportu- some good old-fashioned shoe leather (worn nities available, especially through specialty and through my travels around the state) told me that subspecialty organizations, it appears that rank- there are some very real benefits of chapter mem- and-file chapter members are not attending sci- bership! The problem is that those benefits are entific meetings as much for educational purposes intrinsic and have not changed very much over but for the camaraderie and mentoring opportu- our 50-year history. In fact, some traditionally per- nities. ceived benefits are really of no value to our • Farm system. The ACS looks to the chapters younger members. to recommend/nominate the necessary future sur- So, what are the benefits? Following are some gical leaders. The successful chapter leader uni- of the real, observable benefits of belonging to the versally enjoys the experience and is appreciative Massachusetts Chapter and I suspect other ACS and enthusiastic about providing additional ser- chapters, as well. vice to the ACS and the practice of surgery in the • Camaraderie. Surgeons like to get out of their roles of Governors, Regents, and Officers. My base- operating rooms and interact with one another. ball reference to “farm system” aside, chapters are We help facilitate collaboration through meetings instrumental in developing grassroots initiatives of our council, the 35 members of which include and future leaders of the College. our officers, our regional state representatives, • Socioeconomics. The Massachusetts Chapter ACS Governors, ACS Regents, other College rep- has long been committed to developing strategies resentatives, and the chairs of various committees. to deal with socioeconomic, coding, and reimburse- This body meets quarterly. We also host an an- ment issues. All of our member surveys have told nual meeting in December, which traditionally us that a local voice on socioeconomic issues is attracts 150 members. We have also instituted a highly important to the practicing surgeon. In ad- Town Meeting Program (discussed more com- dition, our chapter leadership has recognized the pletely later in this article), which allows the chap- importance of these strategies in enhancing our ter leadership to hear firsthand the issues affect- practices as well as revitalizing the chapter. ing practicing surgeons in their academic institu- Five or so years ago, the Massachusetts Chap- tions or in their communities. ter was financially flush, with nearly $500,000 • Mentoring. Massachusetts has adopted and in reserves. The leadership of the organization promoted the new Candidate and Associate Soci- realized that this surplus had to go back into a ety of the ACS (CAS-ACS), and we recently ap- program as a member benefit. As the penetra- pointed three representatives of the CAS-ACS to tion of managed care increased, the leadership sit on our Council. In addition, we are attempting decided to develop legislative, political, and me- to deliver programs to address key concerns of dia strategies to combat the negative effects of young surgeons, including financial planning, in- the managed care industry. We collaborated with surance, applying for a position, negotiating con- other political and health care leaders in the tracts, and so on. This program is in its early stages Commonwealth as part of an effort to write, and has become the pet project of our current manage, lobby, and ultimately pass a sweeping President, Maureen Kavanah, MD, FACS. Addi- managed care reform package. tionally, for the past three years, we have offered This omnibus bill addressed restrictions on 11

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS capitated systems, point-of-service options, phy- ultimately was the will of the general public. For sician referral systems, and ERISA. The Massa- all of the political maneuvering and legislative and chusetts Chapter accomplished the following: we media manipulation, the practice of managed care attained representation on the governor’s health was reformed because the people demanded regu- care commissions; we encouraged the state legis- lation of the industry. So, not only did our chapter lature and the U.S. Congress to revisit ERISA is- learn a lesson about public advocacy, but we real- sues; we helped bring focused attention to the ized that organizational participation in advocacy emerging capitation system; and we drew the at- comes with a price, and in order to be truly effec- tention of leaders to the need for unlimited access tive and successful, the public has to be on your to surgeons. This three-pronged approach to deal- side. In our profession, success must always be re- ing with the state’s executive branch, legislature, flected through the care of our patients. and the local media proved to be a successful for- • Town meetings. As President of the Massa- mula. The Governor and legislature appointed a chusetts Chapter, I was curious about the relation- surgical representative to every major commission ship between the ACS and its chapters, and I addressing the issue. We met with key legislative wanted to know why the organizational structure and gubernatorial administration representatives, made the central operation so strong and left the we offered testimony to public hearings, we gen- chapters so vulnerable. Surveys only gave me par- erated a letter-writing campaign, we met with the tial answers, and many of them could have a de- press, and we wrote opinion pieces for every ma- viation based upon what and how the questions jor newspaper in the Commonwealth. were asked. I needed to be sure. So, we instituted The end result was exciting. The legislature a Town Meeting Program, which allowed me to adopted an omnibus managed care bill that in- travel to five regions of the state to meet directly cluded fixes to the ERISA problems. The Gover- with the membership in their respective depart- nor issued an executive order prohibiting the state ments and communities to get straight answers from dealing with insurers that offered capitated to the important questions. We focused on what systems. The Massachusetts House and Senate we thought were the important issues—those that each passed legislation restricting capitation and we felt might help us understand the differences offering better access to specialists. In addition, in relationship between the Fellows and the ACS we successfully raised public awareness about and the one between the Fellows and the chapter. ERISA, capitation, and the importance of access Those questions and issues included: to the physician of your choice. We also succeeded • What is the perceived opinion regarding the in raising the level of awareness of the practice of current relationship between the ACS and the re- surgery and, in so doing, enhanced the profile of gional chapter? the Massachusetts Chapter. In the end, a multi- • What is the ACS/chapter role in the overall level dynamic was at work, which we found very practice of surgery? interesting—in fact, enlightening. • What are the most important services the First, the campaign was not easy, and it was not ACS/chapter can provide? cheap. Our executive director coordinated our ef- • How active and what role would the mem- forts with the assistance of hired public relations bership like to see the ACS/chapter play in the so- and legislative consultants. The cost of the cam- cioeconomic and political agenda? paign consultants was $60,000 per year and de- The answers varied, but the themes were con- pleted our assets from the time of our involvement sistent at all of the town meetings. The role of the through the signing of the bill. The momentum ACS was more defined than that of the chapter. and profile for the chapter dimmed as our fund- However, the question continued to dog the value ing and capital faded. Second, we were very help- of chapter membership: What does the Massachu- ful in bringing many of the damaging effects of setts Chapter do for me? managed care to media forefront. But, did we bring Health policy and education remain the two ser- about legislative reform? We did, partially, but not vices that Fellows demand of both the ACS and entirely. Advocacy and its success or failure are the chapter. The members want both organiza- 12 very hard to measure. Passage of the legislation tions to be more involved in all health policy and

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS political issues. The members want respect re- cally unified ACS instead of one national organi- stored to the surgical profession. “Develop ad- zation and 67 independent chapters. vanced public and media relations to accompany • If such a reorganization were implemented, the political agenda portraying the surgeon as a might the ACS distribute one bill encompassing champion for patient care,” the members said. dues for both bodies? This way, dues income would They specifically suggested that the ACS weigh in support the actions of the national organization on other health care issues, such as specialty-spe- and would provide the chapters with a mechanism cific concerns, the nursing shortage, surgical er- to increase their revenues. rors, quality of life, surgical training, residents’ • The College should consider defining chap- rights, and so forth. They want answers to the fol- ter responsibilities, such as: recruiting, promot- lowing questions: What is the ACS doing to en- ing, and processing Fellowship in the ACS; devel- sure the maintenance of competency? What is the oping educational objectives and other issues for ACS role in recertification? How does the ACS young surgeons; and stimulating advocacy for lo- view the different education and other needs of cal socioeconomic issues. academic-based and community-based surgeons? • The ACS should revisit the importance of We traveled armed with Dr. Russell’s August their Washington representation, the development 2000 Bulletin column outlining the benefits of Fel- of the socioeconomic agenda, and the creation of lowship in the College. Our meetings showed that a political action committee. Local participation either the membership didn’t read the article or, in these efforts will greatly enhance and support more importantly, did read it but didn’t connect the ACS agenda. to the sentiments expressed. The rank-and-file • The College should financially support its members concerned with their grassroots issues agenda through local chapter efforts. The ACS feel disconnected from the chapter and the Col- should establish programs that make funding lege. This disconnect drives the members’ disen- available to support the chapters. In turn, this franchisement. The chapter certainly can’t stem backing will promote the practice of surgery and this tide alone. The answers and approaches to provide benefits to the membership of the ACS. resolving these questions for both the ACS and If the chapters truly are the lifeblood of the ACS, the chapter will not be satisfied by this article then our combined leadership must continue to alone. But in the process of instituting these town strive for common ground—fostering patient care. meetings we realized that perhaps one benefit of The Massachusetts Chapter looks forward to both memberships is that the surgical leadership working with the College on these continued ef- is willing to travel to your community and insti- forts. ⍀ tution to hear your opinion.

Next steps So, where do we go from here? The Massachu- setts Chapter is entering into a period of strategic Dr. Quinlan is a planning ourselves. I am going to ask our Strate- professor of surgery at the University of gic Planning Committee to consider some of the Massachusetts, a ideas that came out of the limited town meetings surgical oncologist at that we have held so far. (The program is ongoing the UMASS Memorial and has been instituted as a formal Massachusetts Health Center, and the Chapter endeavor.) At this point, my conclusions Immediate Past- are as follows: President of the • The College should consider reorganizing Massachusetts Chapter using a bottom-up (grassroots) management ap- of the College. proach as opposed to what is perceived as top-down management style. The ACS should consider set- ting its agenda based on information gathered from the chapters. This might ensure a philosophi- 13

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS he federal government began its efforts to pro- vide health insurance coverage to low-income individuals in 1965 with the creation of the Federal programs TMedicaid program. Unfortunately, decades later, millions of children were slipping through this safety net because they failed to meet Medic- providing health insurance aid eligibility requirements. The good news is that recently implemented government programs now provide funds that enable more than 3 million chil- to children: A review dren to obtain health care services through state- level initiatives. In addition, state and local gov- ernments have made it a priority to use these funds and the increased flexibility accorded by the fed- eral government to reach out and improve access for more uninsured families. Surgeons who care for children should be famil- iar with the two principal federal programs aimed at providing health care coverage to children—the State Children’s Health Insurance Program (SCHIP) and the Medicaid program. This article provides a brief overview of these programs, as well as information about pertinent legislative initiatives pending in Congress that would further expand health insurance coverage and improve care for the nation’s children.

Overview of the Medicaid program Medicaid, created in 1965 as a cooperative ven- ture funded jointly by the states and the federal government, provides medical assistance for cer- tain low-income individuals and families, mostly women and children. Under this partnership, the federal government covers 50 to 83 percent of the Medicaid program costs in each state. In by Erin LaFlair, addition, the program operates under broad Legislative Assistant, national guidelines, which allow states to estab- Division of Advocacy and Health Policy lish regulations and standards that best suit the needs of their citizens. For example, states are able to determine their own payment method- ologies, payment rates, deductibles, and co-pay- ments. Although states may choose to enroll recipi- ents in fee-for-service or managed care plans, all state Medicaid programs must provide finan- cial assistance for a core set of services. Stan- dardized benefits include inpatient and outpa- tient care, hospital services, prenatal care and vaccinations for children, physician and rural health clinic services, lab and X-ray services, and 14 pediatric and family nurse practitioner services.

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Overview of SCHIP In addition, when SCHIP was first enacted, SCHIP, created in 1997 under provisions in the states that did not spend their allotments were Balanced Budget Act, provides federal funding to prohibited from using it in later years, and the help states initiate and expand health insurance federal government was barred from redistribut- programs for low-income children whose families ing it to other states that had exhausted their are currently ineligible for Medicaid. States may funds. However, BIPA allows states to retain and use this money to create a new program that meets use until fiscal year (FY) 2002 unspent SCHIP the statute’s health insurance coverage require- funds from FYs 1998 and 1999. This provision ments, to expand eligibility for children under frees up a total of $1.9 billion in unused funds. their Medicaid programs, or to support a combi- This money, originally intended to be divided nation of both. Although states are required to among states that had spent their entire allot- petition the federal government for these funds, ments, ultimately was divided among 41 states the U.S. Department of Health and Human Ser- with 60 percent of the funds funneled to those vices (HHS) routinely approves these requests. states that had not spent their initial allotments. While HHS has been generous about approving HHS has actively encouraged states that have SCHIP programs, the amount states may receive retained their unused SCHIP funds to use the from the federal government is limited: $40 bil- money to develop new enrollment approaches. The lion for the entire program over a 10-year period. department has suggested that states spend 10 Allotments are based on a formula that reflects percent of the funding to expand efforts to locate each state’s proportion of low-income uninsured eligible children and another 10 percent on ap- and insured children, as well as a geographic ad- propriate outreach activities identified through justment factor. these search programs. HHS also is encouraging federal health centers to help states increase their Expanding SCHIP enrollment SCHIP enrollment. Federally funded health care At the end of 2000, more than 3.3 million chil- centers serve a large number of low-income chil- dren were enrolled in SCHIP, and this figure con- dren, and states have been instructed to provide tinues to increase as states make their eligibility enrollment training to personnel in these centers. requirements more consistent. For example, most Most recently, HHS’s Centers for Medicare & states have created a single income eligibility Medicaid Services (CMS) published an interim fi- threshold for all families with children under age nal rule on SCHIP. Originally published in final 19. Now that all 50 states and the District of Co- format last January, just days before the Clinton lumbia have implemented approved children’s Administration left office, the The rule was put health insurance programs, state governments are on hold by the Bush Administration until it could considering new approaches to reach children who further review the regulation. In June, CMS pub- may be eligible for coverage but are not yet re- lished a new interim rule, which included changes ceiving it. In addition, states are working to en- and a request for public comment. One amend- sure that children who currently are enrolled re- ment is intended to help expand program enroll- tain their coverage when their families’ economic ment by eliminating the requirement that parents circumstances change. Further, the states’ focus or legal guardians provide the Social Security is being directed more toward enrolling targeted, number for both themselves and their children hard-to-reach minority populations. when enrolling in the program. This modification, To give states more flexibility in their efforts to according to CMS, will allow states to more effec- enroll children in SCHIP, the Benefits Improve- tively enroll children on a presumptive basis. ment and Protection Act of 2000 (BIPA) was signed into law in December 2000. Under this law, Efforts to expand coverage health centers, elementary and secondary schools, CMS and state health departments are finding and homeless shelters now may enroll children on it equally important that they increase the effi- a presumptive eligibility basis. Previously, SCHIP ciency and accessibility of SCHIP and Medicaid eligibility had to be proven before enrollment was by expanding the covered population. In June, an possible. independent study conducted by the Common- 15

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS SCHIP plan activity

Source: HCFA Web site (www.hcfa.gov/init/chip-map.htm).

wealth Fund suggested to CMS that another 2 mil- In another attempt to reach out to low-income lion children could potentially receive health in- parents, CMS is requesting comments from states surance if states were to set the same eligibility on whether to extend SCHIP coverage to pregnant requirements for SCHIP and Medicaid enrollment women. While prenatal care is a basic covered ser- for parents as exist for children. The Common- vice under Medicaid, CMS wants to give states the wealth Fund reasoned that permitting parents to option of providing these services to pregnant enroll in the programs would spur an increase in women whose incomes disqualify them from cov- the number of children covered. States now are erage under that program. able to extend Medicaid eligibility to parents, and Additionally, in August, CMS introduced a new CMS has recently developed a demonstration Health Insurance Flexibility and Accountability 16 project to cover parents under the SCHIP program. (HIFA) demonstration initiative. This demonstra-

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS tion project was designed to address the coverage for uninsured families. Sens. Edward Kennedy needs of individuals with incomes less than 200 (D-MA) and Olympia Snowe (R-ME) and Rep. percent of the federal poverty level, who gener- John Dingell (D-MI) introduced a bill called the ally are ineligible for Medicaid. The goal of this FamilyCare Act of 2001, S. 1244 and H.R. 2630, program is to give states the option of offering dif- respectively. Among other provisions, this legisla- ferent benefits levels to people at various income tion would: (1) rename SCHIP the FamilyCare levels in order to extend coverage to more unin- program; (2) extend optional FamilyCare cover- sured people. To implement this program, a state age to parents of targeted low-income children; must seek a waiver from HHS that allows it to (3) provide automatic eligibility for coverage to amend its Medicaid and/or SCHIP laws and sub- children of a parent on FamilyCare assistance; (4) mit a proposal to expand coverage. allow optional Medicaid and FamilyCare coverage The challenge for states under the HIFA initia- for legal immigrants and children through age 20; tive is to take advantage of the increased flexibil- (5) limit specified conflicts of interests under Med- ity these programs offer without spending more icaid and FamilyCare; and (6) increase FamilyCare than their current allotment of federal funds. Par- allotments for FY 2002 through 2004. As an in- ticipating states must continue to comply with centive, states also would receive increased funds Medicaid’s rules, which mandate coverage for chil- for expanding coverage to parents. Lastly, the bill dren under age six and pregnant women with in- would allow additional organizations to determine comes up to 133 percent of the federal poverty whether children are presumptively eligible, and level. States may opt to extend Medicaid coverage information on SCHIP and Medicaid would be in- to qualifying elderly and disabled populations, par- cluded on the National School Lunch Program ents of SCHIP recipients, and individuals whose application. The legislation is awaiting further earnings total 200 percent of the federal poverty action in Congress. (See map, opposite page.) level. These optional populations should receive a benefit package that includes the same basic ser- Changes in Medicaid managed care vices as current SCHIP recipients. Along with the SCHIP final rule, the Clinton Advocates for expanded coverage have expressed Administration published a final regulation per- concern that some states will increase cost-shar- taining to Medicaid managed care shortly before ing and limit benefits to achieve cost savings if leaving office. This rule was written to provide these proposals are implemented. The National Medicaid beneficiaries enrolled in managed care Governors Association, however, has said states plans with the same protections that would be pro- are unlikely to impose these cost-cutting measures vided under pending patient protection bills. This due to fears of a potential political backlash. States regulation, like the one pertaining to SCHIP, was with waivers that had been approved as of press delayed for further review by the Bush Adminis- time for HIFA included Florida, Minnesota, New tration. In August, a new interim rule was pub- York, and Wisconsin. lished with the promise that the revised final regu- Meanwhile, the Bush Administration has iden- lations would take effect in early 2002. When it tified regulatory reform as a priority means of becomes effective, the rule will provide Medicaid helping states to increase coverage for low-income beneficiaries with the following protections: children and their parents. HHS believes the slow • Coverage for emergency department care federal process used to approve amendments and whenever and wherever needed. demonstration waivers has prevented many gov- • Access to a second opinion. ernors and state health departments from devel- • Protection for patient-provider communica- oping new approaches to expanding SCHIP and tion, including a prohibition against gag clauses. Medicaid coverage. With promises of a quick re- • Assurances of network adequacy to meet the view process and less red tape, HHS reports that needs of expected enrollment in the service area. 910 new state amendments and waivers have been • Comprehensive plan information for benefi- approved since January, resulting in expanded cov- ciaries. erage eligibility for an additional 800,000 people. • Grievance and appeals systems. Congress also has sought to broaden coverage Adhering to its pledge to decrease regulation, 17

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS HHS also is looking for ways to increase states’ of 76 cosponsors, although no floor action had been flexibility to determine the best methods for pro- scheduled. viding these Medicaid managed care protections. This rule is viewed as a “floor,” meaning those Conclusion states that already have implemented patient pro- Federal and state governments have been suc- tections that are stronger than those specified by cessful in their renewed efforts to reach out to un- HHS may continue to enforce them. insured children. Yet, policymakers realize much more must be done to meet the coverage needs of Other pediatric programs all children who are at or near the poverty level. Following September’s terrorist attacks in New According to the Administration, an eased regula- York, NY, and Washington, DC, HHS determined tory burden and more flexibility for states in de- that some children may need proper treatment for signing their enrollment practices and coverage traumatic stress. In October, HHS awarded $10 policies will result in greater efficiency and allow million to the National Child Traumatic Stress the states to focus more of their attention on the Initiative. This program is intended to support specific needs of local communities. This open door improved treatment and services for childhood to innovation, combined with financial support and trauma, increase accessibility to community cen- continued analysis of the issues involved, holds ters, and promote clinical research aimed at pro- promise for addressing the long-resistant problem viding adequate care to children who experience of assuring that children have access to the health psychological trauma. care services they need. ⍀ A variety of grants will be awarded through HHS’s Substance Abuse and Mental Health Ser- vices Administration. One type of grant is in- tended for health care facilities to establish treatment/services development centers that will be charged with identifying, improving, and developing effective treatments for traumatic childhood events, such as witnessing and expe- riencing violence, loss of family, traumatic inju- ries, medical procedures, natural disasters, war, and so forth. At press time, such grants had been awarded to Boston Medical Center in Boston, MA, the Early Trauma Treatment Network at the University of California, San Francisco, CA, Northshore University Hospital in Long Island, NY, Yale University in New Haven, CT, and the Allegheny-Singer Research Institute in Pitts- burgh, PA. To deal with other childhood conditions, Rep. Sue Kelly (R-NY) introduced H.R.792, the Treatment of Children’s Deformities Act of 2001. This legis- lation, supported by the College, requires that group health plans and health insurance carriers cover outpatient and inpatient diagnosis and treat- ment of a minor child’s congenital or developmen- tal deformity, disease, or injury. All surgical treat- ment that in the opinion of the treating physician is medically necessary to create a normal appear- ance would be covered under the legislation. At 18 press time, the bill enjoyed the bipartisan support

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS he most recent crisis faced by physicians ability insurance vehicles, such as physician Tin their ongoing struggle with professional mutuals, offshore captives, risk-retention groups, liability is the double-digit yearly increase and insurance trusts. These efforts succeeded in in the cost of professional liability insurance, creating a market for professional liability insur- which is occurring at a time when physician in- ance but did little to improve the tort system. come continues to steadily decline. In the early and mid-1980s, the professional li- ability insurance problem again reached crisis pro- Roots of the problem portions. Driven by a significant increase in both During the past 30 years, physicians have faced the number of claims filed and the size of the settle- a number of crises related to the cost of profes- ments awarded by juries, professional liability pre- sional liability coverage. The first crisis was miums began rising yearly at double-digit rates. sparked in 1975 when professional liability insur- Some physicians faced rate increases of 50 per- ance company actu- cent or more per year. aries discovered that To respond to this they had neglected to crisis of affordability, react to rising loss state legislatures ratios in preceding Double-digit again took action but years. Commercial once more enacted insurance companies premium hikes: reforms that proved responded by either to be too narrow in raising rates signifi- The latest crisis scope or, in many cantly or, as more of- cases, were later ten occurred, by in professional liability found to be unconsti- dropping profes- tutional by the state sional liability cover- judicial systems. age entirely. This situation led to the Temporary relief decreased availabil- by For unexplained ity of professional li- reasons, the rise in fre- ability insurance, quency of claims and and many physicians Barry M. Manuel, MD, FACS, severity of awards were unable to pur- moderated during chase professional li- Boston, MA the late 1980s and ability insurance or early 1990s. During were forced to pay an this period the claims exorbitant price. inflation rate was Physicians and state governments responded still increasing by approximately 4 to 5 percent dramatically to this problem. With the stability of annually but was deemed manageable in light of our health care system threatened, most states re- the exorbitant increases experienced in the early acted by passing legislation aimed at containing 1980s. the problem, and some states formed joint under- In the early 1990s, with physician mutual com- writing associations to establish an insurance mar- panies insuring some 60 percent of the physicians ket. Some states, including California, passed in the U.S., a fundamental shift occurred in the meaningful legislation (such as the Medical Injury rating mechanisms used by professional liability Compensation Reform Act) that significantly eased insurance companies. The agencies responsible for the problem. Most other states approved less ef- rating professional liability insurance companies fective reforms that did little to protect physicians became concerned that physician mutuals, most or the fragile market. Medical organizations and of which limited their coverage to a single state, physicians’ groups took steps toward creating their were more intrinsically risky because of their geo- own insurance market by forming professional li- graphic concentration. As a result, these rating 19

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS organizations began advising physician mutual radar screen 15 years ago, but now accounts for insurance companies to extend their penetration 50 percent of claims against and indemnity paid into other states in order to spread the risk and on behalf of physicians. Failure or delay in diag- maintain their high ratings. This action resulted nosis of cancer is the leading cause of action, with in many physician mutuals expanding into other breast cancer accounting for half of the cases, fol- states, using a technique known as “burning into lowed by colon and lung cancers. Delays as short a market.” Using this mechanism, expanding com- as seven months have resulted in plaintiff verdicts, panies lower their premiums below actuarially and there have been a number of plaintiff verdicts sound rates so they can penetrate new markets. involving patients who were disease-free for five Local companies seeking to retain their market or more years after the alleged delay in diagnosis. share were forced to match these artificially low Although all physicians have been affected by this rates, resulting in predatory price-cutting with in- trend, diagnostic radiologists and primary care surance being sold at inadequate rates. physicians have been targeted most often. In ad- dition, jury awards have skyrocketed beyond all Return of the high rates reason. Jury Verdict Research of Horsham, PA, has After several years of price-cutting, reserves and reported that jury awards rose 79 percent from surpluses at many physician mutuals began to de- $1.95 million in 1993 to $3.49 million in 1999. teriorate, necessitating a return to adequate, ac- These circumstances have resulted in the latest tuarially sound pricing. This situation created a crisis in professional liability. Some of the largest need for large rate increases, not only to cover the commercial insurers are raising their rates in current actuarially defined rates but, in many many states by more than 30 percent. Even phy- cases, to help restore the financial integrity of the sician mutuals are being forced into double-digit insurance company. Several insurance companies rate increases averaging 15 percent nationally this had so greatly discounted their pricing that they year. Predictions are that these premium hikes will were forced into bankruptcy or receivership, caus- be necessary for the foreseeable future. Rate in- ing potential harm to their physician insurers. creases materially affect all physicians but are par- PHICO was taken over in August by the Pennsyl- ticularly devastating to individuals in high-risk vania regulators; soon after Frontier Insurance specialties, such as obstetrics, neurosurgery, and Group was taken over by New York regulators. orthopaedic surgery, where yearly premiums in Other large commercial insurers also experienced some areas are approaching $200,000 or more per difficulty and responded by withdrawing from year for $1 million/$3 million of coverage. Physi- troubled markets and raising their premiums sig- cians in several states, such as Pennsylvania, West nificantly in others (not quite to the extent expe- Virginia, Florida, and Mississippi have been espe- rienced in 1975). One of the largest commercial cially hard hit, and physicians in other locations professional liability insurers has indicated that continued on page 51 it intends to reduce its book of professional liabil- ity insurance by 50 percent. Dr. Manual is associ- ate dean and professor of surgery at the Boston Failure or delay in diagnosis University School of The other driving force behind the latest crisis Medicine, Boston, MA. in professional liability is the rapid rise in claims He also is Chair of alleging failure or delay in diagnosis. Tradition- Regents’ Committee on ally claims against physicians have fallen into two Patient Safety and categories. Perioperative problems (surgery, an- Professional Liability. esthesia, and recovery room) have accounted for 30 to 40 percent of the claims against physicians and indemnity paid to plaintiffs; birthing injuries were the other major category, accounting for some 25 to 30 percent of all claims and indemnity pay- 20 ments. Failed or delayed diagnosis was not on the

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS DOUBLE-DIGIT PREMIUM HIKES, from page 20 will soon suffer a similar fate, unless they are able • Can entail five to seven years of litigation be- to persuade their state legislators to enact major fore an injured patient receives any compensation. reform. • Generates devastating emotional damage to the physician and his or her family even when they Fundamental change needed are later acquitted by the court. The current crisis will not be contained by pal- • Impedes the development of a comprehen- liative measures. We need a fundamental change sive patient safety program because the conse- in the way we deal with medical injuries. For many quences of self-reporting injuries or near misses years, I have favored a no-fault approach (patient may result in prolonged litigation. compensation insurance). This system has worked • Takes 60 percent of the premiums paid by well in other countries, such as Denmark, Finland, physicians and puts them into the hands of law- New Zealand, and Sweden, for many years and has yers. been effective in cases involving newborns with It is time for a change! ⍀ severe neurological damage in Virginia and Florida. It also has also been effective in the U.S. This article was generated through the efforts of for many years as applied to a government-spon- the Regents’ Committee on Patient Safety and Pro- sored program dealing with vaccine injuries. Fur- fessional Liability. Members of the committee believe ther, it is the same approach being advocated for that this and other articles published in the Bulle- those affected by the September 11 tragedy. tin will stimulate thought and possible action on a Physicians cannot continue to shoulder the bur- wider spectrum of issues related to patient safety den of a system that: and professional liability. • Compensates fewer than one in eight pa- tients who are negligently injured. • Is based on the determination of fault where professionals often disagree.

51

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Clinical Congress 2001:

Highlights 21

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS ore than 12,300 surgeons, other phy- sicians, exhibitors, guests, and conven- tion personnel attended the 2001 MClinical Congress October 7-12 in New Orleans, LA. The 87th annual clinical meeting of the College offered its participants the usual op- portunities to learn about the practice of surgery through lectures, panel discussions, postgraduate courses, motion picture sessions, and exhibits. Nonetheless, some sessions set this year’s Clini- cal Congress apart from its predecessors. In re- sponse to the September 11 attacks on the World Trade Center in New York City and the Pentagon in suburban Washington, DC, and growing threats of bioterrorism, the Clinical Congress featured a special session titled Unconventional Civilian Di- sasters: What the Surgeon Should Know. During this session, David B. Hoyt, MD, FACS, Chair of the College’s Committee on Trauma, and Donald E. Fry, MD, FACS, Chair of the Board of Governors’ Committee on Blood-Borne Infection and Environmental Risk, presented information Dr. Jones giving his Presidential Address. about potential health problems stemming from the current international conflicts. Their com- ments were based on statements developed by their committees, which were published in the Novem- ber Bulletin. Other highlights of this year’s Congress included the second presentation of both Programa Hispanico for Spanish-speaking surgeons and “A Day at the American College of Surgeons.” The latter program made it possible for minority high school students from the New Orleans area to meet practicing sur- geons and to experience the meeting. Some other noteworthy moments were reported in the November Bulletin, including the presenta- tion of the Distinguished Service Award to David L. Nahrwold, MD, FACS. The November issue also contained information about the three indi- viduals who were awarded Honorary Fellowship in the College: Pekka Häyry, MD, PhD; Minoru Hirano, MD, PhD; and Albrecht F.W. Encke, MD, FACS. Following are some other high points of the Clini- Dr. Carrico, President-Elect. cal Congress.

Officers installed R. Scott Jones, MD, FACS, a general surgeon ceremonies. Dr. Jones is the S. Hurt Watts Profes- from Charlottesville, VA, was installed as the 82nd sor and chair of surgery at the University of Vir- 22 President of the College during the Convocation ginia Health System in Charlottesville.

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Dr. Hoyt (left) and Dr. Fry during their presention regarding unconventional civilian disasters.

Dr. Jones centered his Presidential Address on tee. Dr. Organ also is the 1999 recipient of the Dis- organized medicine and how it has responded to tinguished Service Award. political and economic pressures during the course A general surgeon in Pensacola, FL, Dr. Gage of its evolution. Dr. Jones stressed the importance has been Chair of the College’s General Surgery of understanding the history of these issues for Coding and Reimbursement Committee since young surgeons who are preparing to deal with January 2001. He served on the Board of Gover- modern-day challenges, such as the demand for nors from 1988 to 1994 and chaired its Committee improved quality of care and evidence-based medi- on Socioeconomic Issues from 1997 to 2000. He cine. A more detailed summary of Dr. Jones’ ad- received the College’s Distinguished Service Award dress appears on pages 8-9 of this issue. in 1995. Further, Kathryn D. Anderson, MD, FACS, was installed as First Vice-President, and Claude New officials H. Organ. Jr., MD, FACS, was appointed to the C. James Carrico, MD, FACS, of Dallas, TX, post of Second Vice-President. John O. Gage, MD, was named President-Elect during the Annual FACS, was appointed as Secretary. Meeting of Fellows and Initiates. Dr. Carrico is the Dr. Anderson is surgeon-in-chief and vice-presi- Doris and Bryan Wildenthal Distinguished Chair dent of surgery, department of surgery, Children’s in Medical Science and professor, department of Hospital of Los Angeles, and professor of surgery, surgery, at the University of Texas Southwestern University of Southern California, Los Angeles, Medical Center at Dallas. CA. She served as Secretary of the College from A Fellow of the College since 1971, Dr. Carrico 1992 to 2001 and has been a member of the Advi- has served in a number of leadership roles within sory Councils for Surgical Specialties. the organization. He served as the Chair of the Dr. Organ is chair of the surgery residency pro- Board of Regents from 1999 to 2001 and was a Re- gram and professor in the department of surgery gent since 1992. He also is currently a member of at the University of California, Davis-East Bay. He the Committee on Continuing Education; he served has been a member of the ACS Commission on as that committee’s Vice-Chair from 1984 to 1986 Cancer and the International Relations Commit- and on its SESAP IV and V Committees from 1980 23

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS During the annual meeting, Dr. Nahrwold (left) was Dr. Simmons (right) received a copy of the Owen H. presented with the 2001 Distinguished Service Award Wangensteen Surgical Forum, Volume LII, which was by Dr. Bender. dedicated to Dr. Simmons, from Dr. Mentzer.

to 1982 and from 1982 to 1984, respectively. Dr. formed his research fellowship under the direction Carrico served on the Board of Governors from of G. Tom Shires, MD, FACS. He completed his in- 1984 to 1990 and as its Chair from 1989 to 1990. ternship and residency at Parkland Memorial Hos- In addition, he was a member of the Program Com- pital in Dallas. After finishing his residency, Dr. mittee in 1995 and of the Pre- and Postoperative Carrico served in the U.S. Navy and established Care Committee from 1975 to 1983 and had a seat the shock unit at San Diego Naval Hospital. on the Executive Committee of the latter body from From 1969 to 1972, Dr. Carrico was an assistant 1978 to 1981. professor of surgery at the University of Texas A specialist in burn, trauma, and critical care, Southwestern Medical School; he served as associ- Dr. Carrico was on the Committee on Trauma from ate professor of surgery at that institution from 1982 to 1992; he was Vice-Chair of its Executive 1972 to 1974. Dr. Carrico then ventured to the Committee from 1986 to 1989, Chair of the Wash- northwest to work at the University of Washing- ington State Committee from 1979 to 1982, and ton School of Medicine in Seattle. While there, he Chair of Region X from 1982 to 1990. served as associate professor of surgery from 1974 Dr. Carrico has been very active at the chapter to 1976, professor of surgery from 1976 to 1990, level as well. He served as President of the Wash- and chairman of the department of surgery from ington State Chapter from 1989 to 1990 and as 1983 to 1990. In 1990, Dr. Carrico returned to his President of the North Texas Chapter from 1996 roots to assume the role of professor and chair, to 1997. department of surgery, at the University of Texas Dr. Carrico earned his medical degree in 1961 Southwestern Medical Center. from the University of Texas Southwestern Medi- Dr. Carrico is a member of numerous medical 24 cal School at Dallas, where he subsequently per- and surgical organizations, including the Ameri-

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS can Association of Surgery of Trauma, of which he was president from 1992 to 1993. Dr. Carrico also holds membership in the American Surgical Association, American Trauma Society, scientific research society of Sigma Xi, Surgical Infection Society, Society of University Surgeons, and Société Internationale de Chirurgie. A prolific author, Dr. Carrico currently serves on the editorial boards of the Journal of the Ameri- can College of Surgeons, the Annals of Surgery, and the World Journal of Surgery. In addition, Dr. Carrico serves on the Injury Re- search Grant Review Committee of the Centers for Disease Control and Prevention and the Ameri- can Board of Surgery (ABS). He was president of the ABS from 1992 to 1993. In other actions taken during the Convocation, the Fellows named Richard R. Sabo, MD, FACS, Bozeman, MT, First Vice-President-Elect, and Dr. Thompson (left) presented the Distinguished Amilu S. Rothhammer, MD, FACS, Colorado Philanthropist Award to Dr. Satitpunwaycha. Springs, CO, as Second Vice-President-Elect. Dr. Sabo is a general surgeon in private practice and is a staff surgeon at Bozeman Deaconess Hos- pital. He was a Regent from 1991 to 2000 and Vice- Chair of the Board of Regents from 1999 to 2000. Dr. Sabo has been active on many ACS commit- tees, including the Informatics, Central Judiciary, Communications, Organization, and Nominating Committees. Dr. Rothhammer also is a general surgeon in private practice. She is on staff at Penrose Hospi- tal in Colorado Springs. Dr. Rothhammer repre- sents the College on the national Practicing Phy- sicians Advisory Council and in the American Medical Association’s House of Delegates. She is a member of the College’s Development Committee and served as Secretary and Chair of the Board of Governors in 1996 to 1998 and 1998 to 1999, re- spectively.

Board of Regents In other College actions during the Clinical Con- The 2001 National Safety Council’s Surgeons Award gress, Edward R. Laws, Jr., MD, FACS, was for Service to Safety was presented to Dr. Carrico elected Chair of the Board of Regents. Dr. Laws is (center) by Dr. Hoyt (left) and Dr. Maier. a professor of neurosurgery and medicine at the University of Virginia Health Sciences Center in Charlottesville, VA. He has been a Regent since visory Councils for Surgical Specialties and the 1994 and has served in various capacities on the Nominating Committee of the Fellows; served on Advisory Council for Neurological Surgery since the Central Judiciary, Medical Motion Pictures, 1991. Additionally, Dr. Laws has: chaired the Ad- and Fellowship Liaison Committees; and been a 25

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Past recipients of the Distinguished Service Award gathered for their annual luncheon. Front row, left to right: John O. Gage, Josef E. Fischer, James C. Thompson, Seymour I. Schwartz, Harris B. Shumacker, Jr., and S. Stuart Mally. Back row: Vallee L. Willman, Claude H. Organ, Jr., Frank Padberg, Murray F. Brennan, C. Barber Mueller, and C. Thomas Thompson.

member of the Board of Governors. ernors’ Committee on Surgical Practice in Hospi- Jonathan L. Meakins, MD, FACS, continues tals from 1997 to 1998 and as a member of the ACS to serve as the Vice-Chair of the Board of Regents. Communications, Organization, and Program Dr. Meakins is the E.W. Archibald Professor of Committees. She also is a member of the ACS Com- Surgery and chair, McGill University, and is chief mittee on Women’s Issues. Dr. Bass has been a Fel- of surgical services at McGill University Health low of the College since 1989 and will serve an ini- Centre in Montreal, PQ. He has been a Regent tial three-year term as a Regent. since 1993. Dr. Eastman is N. Paul Whittier Chair of Trauma In addition, the ACS Board of Governors elected and an associate clinical professor of surgery at two new Regents—Barbara L. Bass, MD, FACS, the University of California, San Diego. He has and A. Brent Eastman, MD, FACS. played an active role on the Committee on Trauma Dr. Bass is professor of surgery and vice-chair, since 1984, serving as its Chair from 1989 to 1994. academic affairs and research, University of Mary- He has been an instructor for the Advanced land School of Medicine, Baltimore, MD. She is the Trauma Life Support® certification course since Immediate Past-Chair of the Board of Governors 1992. Dr. Eastman also is the former Vice-Chair of (B/G), serving in that function from 1999 to 2001, the Program Committee. He has been a Fellow and was a member of the B/G Executive Commit- since 1976 and will serve an initial three-year term 26 tee since 1998. She also served as Chair of the Gov- as Regent.

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS The Past-Presidents of the College met for their annual luncheon. Left to right, front row: George R. Dunlop, James C. Thompson, Frank C. Spencer, W. Gerald Austen, C. Rollins Hanlon, and Henry T. Bahnson. Back row: Seymour I. Schwartz, David G. Murray, LaSalle D. Leffall, Jr., Lloyd D. MacLean, G. Tom Shires, and Thomas R. Russell, Executive Director.

The following surgeons were reelected to addi- Guyton, MD, FACS; Rene Lafreniere, MD, tional three-year terms as Regents: William H. FAC S; and Courtney M. Townsend, Jr., MD, Coles, MD, FACS; Richard J. Finley, MD, FACS. FACS; Jack W. McAninch, MD, FACS; and Maurice J. Webb, MD, FACS. Awards and honors In addition to the presentation of Honorary Board of Governors Fellowships and the Distinguished Service Award, With regard to the Board of Governors, J. other distinctions accorded during the Clinical Patrick O’Leary, MD, FACS, was elected to a Congress included the dedication of the 51st vol- one-year term as Chair of its Executive Commit- ume of the Owen H. Wangensteen Surgical Forum tee. Dr. O’Leary replaces Dr. Bass in that position. to Richard L. Simmons, MD, FACS. The Com- Sylvia D. Campbell, MD, FACS, was elected to mittee for the Forum on Fundamental Surgical a one-year term as Vice-Chair of the Executive Problems dedicates the symposium each year to a Committee and Timothy C. Fabian, MD, FACS, preeminent surgical scientist who has made ex- to a one-year term as Secretary. ceptional contributions to research and who is a The following individuals also were elected to role model for aspiring academic surgeons. Rob- the Board of Governors’ Executive Committee: ert L. Mentzer, Jr., MD, FACS, Chair of the Julie A. Freischlag, MD, FACS; Steven W. committee, presented the award. 27

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS The International Guest Scholars for 2001 and International Relations Committee members met during the Congress. Left to right, front row: Dr. Lopez, Chair of the Selection Subcommittee; Dr. Sinagra; Dr. Rodriguez; Dr. Ezeome; and Dr. Kelly, Chair, International Relations Committee. Back row, left to right: Dr. Meneu-Diaz; Dr. Kuzu; and Dr. Corrales V.

Additionally, each year the Fellows Leadership Carrico, who is internationally recognized as an Society (FLS) presents the Distinguished Philan- eminent surgical scientist and humanitarian dedi- thropist Award in recognition of extraordinary cated to the care of injured patients. He has fo- philanthropic support of the College. This year’s cused much of his professional career on illumi- award was presented to Pon Satitpunwaycha, nating the issues of injury prevention and safety. MD, FACS, by James C. Thompson, MD, Presenting the award on behalf of the National FACS, Chair of the FLS. Dr. Satitpunwaycha’s Safety Council were Dr. Hoyt and Ronald V. generous support of the ACS Development Pro- Maier, MD, FACS, president of the American gram has contributed significantly to the research Association for the Surgery of Trauma. and education programs of the College, helping to Lastly, the International Relations Commit- ensure progress in the science and art of surgery tee, chaired by Keith A. Kelly, MD, FACS, and ultimately benefitting surgical patients. hosted a luncheon to honor the 2001 Interna- The 2001 National Safety Council’s Surgeons tional Guest Scholars. Physicians receiving the 28 Award for Service to Safety was presented to Dr. distinction this year are as follows: Juan

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Representatives of Merck & Co., Inc., U.S. Human Health, presented a check in the amount of $100,000 in the form of an unrestricted educational grant to support the work of the College. This payment is the first of three scheduled unrestricted educational grants totaling $300,000 to be made to the College over the next three years. Left to right: Merck representatives Linda T. Raichle, PhD; Richard Murray, MD; Rose Arnone; and Michael W. Skoien, RPh, MBA; and ACS Officers Harvey W. Bender, Jr., President; James C. Carrico, Chair, Board of Regents; Barbara Bass, Chair, Board of Governors; Thomas R. Russell, Executive Director; and Robert E. Berry, Chair, Development Committee.

Carlos Meneu-Diaz, Spain; Emmanuel nia. The award of approxi- Rapuluchuk Ezeome, Nigeria; M. Virginia mately $5,000 is given to Rodriguez Funes, El Salvador; Mehmet support travel and subsis- Ayhan Kuzu, Turkey; Diego Luis Sinagra, tence at the annual Clinical Argentina; and Noel Ernesto Corrales V., Congress, including post- Guatemala. The International Relations graduate course fees. The Committee’s Selection Subcommittee is chaired purpose of the Oweida by Marvin Jose Lopez, MD, FACS. Scholarship is to help young general surgeons practicing 2001 Oweida scholar in rural communities attend William H. McGeehin, MD, FACS, the Clinical Congress and Torrington, CT, received the 2001 Nizar N. benefit from the educa- Dr. McGeehin Oweida, MD, FACS, Scholarship of the Ameri- tional experiences it pro- can College of Surgeons. vides. The Oweida Scholarship was established in The Oweida Scholarship is awarded each year 1998 in memory of Dr. Oweida, a general sur- on a regional rotation basis by a subcommittee ⍀ geon from a small town in western Pennsylva- of the Board of Regents. 29

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS eport of the Chair R of the Board of Regents

by C. James Carrico, MD, FACS, Dallas, TX

his has been a busy and productive year who had completed their “training” in the use for the College. Under the leadership of and application of new techniques, such as ul- Thomas R. Russell, MD, FACS, Executive trasound image-guided breast biopsies, and so T Director, we have successfully completed on. These courses offer verification in the skills a strategic planning process, the results of which presented, and we anticipate that the breadth can be found in the September 2001 issue of the of this verification will expand. In addition, the Bulletin. I would encourage each of you to take College has now started a joint sponsorship pro- the time to read it, if you have not already done gram so that ACS courses may be offered by as- so. As Dr. Russell points out in his “From my sociated regional and surgical specialty organi- perspective” column in the September issue, this zations in order to make this type of education is not intended to be a static document, but a more broadly available. starting place to help the College move into the 21st Century. Research and optimal care One thrust of this plan is to focus on four di- With respect to research and optimal patient visions, which represent the primary services care, the College has provided research support provided by the American College of Surgeons. and encouragement to the Fellows and residents, These are: (1) education, (2) research and opti- including the Clowes Research Career Develop- mal patient care, (3) advocacy and health policy, ment Award. Additional major advances in the and (4) member services. This report serves as last several years have been the direct involve- a brief update on the status of each of these pro- ment of the College itself in a number of pri- grams. Because this is my ninth and final year mary clinical research projects, which include on the Board of Regents, I have taken the lib- two hernia studies—one comparing laparoscopic erty of looking back to see what progress we have with open hernia repair, and the other evaluat- made in the last decade. ing the role of watchful waiting in symptomatic hernias. Education The studies being conducted by the American Education has been a major thrust of the Col- College of Surgeons Oncology Group (ACOSOG) lege since its inception. Major changes in our under the leadership of Samuel A. Wells, Jr., MD, educational program began in the early 1990s FACS, continue to accrue patients. ACOSOG is with the establishment of the Committee on the only truly surgical oncology group receiv- Emerging Surgical Technology and Education ing funding from the National Institutes of in response to the evolution of laparoscopic Health. cholecystectomy and other minimal access pro- Recently, the College received support for cedures. Under the leadership of that commit- three new projects. The largest is in conjunc- tee and with extensive staff support, the College tion with the Veterans Administration and will has made major progress in establishing a lead- attempt to apply the National Surgical Quality ership role in recognizing and evaluating new Assurance Program methodology to private in- technology. stitutions. This program should help put the The rapid evolution of new technology pre- control of quality back into the hands of sur- sented the College with the opportunity and re- geons and keep it out of the hands of bureau- sponsibility to develop a series of hands-on crats. courses specifically designed to educate surgeons Additionally, Ajit Sachdeva, MD, FACS, the 30

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS new Director of the Division of Education, has (including the chapters), broaden our advocacy just been notified that a major program explor- efforts, undertake revenue-producing activities, ing new ways to educate surgeons will be funded and increase our opportunities to participate in by the Agency for Healthcare Research and competency programs in conjunction with other Quality. While some of our programs (for in- appropriate organizations. stance, the hands-on courses) provide immedi- ate impact, some of these research programs will Closing thoughts be extremely important to surgeons over a long This ends my nine years of service on the Board period of time. of Regents. I am honored to have served and hope this review gives you some idea of the progress we Advocacy and health policy have made over the last several years. ⍀ The College’s Washington Office was estab- lished in 1979, and we purchased a building to house our federal affairs staff in 1988. Over the years, the Washington Office has grown progres- sively in terms of both size and effectiveness. Our efforts have successfully slowed the erosion of surgical income and, more recently, led to the establishment of significant new general surgery CPT codes. Dr. Russell addresses these new pay- ment codes and related developments in his col- umn on page 3. Over the next year, there will major new efforts to modify health policy both through public education about the importance of Fellowship in the College and the quality of care that can be obtained through surgical spe- cialty services.

Member services The member services area has been stream- lined and will be increasingly responsive to member needs. New programs are being added, and, as I think one can see, all of the major divi- sions really focus on services to members. The College has added the Candidates and Associate Fellows to the pool of formal members of the College and is considering the possibility of ex- Dr. Carrico is Doris tending membership to other health care pro- and Bryan Wildenthal fessionals. Distinguished Chair in Medical Science and Other business professor, department of Last but not least, at its meeting this past Oc- surgery, University of tober, the Board of Regents approved the estab- Texas Southwestern Medical Center, Dallas, lishment of a 501(c)6 organization. This new or- TX. ganization will not only give us more freedom in terms of legislative activity, but will allow us to have increased flexibility in verification and credentialing activities, provide information to the Fellowship about outcomes, offer manage- ment services for other surgical organizations 31

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS eport of the Chair R of the Board of Governors

by Barbara L. Bass, MD, FACS, Baltimore, MD

t is my distinct honor to report on the activi- bers of other surgical organizations in our coun- ties of the Board of Governors. I can assure try. I can assure you that the Board of Governors you that the Governors—the representatives is unified in supporting the development and Iof our Fellows—care deeply about the prin- implementation of such a preparedness plan and ciples upon which this College was founded. The considers this the most important mission for our Fellows look to the College to support their efforts College in these uncertain times. to provide the highest quality of care to their sur- gical patients. They also anticipate that the Col- Charges to College lege will support them in their efforts to preserve In the summer of each year—this year, prior to and create health care systems in which their ser- the events of September 11—the Governors send vices are rendered in an effective, professional reports to the Chair of the Board of Governors de- manner with due recognition and respect for the tailing their concerns as surgeons. This year, 233 services they provide to their patients and com- Governors submitted annual reports. These in- munities. cluded 137 Governors-at-Large in the U.S. and Canada, 28 Governors in other countries, and 68 Responding to terrorism Governors representing surgical societies. During the course of this Clinical Congress, the The Governors noted with gratitude the out- Governors’ focus was drawn to the threat to our standing educational programs the College has nation from the evil forces of international ter- continued to provide. For special commendation, rorism. One month after the attacks in New York, they pointed to the hands-on courses in new tech- NY, and Washington, DC, the Governors expressed niques and technology, which allow practicing sur- a clear commitment to being leaders in preparing geons to add new procedures and techniques to our nation to protect and care for our citizens who their surgical armamentarium. They requested are exposed to these threats. We committed to edu- that the steps to allow verification of training to cating ourselves and the broader surgical, medi- support credentialing, in conjunction with surgi- cal, and public communities about potential cal boards, move forward. threats. The Governors urged the College to par- The Governors applauded the College’s commit- ticipate in crafting an immediate response plan. ment to defining best practices through evidence- As a first step, during the course of this meet- based analyses. They charged the College with ing, the Governors’ Committee on Blood-Borne utilizing these data to improve the care of the sur- Pathogens and Environmental Risk prepared a gical patient and to support the surgeon in prac- document on the unconventional and, to many, tice who, over the course of a career, continually unfamiliar threats associated with acts of civilian strives to improve his or her own understanding terrorism. We request that this document be dis- of the science of surgery. tributed to our Fellows rapidly and effectively. In The Governors continued to voice serious con- conjunction with the Committee on Trauma, the cerns regarding the impact of managed care and Board of Governors calls upon the College to pro- government agencies on the profession of surgery. vide tangible leadership in helping to establish a The Governors lauded the success achieved by the network of preparedness in conjunction with civil advocacy efforts of Fellows on the College’s Gen- and military authorities. This preparedness plan eral Surgery Coding and Reimbursement Commit- should include not only Fellows of the College but tee to improve payment for some surgical proce- also should incorporate the talents of the mem- dures but acknowledged that continued diligence 32

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS will be required to sustain even these modest gains. ership to develop new tools and strategies to ef- An even greater concern was voiced regarding the fect this mission. The Fellows will surely support onerous burden of complex coding and billing sys- and embrace these new and sustained efforts. tems, which require ever greater efforts by prac- I am most grateful to have had this opportunity tice staff, which, in turn, result in higher costs with to serve as Chair of the Board of Governors. I the final result being decreased payment for sur- thank all of the Governors for their diligent work gical services. The strains that managed care con- on behalf of the College. ⍀ tracts have introduced to the surgeon-patient re- lationship was decried. The Governors urged the College leadership to continue to enhance its ad- vocacy efforts on behalf of the Fellows in these important areas. As the College moves toward establishing a new organizational structure to enhance its functions, the Governors requested the leadership to con- tinue to pursue options that will strengthen its voice in legislative bodies at both the state and national level. A political action committee, as pro- posed by the Governors one year ago, may prove to be an effective tool to this end. The Governors also proposed that the College consider develop- ment of a broader legislative action program to enlist grassroots support from surgeons and their patients. With urgency, the Governors in many states re- ported skyrocketing malpractice premiums. They asked the College to consider new strategies, with targeted local efforts, coalition building with other organizations, and an awareness campaign di- rected toward our patients to make some progress on this new exacerbation of an old problem. Additionally, the Governors noted with concern the declining interest in surgical residency train- ing. While the Governors acknowledged that the causes of this decline are many and complex, they recommended that the College seize this opportu- nity to educate the public and our students about Dr. Bass is professor the rare privilege of being a surgeon, highlighting of surgery and vice- the sophisticated talents, knowledge, and commit- chair, academic affairs ment a surgeon brings to his or her care of the and research, Univer- surgical patient. sity of Maryland School of Medicine, Conclusion and director, Surgical Clinical Care Center The Governors remained firm in their resolve of the VA Maryland to provide the best possible surgical care for their Health Care system, patients. They applauded the College for its Baltimore, MD. She is longstanding role as the guardian of this mission. also a Regent of the They requested that the ACS continue to seek out College. new avenues to augment the Fellows’ effectiveness in this mission and they urged the College’s lead- 33

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS eport of the R Executive Director

by Thomas R. Russell, MD, FACS, Chicago, IL

s C. James Carrico, MD, FACS, reports cal societies and other physician organizations, on page 30, and as announced in the Sep- such as the American Medical Association, to ad- tember 2001 Bulletin, the College com- vance a legislative agenda that stresses those is- Apleted its strategic planning process this sues of most importance to surgeons. At the same year. Perhaps the most significant outcome of that time, we are acutely aware of the regulatory bur- process is the development of the four central di- dens that all of us practice under, and we will need visions within the organization, each of which will to address this problem in a timely and proactive have specific strategic initiatives that will be used fashion. To that end, I believe the Health Policy as a yardstick to measure progress in these vari- Steering Committee, composed of a broad con- ous areas of activity. The four core divisions focus stituency of surgeons from all disciplines, will do on education, advocacy and health policy, research much to respond in a timely fashion to activities and optimal care, and member services. in Washington and at the state level. This year, we also completed an extensive inter- The new Division of Research and Optimal Pa- nal review of our structure and performance tools tient Care and the Office of Evidence-Based Sur- for the staff. This review was conducted by an out- gery will be critically important in the future with side consulting group. The findings were indica- regard to evaluating data. The division also will tive of a dedicated and hard-working staff func- assist us in determining best practices and the po- tioning in an appropriate work environment. tential for clinical trials even beyond what we are currently doing through the American College of Divisions get to work Surgeons Oncology Group. This office and division With the blueprint now set, our work really be- will be staffed with biostatisticians and will have gins. In each of the four divisions, new and inno- the ability to write and obtain grants from vari- vative activities must be pursued. ous federal and non-federal agencies. We have al- In terms of education, we clearly need to look ready been awarded three grants from the Agency very seriously at the way our products are deliv- for Healthcare Research and Quality, which we will ered and at the likely future needs of surgeons in use to examine surgical outcomes and the work- all specialties. As all of you know, there is a move- continued on page 53 ment afoot focused on the maintenance of lifelong learning and competency. How it will be measured Dr. Russell is and met in the future remains to be seen. We are Executive Director of actively working with a number of organizations, the American College such as the American Board of Medical Special- of Surgeons. ties, the Council of Medical Specialty Societies, and the various surgical boards, to study and eventu- ally produce educational material to meet these needs. There also is an unmet need for patient edu- cation, the satisfaction of which I believe should be a high priority. With regard to advocacy and health policy, we have developed and will continue to form strong coalitions with other surgical organizations. We currently are working closely with all the surgi- 34

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS ACS Officers and Regents Officers/Officers-Elect

R. Scott Jones Kathryn D. Anderson President First Vice-President General surgery Pediatric surgery S. Hurt Watts Professor and Surgeon-in-chief and chair, department of surgery, vice-president of surgery, University of Virginia Health Children’s Hospital of System Los Angeles, Charlottesville, VA professor of surgery, University of Southern California Los Angeles, CA

Claude H. Organ, Jr. John L. Cameron Second Vice-President Treasurer General surgery General surgery Chair, surgery residency Professor and chair, program, professor, depart- department of surgery, ment of surgery, University The Johns Hopkins of California, Davis-East Bay University School of Medicine Oakland, CA Baltimore, MD

C. James Carrico Richard R. Sabo President-Elect First Vice-President- Trauma and critical care Elect Doris and Bryan Wildenthal General surgery Distinguished Chair in Private practice and Medical Science and professor, staff surgeon, department of surgery, Bozeman Deaconess University of Texas Hospital, Southwestern Medical Bozeman, MT Center Dallas, TX

Amilu S. Rothhammer John O. Gage Second Vice-President- Secretary Elect General surgery General surgery Private practice, Private practice, Pensacola, FL Colorado Springs, CO

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DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Board of Regents

Edward R. Laws, Jr. Chair Neurosurgery Professor of neurosurgery Jonathan L. Meakins and medicine, Vice-Chair University of Virginia General surgery Health Sciences Center E. W. Archibald Professor Charlottesville, VA of Surgery, chair, McGill University, chief, surgical services, McGill University Health Centre Montreal, PQ

Barbara L. Bass General surgery Professor of surgery and vice-chair, academic affairs L. D. Britt and research, General surgery University of Maryland Brickhouse Professor and School of Medicine chair, department of surgery, Baltimore, MD Eastern Virginia Medical School Norfolk, VA

William H. Coles Ophthalmic surgery Professor emeritus, State University of New York Paul E. Collicott New Orleans, LA Vascular surgery Private practice, Lincoln, NE

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VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Board of Regents (continued)

Edward M. Copeland III General surgery Edward R. Woodard Professor and chairman, A. Brent Eastman department of surgery, General surgery University of Florida College N. Paul Whittier Chair of of Medicine Trauma and associate clinical Gainesville, FL professor of surgery, University of California, San Diego, San Diego, CA

Richard J. Finley General surgery C. N. Woodward Chair in Surgery; professor and head, Josef E. Fischer division of thoracic surgery, General surgery University of British Colum- Professor of surgery bia Faculty of Medicine designate, Harvard Vancouver, BC Medical School, and chairman of surgery designate, Beth Israel Deaconess Medical Center Boston, MA

Alden H. Harken Cardiothoracic surgery Professor and chairman, department of surgery, Gerald B. Healy University of Colorado Otorhinolaryngology Denver, CO Otolarynogologist-in-chief, Children’s Hospital Boston, MA

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DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Board of Regents (continued)

Margaret F. Longo General surgery Hot Springs, AR Jack W. McAninch Urology Professor of urology, University of California- San Francisco, chief of urology, San Francisco General Hospital San Francisco, CA

Mary H. McGrath Plastic surgery Chief, department of plastic surgery, Loyola University John T. Preskitt Medical Center General surgery Maywood, IL Attending surgeon, Baylor University Medical Center Dallax, TX

Ronald E. Rosenthal Orthopaedic surgery Wayland, MA Maurice J. Webb Gynecology (oncology) Gynecologic oncologist, Mayo Clinic Rochester, MN

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VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Keeping current

What’s new in ACS Surgery: Principles and Practice? by Richard Lindsey, New York, NY

ollowing are highlights of recent additions publication of the initial version of this chapter to the online version of ACS Surgery: Prin- in 1998, considerable additional data have become Fciples and Practice, the practicing surgeon’s available that confirm the validity and utility of first Web-based and only continuously updated sur- the technique and refine its practice. For instance, gical reference. Chapters may be viewed in their the evidence strongly argues that a combination entirety by visiting the online version of ACS Sur- approach yields better results than either radio- gery: Principles and Practice in the physician por- colloid or blue dye alone, and it is now clear that tion of the WebMD Web site at www.webmd.com. the blue dye can be injected as long as 16 to 24 hours after injection of the radiocolloid. In addi- XI. Surgical Techniques tion, alternative techniques for breast mapping 17. Lymphatic Mapping and Sentinel Node Bi- have been developed that involve injection of the opsy. Douglas Reintgen, MD, FACS; Fadi Haddad, mapping agents into either the subareolar plexus MD; Solange Pendas, MD; Ni Ni Ku, MD; Claudia or the skin above the tumor; for axillary mapping, Berman, MD, FACS; Frank Glass, MD; Jane these techniques seem to work as well as Messina, MD; and Charles Cox, MD, FACS. intraparenchymal injection. The development of intraoperative lymphatic mapping and selective lymphadenectomy has XI. Surgical Techniques made it possible to map the lymphatic flow from a 9. Breast Procedures. Barbara L. Smith, MD, primary tumor and to identify its so-called senti- PhD, and Wiley W. Souba, MD, ScD, FACS. nel lymph node (SLN) in the regional basin. Inte- Surgical procedures for the diagnosis and treat- gration of this technique, in association with de- ment of breast cancer continue to become less in- tailed pathologic examination of the SLN, into the vasive and extensive while still allowing excellent surgical treatment of melanoma and breast can- control of local recurrence. For example, stereo- cer offers the potential for more conservative op- tactic core-needle biopsy performed with larger erations that not only result in lower morbidity (that is, 11- to 14-gauge) needles currently misses but also permit more accurate staging. Since the only about 1 to 2 percent of lesions, a rate compa- rable to that associated with wire-localized open surgical biopsy. In addition, many surgeons now employ directional vacuum-assisted biopsy Monthly updates to the online version of ACS (DVAB), or mammotomy, a special diagnostic pro- Surgery: Principles and Practice in the physician cedure for obtaining specimens for single or mul- portion of the WebMD Web site, www.webmd.com, tiple breast lesions. This procedure is done on an are also available quarterly through subscription to the ACS Surgery CD-ROM, which incorporates outpatient basis and can generally be completed every online update from the previous three in one hour or less. DVAB is generally safe, has an months and yearly through subscription to the acceptably low complication rate, and may diag- annual hardcover edition of ACS Surgery: Prin- nose nonpalpable breast lesions more effectively ciples and Practice, which incorporates every than stereotactic core-needle biopsy does. Suitable online update from the preceding year. To learn candidates for DVAB include patients with more, visit the ACS Surgery: Principles and Prac- continued on page 56 tice page on the ACS Web site, www.facs.org/mem- bers/acs_surgery.html. Mr. Lindsey is managing editor of ACS Surgery: Prin- ciples and Practice, WebMD Reference, New York, NY. 39

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Socioeconomic tips of the month

Filing for Medicare services

he end of the year is when surgical practices must decide whether to participate in or Around the corner Twithdraw from the Medicare program. Sur- geons who sign participation agreements agree December to accept assignment for all covered services pro- • Medicare participation agreements due to Part vided to Medicare patients in 2002. Participation B carriers by December 31, 2001. agreements and the Medicare fee schedule for the • The 90-day implementation period for the 2002 coming year are distributed to surgeons annually ICD-9-CM codes ends December 31, 2001. by Part B carriers by December 1 of the current year. January Surgeons who choose to be participating pro- • Effective January 1, 2002 viders are reimbursed under the Medicare fee • 2002 Medicare fee schedule. schedule for amounts that are 5 percent higher • First-quarter update to Correct Coding Edits. than those of nonparticipating providers. Medi- • The 90-day implementation period for the 2002 CPT and HCPCS codes begins. care sends participating physicians direct payment • ACS-sponsored basic coding workshop for sur- for 80 percent of the allowable, and their offices geons at the Louisiana Chapter meeting on Janu- are only responsible for collecting the 20 percent ary 11. Contact Irene Dworakowski at 202/672- copayment and applicable deductibles. In addition, 1507 or e-mail [email protected] for regis- Medicare automatically forwards claims to any tration information. Medigap insurer. Finally, participating physicians are listed in the Medicare Participating Physician/ Supplier Directory. data/index02.pdf and http://www.cdc.gov/nchs/ On the other hand, surgeons who opt to be non- data/tabulr02.pdf, respectively. participating providers may bill 115 percent of the 2002 CPT and HCPCS become effective Janu- Medicare nonparticipating allowable. Please visit ary 1, 2002. The grace period for incorporating the the ACS Division of Advocacy and Health Policy changes is March 31, 2002. CPT may be purchased Web page for more detailed information (http:// directly from the AMA publications Web site (http: www.facs.org/dept/hpa/medenroll.html). //www.amasolutions.com) or from a vendor. The Centers for Medicare & Medicaid Services (CMS) Important changes posts a zip file (ANHCPC02.EXE) on its Web site, Regardless of whether a surgeon chooses to par- which contains the Level II alpha-numeric HCPCS ticipate, there are some changes in the way ser- procedure and modifier codes, their long and short vices provided to Medicare beneficiaries should be descriptors, and applicable Medicare administra- reported. Some changes surgeons should be aware tive, coverage, and pricing data in both Microsoft of are as follows: Excel and delimited text formats. The document Updates for ICD-9-CM and the 2002 versions of Hrrec02.doc contains the legends to interpret the Current Procedural Terminology (CPT) and administrative and coverage policies. The product HCPCS have been released. can be downloaded at http://www.hcfa.gov/stats/ ICD-9-CM was effective on October 1, 2001, and pufiles.htm#alphanu. the 90-day grace period for incorporating the CMS has made changes in the HCPCS codes and changes into claims ends December 31, 2001. The modifiers to allow physicians to bill Medicare in changes in the 2002 ICD-9-CM index and tabular order to get denials for secondary payors for lists can be downloaded at http://www.cdc.gov/nchs/ noncovered items and services. Codes A9190 (Personal comfort item, not cov- All specific reference to CPT terminology and phraseology are CPT only © 2000 American Medical Association. All rights re- ered by Medicare statute) and modifier –GX (Ser- 40 served. vice not covered by Medicare) have been deleted.

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS The reimbursement status for code A9270 (Non- sician reporting the test to Medicare should report covered item or service) has been changed to “Not the confirmed diagnosis. The signs or symptoms Valid for Medicare.” that prompted the test may be reported as addi- Beginning January 1, modifier -GY (Item or ser- tional diagnoses if they are not fully explained by vice statutorily non-covered) and modifier -GZ or related to the confirmed diagnosis. The physi- (Item or service not reasonable and necessary) cian also may report unrelated and co-existing con- should be appended to the code that describes the ditions. Incidental findings may be reported as sec- item or service provided to the beneficiary if a phy- ondary diagnoses (not the first diagnosis). When a sician wants to indicate that the item or service is test was done in the absence of signs or symptoms, not covered or is considered a not reasonable and screening (code V82.9) should be reported as the necessary service under Medicare. These modifi- primary diagnosis code; any results of the test may ers cannot be used with any HCPCS codes that be recorded as additional diagnoses. If the results indicate the item or service is “Not Otherwise Clas- of the diagnostic test are normal or nondiagnostic, sified.” then the reporting physician should report the Code Q3015 (Item or service statutorily sign(s) or symptom(s) that prompted the study. As noncovered, including benefit category exclusion) always, diagnoses should be reported using the or code Q3016 (Item or service not reasonable and ICD-9-CM code that provides the highest degree necessary) should be reported if no specific code of accuracy and completeness for the diagnosis re- describes the item or service provided to a Medi- sulting from a test or for the sign(s)/symptom(s) care beneficiary. that prompted the ordering of the test. When a service is performed or an item is sup- The program memorandum also provides some plied that is not reasonable and necessary under information to physicians who send their patients the specific circumstances, the physician is respon- or specimens to another facility for testing. Refer- sible for notifying the beneficiary in writing by ring physicians are required to provide diagnostic using the advance beneficiary notice (ABN). The information to the testing entity at the time a test provider or supplier should file the pertinent ser- is ordered. An order may be a written document vices or items on the claim with the -GA modifier signed by the treating physician/practitioner, (waiver of liability statement on file). The GA which is hand-delivered, mailed, or faxed to the modifier must be used in conjunction with the testing facility; a telephone call by the treating Q3016 or GZ modifier, not instead or in place of physician/practitioner or his/her office to the test- them, with all Part B claims in which an ABN is ing facility; or an e-mail by the treating physician/ given. practitioner or his/her office to the testing facility. Also effective on January 1 is CMS’s clarifica- If the order is given by telephone, both the treat- tion of its coding guidelines for determining the ing physician and the testing facility must docu- appropriate primary ICD-9-CM diagnosis codes ment the telephone call in their respective copies when reporting diagnostic test results (CMS Pro- of the beneficiary’s medical records. gram Transmittal AB-01-114, September 26, On the rare occasion when the interpreting phy- 2001). This program memorandum applies to all sician does not have diagnostic information as to diagnostic testing, including clinical laboratory the reason for the test and the referring physician tests, radiology services, pathology services, and is unavailable to provide such information, it is medical services, such as electrocardiograms. Of appropriate to obtain the information directly from course, diagnostic tests performed on surgical the patient or the patient’s medical record. How- specimens (usually surgical pathology tests) are ever, an attempt should be made to confirm any subject to the policy, but the procedure itself is not. information obtained from the patient by contact- The material that follows substantially simplifies ing the referring physician. the program memorandum by limiting it to situa- The complete text of the program memorandum tions in which the physician “ordered” the diag- may be viewed at http://www.hcfa.gov/pubforms/ nostic test, performed it, and reports it to Medi- transmit/AB01144.pdf. The latest ICD-9-CM cod- care. ing guidelines can be downloaded at http:// If a test confirms a tentative diagnosis, the phy- www.cdc.gov/nchs/data/icdguide.pdf. ⍀ 41

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS College news

Dr. Collicott named to ACS executive staff

ACS Executive Director Tho- Trauma (COT) from 1984 to mas R. Russell, MD, FACS, re- 1993 and of the COT Executive cently appointed Paul E. Committee from 1984 to 1987. Collicott, MD, FACS, to the ex- He was Chair of the Advanced ecutive staff of the College. Dr. Trauma Life Support® (ATLS®) Collicott is the Director of the Subcommittee of the Committee College’s new Division of Mem- on Trauma from 1982 to 1988, ber Services. and served as National ATLS® Dr. Collicott has been a Re- Course Director from 1980 to gent of the College since 1993, a 1987 and as International member of the Board of Re- ATLS® Course Director from gents’ Executive Committee 1987 to 1992. He continues to since 1999, and a member of the serve as one of the College’s gen- Central Judiciary Committee eral surgery advisors to the since 1995 and its chair since Committee on Trauma. 1998. Prior to his appointment In addition, Dr. Collicott at the College, he was in the pri- served on the ACS CPT/RUC vate practice of vascular surgery Review Committee from 1990 to in Lincoln, NE, and served as 1998, and he has been a mem- medical director of trauma ser- ber of the ACS General Surgery vices at Lincoln (NE) General Coding and Reimbursement Dr. Collicott Hospital (LGH). He was chair- Committee from 1998 to the man of the department of present. trauma at LGH from 1981 to Dr. Collicott obtained his an editorial consultant for 1983, 1989 to 1995, and 1998 to medical degree in 1966 from the Trauma Quarterly, the Journal 1999; he also served as chief of University of Nebraska College of Emergency Nursing, the Jour- surgery at LGH from 1984 to of Medicine, Omaha. His intern- nal of Trauma, and the Journal 1985. In addition, Dr. Collicott ship took place at Lincoln Gen- of the American College of Sur- was chief of the trauma division eral Hospital from 1966 to 1967. geons. at Bryan/LGH Hospital in Lin- From 1967 to 1969, Dr. Collicott Among the numerous awards coln. was a captain in the U.S. Air Dr. Collicott has received are the A Fellow since 1977, Dr. Force and chief of outpatient Trauma Achievement Award of Collicott has been active in a services at Malmstrom Air Force the ACS Committee on Trauma wide range of College activities. Base. He performed his resi- (1982); the COT Service Award He was a member of the Board dency at the University of Wash- (1987); the ATLS® Meritorious of Governors from 1992 to 1994, ington from 1969 to 1973. While Service Award (1988); the President of the Nebraska in private practice Dr. Collicott Surgeon’s Award for Service to Chapter of the College from held academic appointments at Safety—American College of 1987 to 1990, and has been a the University of Nebraska Col- Surgeons, American Association member of the Advisory Coun- lege of Medicine and Creighton for the Surgery of Trauma, and cil for Vascular Surgery from University School of Medicine. the National Safety Council 1994 to the present. The author/contributor of (1992); and the Meritorious Ser- Dr. Collicott was also a mem- many articles and book chap- vice Award of the Nebraska 42 ber of the ACS Committee on ters, Dr. Collicott has served as Medical Association (2001).

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Take a look at the activities of the ACS Insurance Program by Gay L. Vincent, CPA, Comptroller, Chicago, IL

The ACS Insurance Program Candidates/Associate Fellows and purchase additional insur- has been in existence for 52 Beginning some time in 2002, ance under the new 10-year years. As of the plan year end- Candidates and Associate Fel- level term life plan. ing March 31, 2001, there were lows will receive, at no cost, a Under the 10-year level term 6,612 members participating in $50,000 life insurance policy for life plan, New York Life has pro- the program and 13,512 certifi- one full year. Each individual posed and the Trustees accepted cates in force. Faced with an will receive a certificate of insur- a dramatic new premium sched- overall decline in program par- ance as proof of coverage. You ule that will apply to all new ap- ticipation, members of the ACS will not need to sign up for the plicants. While there are hun- Finance Committee joined the insurance unless required by dreds of companies offering Insurance Trustees to assess the state law. You will be billed af- term-life insurance, New York insurance plans and their ben- ter one full year of coverage. Life feels that the new rates de- efit to the membership. The In- However, you are under no ob- veloped exclusively for ACS will surance Trustees and Finance ligation to continue your cover- be among the lowest in the mar- Committee members are excited age. We hope to continue this ketplace. The plan features in- about the recent changes they offer each year for new Candi- clude: authorized to the program and dates and Associate Fellows as • The initial-period premi- hope members will take advan- they join the College. ums are level and are guaran- tage of the benefits provided. teed for 10 years. Life insurance plans • There are volume dis- 2001 Initiates The life insurance plans have counts. There are benefit The ACS Insurance Program consistently been the most amounts available up to $2 mil- will provide to 2001 Initiates, at popular coverage. Those who lion. no cost, life, accidental death and participate will be very pleased • Insured members under dismemberment, and disability with the upcoming reduction in age 65 can apply for new en- coverages for one year. There is premium. There are two plans try-level rates at the end of the absolutely no reason for a new available—the traditional term- initial 10-year period. Those Fellow to pass on this offer. You life plan and the 10-year level individuals who don’t apply or will be billed at the beginning term-life plan. who don’t qualify for health of the second year for the appro- Under the traditional plan, reasons will be charged the priate premium. However, you the College has approved a pre- current ACS traditional term are under no obligation to con- mium discount for current par- level rates. tinue coverage. Obviously, we ticipants. The discounts, au- • The underwriting is ex- hope you will stay with the pro- thorized for the plan year be- panded to include multiple risk gram, but it is your choice. If you ginning April 1, 2002, vary by categories (super-preferred, pre- are a 2001 Initiate, call the plan age. The College hopes to con- ferred, and standard). administrator at 800/433-1672 tinue discounts beyond the • Coverage is renewable to to sign up for the no-cost offer. upcoming plan year, but it will age 75. The deadline for enrollment is depend on a year-to-year If you are looking for life in- December 31, 2001. There may evaluation of the claim experi- surance, include this product in be restrictions in some states ence. Participants may want to your evaluation. We think you due to insurance regulations. take advantage of the savings will be pleased. 43

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Disability/health plans tions to give additional pre- Potential new products The steepest decline in partici- mium rate alternatives. New The ACS Insurance Program pation has been in disability and applicants will be individually continues to review and evaluate health coverage. The single most underwritten to determine the new products that may be of ben- given reason is cost. The premi- appropriate premium rate efit to membership. Some of the ums are based on the actual classification. new products recently introduced claim experience of our group, The Cost Advantage Medical include critical illness, small em- which has not been favorable. As Plan will include more PPO type ployer health insurance, a Medi- a result, the premium increases provisions. With these changes care supplement, and an MSA have been in the double digits for and some additional administra- medical plan. More products, the past several years. tive cost savings measures, we such as auto and homeown-ers, The Insurance Trustees, anticipate minimal premium in- are being reviewed. with the help of the Finance creases for the next plan year Committee, Insurance Advi- beginning April 2002. Partici- Contacts sors, New York Life, and USI pants will receive new identifi- Contact our plan administra- Administrators, have been cation cards and details about tor at 800/433-1672, or e-mail evaluating both products. Plan the plan changes. [email protected]. You can design changes were approved The disability coverage—pre- also access the Insurance Pro- for both the Conventional and mium rates and benefits—will gram through the American Cost Advantage Medical plans remain unchanged. Recent ad- College of Surgeons’ Web site consisting of revised surgical ministrative cost savings will (www.facs.org)—select “Links schedules, use of a discount help improve claim experience to all College programs and ac- drug card, implementation of and preclude premium rate or tivities from A to Z” on the home a Medicare carve-out feature, benefit changes—at least for the page, then under “I” select “In- and additional deductible op- near future. surance Program.”

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VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Working in the dark by Wu Shaotung, San Francisco, CA

Bill Schecter likes to operate ploded, and health care as it had volved hundreds of volunteer in the dark. That is, he doesn’t been known imploded. Surgeons surgeons, anesthesiologists, know whether the hernia case felt the squeeze. Between the en- nurses and hospital administra- under his hands belongs to a trance of the federal govern- tors. paying, insured client or one re- ment into the health picture in Dr. Grey says Operation Ac- ferred by Operation Access, the the 1960s and managed care in cess gives health care providers not-for-profit organization that the late 1980s, surgeons felt less a chance to express the most serves the uninsured poor. To incentive toward charity work. basic instinct of health care giv- him, this is medical justice at its Dr. Schecter understands. “Ev- ers. “It’s a big gratification to best; it meets the highest call- eryone would like to be paid for serve the underserved. Some of ing of the physician to treat the work that they do.” us can travel around the world those who cannot afford it—and However, at the same time, to save people, but many of us to do it indiscriminately. these same forces were creating cannot take the time away from “I treat these patients like I a new class of patients—the un- their families or their jobs.” Yet treat every other patient. We see insured. While the indigent were the underserved are right in them in clinic. We schedule being taken care of with Medic- front of us, he says, “100 yards them. And everyone gets treated aid, the working poor were fall- from any city hospital.” the same,” he says. “It’s really ing through huge cracks in the Beginning with low-risk, elec- part of our medical ethic; it’s system. Today, there are at least tive, general surgery, Schecter what it’s all about; it’s part of 1 million newly uninsured indi- and Grey now have added spe- what our job is.” viduals per year, Dr. Schecter cialists: “Now that the program The chief of general surgery at says. is more mature, we’ve extended San Francisco General Hospital, He has experienced the plight the repertory and we now have William Schecter, MD, FACS, of these patients directly. “There ophthalmologists, orthopaedists, founded Operation Access in the were people dropping off the op- ear-nose-throat and reconstruc- early 1990s. At that time, the erating schedule. They had to tive specialists.” The surgeries managed care industry ex- decide between having an opera- are all outpatient and elective tion or eating.” Of course, “food but often prevent the conditions won out,” he says. from becoming catastrophic and Dr. Schecter called his friend allow patients to continue at Operation Access began in Douglas Grey, MD, FACS, chief their jobs. 1993. Currently, there are 225 of thoracic and vascular surgery At some hospitals, volunteers medical volunteers, 60 com- munity clinics, and 13 private at Kaiser Permanente San Fran- have made once-a-month Satur- hospitals that participate in cisco Medical Center, and to- day surgery their donation. public/private partnership to gether they founded Operation These medical professionals, serve the uninsured in seven Access. In eight years, the not- unlike Dr. Schecter, who doesn’t counties. Since its inception, for-profit organization has aver- differentiate the charity cases, Operation Access has saved aged about 200 operations a know exactly why they’re the public health system ap- year. Beginning with the two there—to donate their skills. proximately $2.6 million. On hospitals of the two founders The scene, as captured in a re- average the organization and friends they recruited, Op- cent Los Angeles Times front- serves between 200-250 unin- eration Access has grown to 13 page health feature, is cele- sured clients per year. hospitals in seven counties in bratory; the work moves faster Northern California and in- and more efficiently and the staff 45

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS genuinely enjoys what it is do- nating the patients is enough to eryone has health insurance, ing. discourage a surgeon from con- and we’re no longer needed.” As Dr. Grey says, “It’s win-win tributing. But the organization In the meantime, there is so for everybody. It gets them back takes care of these problems, much all surgeons can do. to the roots of why they went and all a surgeon has to do is For more information, please into medicine in the first place— walk into the operating room contact: Betty Hong, Executive for altruism. We get back to a and do what he or she knows Director, Operation Access, social contract: Someone with a and loves best. 1409 Sutter St., Suite 301, San problem walks in, we fix it, he While he likes to operate in Francisco, CA 94109, tel. 415/ shakes hands, says thank you to the dark, Dr. Schecter is not 733-0051, fax 415/733-0019, e- the doctors and nurses, and blind. “We’re not claiming that mail [email protected]. walks out.” we’re the solution to the health Operation Access takes the care situation. Our program is paperwork burden off the shoul- a temporary measure,” he says. Ms. Shaotung (also known as ders of physicians who want to The light at the end of the tun- Olivia Wu) is a freelance journalist help. Sometimes the gargantuan nel is simple—health care for specializing in health care and tasks of convincing hospital bu- all. “My goal is for Operation based in the San Francisco (CA) Bay reaucrats to join and of coordi- Access to disappear—when ev- area.

Clowes research award given

The George H.A. Clowes, Jr., support for promising young MD, FACS, Memorial Research surgical investigators. The Career Development Award for award is sponsored by The 2002 was granted to Robert A. Clowes Fund, Inc., of Indianapo- Montgomery, MD, DPhil, assis- lis, IN, in the amount of $40,000 tant professor of surgery, The for each of five years, beginning Johns Hopkins University July 1, 2002. School of Medicine, Baltimore, Further information regard- MD, for his research project on ing the scholarships, fellow- strategies for silencing genes ships, and awards offered by the that potentiate ischemia College will be published in the reperfusion injury. January 2002 issue of Bulletin The purpose of the Clowes and appear on the College’s Web Dr. Montgomery Award is to provide five years of site, www.facs.org.

2003 Travelling Fellowship available

The International Relations ling Fellowship for the year 60611-3211. They are also Committee of the American Col- 2003. posted on the College’s Web site, lege of Surgeons announces the Complete details and the re- www.facs.org. The requirements availability of a travelling fel- quirements are available upon will be published in their en- lowship, the Australia and New request from the International tirety in the January 2002 Bul- Zealand Chapter of the Ameri- Liaison Division, ACS, 633 N. letin. 46 can College of Surgeons Travel- Saint Clair St., Chicago, IL

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS 47

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Contributions to the 2002 Surgical Forum are requested

Abstract deadline: March 1, 2002 Congress: October 6- 11, San Francisco, CA

The Committee for the Forum on Fundamen- preparation of the extended abstract for publi- tal Surgical Problems invites young surgical in- cation in the Surgical Forum Volume LIII. vestigators to submit abstracts to be considered Please do not call the Forum office; the for presentation during the Surgical Forum at staff is unable to acknowledge receipt of the 2002 Clinical Congress in San Francisco, abstracts, is not permitted to alter ab- October 6-11. Preparation of the Forum pro- stracts in any manner, and cannot release gram is achieved entirely through the review of the results of the Forum Committee’s se- abstracts of papers reporting original work per- lections. formed by young surgical investigators. Ab- stracts that are accepted will appear in a supple- Regulations for submitting an abstract ment of the Journal of the American College of The Owen H. Wangensteen Forum on Funda- Surgeons (JACS), a publication recognized by mental Surgical Problems requires that any in- Index Medicus. In addition, authors whose ab- vestigator who wishes research to be considered stracts are accepted for the program will be ex- for presentation must comply with the instruc- pected to publish their extended abstracts in the tions concerning the preparation and submis- Owen H. Wangensteen Surgical Forum Volume sion of abstracts. LIII, which will be available in time for purchase 1. Abstracts are due in the Surgical Forum of- at the Clinical Congress. fice no later than March 1, 2002. Submission of Abstracts received on time and in the pre- an abstract signifies the intent of its principal scribed form noted below are reviewed. Abstracts and associated authors to present the paper at not received on time or not exactly as prescribed the Surgical Forum, if it is accepted. will not be considered. Please read and follow 2. The abstract must present original re- the regulations and specifications carefully. search, with the understanding that the research Proofread the abstracts; they cannot be resub- will be presented for the first time at the Fo- mitted for corrections or alterations. rum. The principal author is responsible for Abstracts are reviewed and selected by the Fo- making certain that the paper submitted contains rum Committee, with each surgical specialty topic no material that has been published elsewhere being reviewed by appropriate specialty members. prior to presentation at the Surgical Forum. In General abstracts are graded by committee mem- addition, the principal author is responsible for bers most familiar with the abstract’s designated informing the Forum Committee if the abstract category. Following the grading, the full commit- or the paper has been or is to be presented in to- tee meets to discuss the abstracts and select the tal or in part at any regional or national meet- work to be presented at the Congress. The ing prior to the Clinical Congress of the Ameri- committee’s selections are final. can College of Surgeons; this is cause for exclu- Notice of acceptance or rejection will be mailed sion of the paper from the Forum. Discretionary to the principal author of each abstract by May 1. consideration will be given to papers for which The acceptance notice designates the session abstracts may have been published outside the where the paper is to be presented and provides United States and Canada; principal authors are 48 information regarding presentation and the nonetheless bound to inform the Committee of

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS such abstract publication via e-mail at one blinded version bearing only the title and [email protected]. the body of the abstract (omit identifying au- 3. The principal (first-named) author must be thor information). The complete and blinded a young surgical investigator. Older, established versions should be submitted as separate files. surgeons may be included as co-authors, but not Submitted abstracts must contain the ENTIRE as the principal author of an abstract. Please title in the file name and indicate which file is limit the number of co-authors to nine persons. the blinded version at the end of the filename, 4. An author may submit only two abstracts i.e., “(title of abstract)blindvers.wpd” (or as the principal author, and no more than one ‘blindvers.doc’ etc.). may be selected for presentation. Any principal 2. Each abstract must be confined to one side author submitting two abstracts should submit of one 8-1/2" x 11" page, contain no more an e-mail stating the titles, categories, and in- than 30 lines of text and no more than 250 stitution affiliation to: [email protected]. words. This includes title, text, authors, and 5. The principal author may not be changed mailing information. after an abstract is submitted, nor may co-au- 3. Allow a 1-1/2" margin on the left side, and thors be added or deleted. a 1/2" margin on all other sides of the page. 6. Each abstract should be a concise report 4. At the top of the page, the full title of the summarizing work done and in progress. The abstract should be typed with initial capitals. title of the abstract should be brief, but long The title should be single-spaced. enough to identify clearly the nature of the 5. All abstracts must be designated for one of study. The body of the abstract should clearly the categories listed below. The author must state the reason for doing the study and include choose the category most appropriate for his or a brief description of methods, the exact results her abstract and type the category in the upper obtained, and the conclusions reached. right hand margin of the abstract. The catego- It is essential that the abstract present objec- ries are: Alimentary (includes liver, pancreas, tive data and an accurate analysis of the results. biliary tract); Cardiac; Thoracic; Critical Care It must be clear that sufficient evidence has been (includes metabolism, infection, nutrition, found to support the conclusions. Vague descrip- blood, endocrine); Surgical Oncology and Asso- tions and promises to present additional infor- ciated Immunology; Transplantation and Asso- mation will result in almost certain rejection. ciated Immunology; Gynecology and Obstetrics; Abstracts should not include unnecessary ma- Neurological Surgery; Ophthalmology; Ortho- terial such as historical reference, controversial paedic Surgery; Otorhinolaryngology; Pediatric discussion, bibliographies, and review of the lit- Surgery; Plastic Surgery (includes wound heal- erature. Abstracts should be prepared and ed- ing, burns); Quality, Outcomes, and Cost; Re- ited carefully. productive Biology and Related Endocrinology; 7. The extended abstract submitted for pub- Urology; and Vascular Surgery. lication in the Surgical Forum Volume LIII must The author may, in addition, designate a sec- accurately reflect the significant substance and ond category for the abstract. The second cat- conclusions represented in the initial abstract egory may be selected from the list above, or may accepted by the Surgical Forum Committee. If be created by the author. Designation of a sec- changes in the substance or conclusions in the ond category for any abstract is at the author’s abstract would be necessary for publication of discretion. the extended abstract, the submission should be 6. Leave a double space after the title. The withdrawn by the author(s). body of the abstract must be double-spaced. Use a 12-point font or larger, and no more than Specifications for the abstract 16 characters per inch. Organize the abstract 1. Abstracts for the Surgical Forum Program with the following headings (non-indented): IN- will be accepted ONLY via Internet submission at: TRODUCTION (include the reason or rationale http://web.facs.org/surgicalforum/abstract.cfm. for the study, as well as the hypothesis being Submit a complete version of the abstract and tested or objective of the study); METHODS (in- 49

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS clude a brief notation of the statistical methods during that time, provide a mailing address and/ employed); RESULTS (tables should be single or contact person that will ensure prompt re- spaced, using the same font as in the body of ceipt of communications from the Surgical Fo- the abstract; graphs or figures must be clearly rum Committee. Single-spacing should be used legible and contain legends or notations no for this information. Changes in authorship will smaller than 20 characters per inch); and CON- not be accepted. PLEASE NOTE: Only one in- CLUSIONS. stitution will be published. Contributors (finan- 7. Leave a double space after the body of the cial, material, laboratory space, etc.) to the re- abstract and list the full names and all academic search will not be published. degrees of all authors, followed by the institu- 8. Abstracts are to be submitted no later than tion from which the work originates. List the March 1, 2002. For further instructions or clari- institution first, followed by the mailing address fication, please forward your e-mail request to: and daytime telephone number of the principal [email protected]. author or designated contact person in sufficient 9. Abstracts submitted via fax transmittal are detail to ensure prompt delivery of communica- unacceptable. tion. The mailing address should be accurate for 10.Abstracts are not to be submitted to the correspondence in May. If the principal author chairman or to members of the Surgical Forum anticipates an address or institutional change Committee.

Scientific contributions sought for 2002 Clinical Congress

Motion Picture videotape and form Papers Sessions abstracts due by March 1 due by March 1, 2002 Papers Sessions are planned for the 88th annual The College will again be reviewing and showing Clinical Congress, October 6-11, 2002, in San Fran- videotapes at the 2002 Clinical Congress. Only vid- cisco. These sessions are restricted to clinical work eotapes in the 3/4-inch U-matic or 1/2-inch Super that has not been presented previously or published VHS format (NTSC) will be considered. Authors of elsewhere. (Basic laboratory research should be medical motion pictures who wish to have their work submitted to the Committee for the Forum on Fun- presented during the 2002 Clinical Congress in San damental Surgical Problems.) The Committee on Francisco (October 6-11) should submit the video- Papers will consider only those abstracts of which tape and specific information about the videotape the principal author or a co-author is a Fellow of and the author on a special Videotape Information the College. Authors should adhere to the follow- Form to the College’s Committee on Medical Mo- ing instructions: tion Pictures by March 1, 2002. The form is avail- 1. The abstract should provide adequate infor- able from the Committee on Medical Motion Pic- mation and objective data to evaluate the abstract tures, Attn: Gay Lynn Dykman, American College properly. of Surgeons, 633 N. Saint Clair St., Chicago, IL 2. The abstract must be limited to one 8-1/2" x 60611-3211. The print of the videotape for commit- 11" page, with a left margin of 1-1/2". (It is permis- 50 tee review must be received by March 1, 2002. sible to single-space the abstract.)

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS 3. At the top of the page, the full title of the ab- stracts received. However, because of the com- stract and the full names and academic degrees of petitiveness of this portion of the scientific pro- all authors must be listed. gram, it is unlikely that an author would be se- 4. At the bottom of the page, a footnote should lected to present his or her work in two succes- be included to provide the principal author’s mail- sive years. ing address, telephone number, e-mail, and fax number and, where pertinent, medical school af- Scientific exhibits due March 1, 2002 filiation and other institutions from which the Applications for participation in the scientific ex- work originates. hibits at the 2002 Clinical Congress will be avail- 5. The original and one copy of the abstract able in January from the Committee on Scientific should be submitted. Exhibits, 633 N. Saint Clair St., Chicago, IL 60611- 6. Photographs should not accompany the ab- 3211. The deadline for receipt of completed appli- stract. cations is March 1, 2002. 7. The deadline for the receipt of abstracts is There is no charge to scientific exhibitors for dis- March 1, 2002. They should be mailed to the Com- play space. They must, however, pay their own mittee on Papers, American College of Surgeons, shipping and assembly costs. The exhibit area will 633 N. Saint Clair St., Chicago, IL 60611-3211. be open Monday through Thursday, October 7-10, Quality and a balanced program are the 2002. committee’s chief criteria for evaluating the ab-

DOUBLE-DIGIT PREMIUM HIKES, from page 20 year for $1 million/$3 million of coverage. Physi- • Compensates fewer than one in eight pa- cians in several states, such as Pennsylvania, West tients who are negligently injured. Virginia, Florida, and Mississippi have been espe- • Is based on the determination of fault where cially hard hit, and physicians in other locations professionals often disagree. will soon suffer a similar fate, unless they are able • Can entail five to seven years of litigation be- to persuade their state legislators to enact major fore an injured patient receives any compensation. reform. • Generates devastating emotional damage to the physician and his or her family even when they Fundamental change needed are later acquitted by the court. The current crisis will not be contained by pal- • Impedes the development of a comprehen- liative measures. We need a fundamental change sive patient safety program because the conse- in the way we deal with medical injuries. For many quences of self-reporting injuries or near misses years, I have favored a no-fault approach (patient may result in prolonged litigation. compensation insurance). This system has worked • Takes 60 percent of the premiums paid by well in other countries, such as Denmark, Finland, physicians and puts them into the hands of law- New Zealand, and Sweden, for many years and has yers. been effective in cases involving newborns with It is time for a change! ⍀ severe neurological damage in Virginia and Florida. It also has also been effective in the U.S. This article was generated through the efforts of for many years as applied to a government-spon- the Regents’ Committee on Patient Safety and Pro- sored program dealing with vaccine injuries. Fur- fessional Liability. Members of the committee believe ther, it is the same approach being advocated for that this and other articles published in the Bulle- those affected by the September 11 tragedy. tin will stimulate thought and possible action on a Physicians cannot continue to shoulder the bur- wider spectrum of issues related to patient safety and professional liability. den of a system that: 51

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS American College of Surgeons at www.facs.org MEMBERS ONLY ▲ ● Now ACS Fellows can do all of these things ONLINE:

Change your Update your Update other Pay your address & professional/ practice dues contact info academic information information

Just go to www.facs.org, and click on the Members Only link. There you can Access the Fellowship Database by entering your eight-digit Fellowship ID number (found on your Fellowship ID card) and your last name.

There’s no need to contact the American College of Surgeons— your membership record is automatically updated for all ACS mailings, including the Bulletin and the Journal of the American College of Surgeons.

You can also pay your dues online and search for contact infor- mation on other Fellows in the database.

52

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Fellows and facts

The 2001 Bucy Award was pre- Alan Koslow, MD, FACS, is from 1994 to 1999. Most re- sented to George J. Dohr- one of six people nationwide who cently, he directed the Consumer mann, MD, PhD, FACS, in rec- were presented with the March Healthcare Products Associa- ognition of his national and in- of Dimes’ Distinguished Volun- tion in Washington, DC. Dr. ternational efforts in neurosur- teer Award this year at a cer- Maves served on the ACS Board gical education. Dr. Dohrmann emony attended by President of Governors from 1995 to 2000, is a neurosurgeon at the Univer- Bush. Dr. Koslow, a vascular sur- and has been an active partici- sity of Chicago Medical Center geon in Des Moines, IA, was rec- pant in many medical and sur- and a member of the faculty of ognized for being one of 10 stu- gical organizations throughout the Brain Research Institute at dents who organized the first his professional career. the University of Chicago, IL. March of Dimes walk in 1971 The Bucy Award is presented and for his continuing commit- Eugene N. Myers, MD, annually by the national Bucy ment to the organization over FACS, professor and eye and ear Committee and honors Paul C. the last 30 years. He has directed foundation chair at the Univer- Bucy, MD, FACS. the public affairs committee of sity of Pittsburgh School of the Iowa chapter of the March Medicine, received the American The members of the Ameri- of Dimes for the past four years Laryngological Association can Academy of Otolaryngol- and is chair-elect of the chapter. (ALA) Award and the deRoaldes ogy-Head and Neck Surgery Award at the annual meeting of (AAO-HNS) elected Jonas T. On January 15, 2002, Michael the ALA earlier this year. The Johnson, MD, FACS, to serve D. Maves, MD, FACS, will be- ALA Award has been presented as president of the organiza- gin serving as the executive vice- annually since 1987 to recognize tion and its foundation for the president and chief executive of- an individual who has contrib- 2002-2003 term. Dr. Johnson is ficer of the American Medical uted significantly to laryngology. professor of otolaryngology at Association. Dr. Maves served as The deRoaldes Award was estab- the University of Pittsburgh executive vice-president of the lished in 1907 and is presented School of Medicine in Pitts- American Academy of Otolaryn- to acknowledge outstanding ac- burgh, PA. gology-Head and Neck Surgery complishments in the specialty.

REPORT OF THE EXECUTIVE DIRECTOR, from page 34 ing conditions of surgical residents. There are a Preparedness multitude of other topics this division could effec- Following the recent Clinical Congress in New tively evaluate in the future. Orleans, I can assure you that one of the highest Finally, with new leadership in the Division of priorities of the College is addressing the broad Member Services, I anticipate a vast array of po- issue of bioterrorism. Again, there are real oppor- tential opportunities will unfold. Some of those pos- tunities for developing educational activities that sibilities include new programs, such as courses will allow surgeons to become more active and par- on association management, improved instruction ticipatory in their local communities with respect in practice management, and efforts to relieve some to future terrorism and the ability to provide ap- of the regulatory burdens of practice. I also believe propriate and timely responses. As surgeons, we, we will see renewed efforts to reach out to and in- along with the entire community of trauma phy- fluence the international surgical community, sicians and institutions, are uniquely capable of thereby making the College a more effective and assisting in this process. ⍀ global organization. 53

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Chapter news

by Rhonda Peebles, Chapter Services Manager, Division of Member Services

To report your chapter’s news, contact Rhonda Peebles toll-free at 888/857-7545, or via e-mail at [email protected]. Michigan Chapter conducts 48th annual meeting

During its 48th annual meeting, May 10-12, the Michigan Chapter conducted its Resident Surgeons Competition with Barbara L. Bass, MD, FACS, Tennessee Chapter, left to right: Calvin Morgan Jr., MD, then-Chair of the Board of Governors and current FACS, Governor; Timothy Fabian, MD, FACS, Regent, leading the judging of 37 abstracts. The Governor; David N. Walters, MD, FACS, President; 2001 competition produced seven winners. Also Martin Croce, MD, FACS, President-Elect; Laura during the annual meeting, the chapter’s Young Witherspoon, MD, FACS, Secretary-Treasurer; K.C. Surgeons Issues Committee conducted its first Jonas, MD, FACS, Governor; Wanda Johnson, Executive Director; Ken Sharp, MD, FACS, Immediate Past- Young Surgeons Forum. During this symposium, President and Governor; and George Eckles, MD, FACS, the chapter’s young surgeons agreed to review and Vice-President. report on state legislative issues that affect sur- geons and their patients. They also established small, ad hoc committees to examine several top- education program for residents and young sur- ics: liability immunities for uncompensated care, geons that will address disability insurance, em- issues related to certified registered nurse anesthe- ployment opportunities, contract negotiation tists, prompt payment by insurers, the state skills, and other practice-related topics. The chap- trauma system, and the chapter’s annual scientific ter also intends to survey program directors for education programs. Finally, the chapter elected additional potential topics and to seek opportuni- its officers for 2001-2002, who are as follows: Drs. ties to partner with the College on enhanced and Verne L. Hoshal, President; Farouck Obeid, Presi- timely education programs. dent-Elect; Donald Scholton, Secretary; and Cheryl • Socioeconomics: The chapter will meet with Wesen, Treasurer. the Governor of the Commonwealth to develop an agenda for the future and will continue a limited Massachusetts Chapter public relations/education program. identifies strategies for future • Communications: The chapter will continue the Town Meeting Program and will attempt to The Massachusetts Chapter engaged its officers, assume responsibility of the Massachusetts Com- councilors, Governors, and past-presidents in a mittee on Applicants of the College and will seek strategic planning session this August. The spe- opportunities to participate in the selection of the cial working session was convened to address: (1) College’s leadership. (See related story, p. 10.) a nearly 30 percent decline in membership and revenue; (2) the perceived need to establish a closer, Tennessee Chapter conducts more collaborative relationship with the College; annual meeting and (3) the responses and results of the chapter’s Town Meeting Program, which involved meetings The Tennessee Chapter conducted its annual with Fellows that took place at individual hospi- meeting August 17 to 19 at Fall Creek Falls State tals. After completing its initial deliberations, the Park (see photo, this page). During the three-day chapter developed strategies to respond to the fol- event, the trauma and cancer committees met, lowing areas of concern: chapter business activities were conducted, the 54 • Education: The chapter plans to develop an chapter’s new Web site was unveiled (http://

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS www.tnacs.org). John R. Potts III, MD, FACS, from Houston, TX, served as the visiting professor, and three resident paper competitions were conducted. Taking first place in the paper competitions were: • Trauma: Michael Kelly, MD,* University of Tennessee, “Effects of selective A2a activation dur- ing resuscitation from severe chest trauma with either crystalloid or colloid.” • Basic Science: Ben Zarzaur Jr, MD,* Univer- sity of Tennessee, “Intravenous feeding (IV-TPN) increases inflammation following gut ischemia/ reperfusion (gI/R).” West Virginia Chapter, left to right: Stephen McNatt, • Clinical Science: Henry Kaufman, MD,* Uni- MD, FACS, assistant professor of surgery; visiting versity of Tennessee, “Stereotactic breast biopsy— professor Dr. Talamini; Dr. McFadden; Dr. Fort; Dr. a study of first core samples.” Szwerc; and Dr. Oliver. The Tennessee Chapter’s 50th annual meeting will take place July 27-28, 2002. the Young Surgeons Representatives Annual Meet- West Virginia Chapter ing and the Chapter Leadership Conference. A pre- liminary schedule for the combined event includes: conducts Surgery Update 2001 May 15: Half-day education program for chap- ter administrators and executive directors. The West Virginia Chapter (WVC) conducted its May 16: Full-day education program for chap- Surgery Update 2001 September 21-22. The edu- ter officers and chapter administrators; joint re- cation program was hosted by the West Virginia ception and dinner for young surgeons, chapter University department of surgery (WVU-DOS) in officers, and chapter administrators. Morgantown. The theme for the conference was May 17: Full-day education program for young The Latest in Minimally Invasive Surgical Tech- surgeons, chapter officers, and chapter adminis- niques; 12 speakers addressed the topic during the trators, including plenary sessions and break-out course of the event. Presiding over the education workshops. program were: David W. McFadden, MD, FACS, May 18: Half-day education program for young chairman of WVU-DOS, and Michael Szwerc, MD, surgeons. FACS, assistant professor of surgery, as conference directors; Mark Talamini, MD, FACS, from The Chapter anniversaries Johns Hopkins University, Baltimore, MD, as the visiting professor; Kyle Fort, MD, FACS, WVC Month Chapter Years President, and R. Samuel Oliver, MD, FACS, WVC President-Elect. (See photo, this page). November Arkansas 49 On September 22, the West Virginia Committee Chile 50 on Trauma (WV-COT) Resident Paper Competi- Florida 49 tion took place, and David Kappel, MD, FACS, the Indiana 50 Chair of the WV-COT, served as the presiding of- Kentucky 49 ficer of that event. Michigan 50 Nebraska 50 Special notice Bronx, New York 50 Central Pennsylvania 49 In 2002, two important education programs are Southwest Pennsylvania 49 being combined. These education programs include December Argentina 48 Missouri 35

*Denotes participant in the Candidate Group. 55

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS KEEPING CURRENT, from page 39

nonpalpable but mammographically visible clus- study found meglumine diatrizoate to promote ters of suspicious calcifications, those with well- resolution of obstruction (though not to affect the defined masses that are likely to be benign, and need for laparotomy); however, another reported those with suspicious masses. no therapeutic effect (and no complications). That some investigators have reported positive findings VIII. Evaluation of Common Clinical and none to date have reported significant com- Problems plications argues that giving 100 ml of meglumine 6. Intestinal Obstruction. W. Scott Helton, MD, FACS. diatrizoate to patients with adhesive small bowel In as many as 90 percent of patients with adhe- obstruction is a reasonable choice. If this step accel- sive partial small bowel obstruction, nonoperative erates the resolution of adhesive small bowel obstruc- surgery will lead to resolution of the obstruction. tion and ileus, it may also shorten hospital stay and How to identify those who require operation re- thereby reduce the cost of care. mains an issue. Several studies have reported that recording the arrival of a contrast agent in the right Looking ahead colon within a specified period can be a highly reli- New chapters scheduled to appear as online up- able predictor of whether nonoperative therapy dates to ACS Surgery: Principles and Practice in is likely to succeed. In addition, several studies, the first part of 2002 include Laparoscopic Donor though not in perfect agreement, have yielded re- Nephrectomy, by Stephen Bartlett, MD, FACS, and sults suggesting that administration of contrast Stephen Jacobs, MD, FACS, and Open Esophageal agents may in itself be therapeutic for adhesive Procedures, by Richard Finley, MD, FACS, and small bowel obstruction in some settings. One such John Yee, MD. ⍀

The Surgical Research and Education Committee of the American College of Sur- 2002 geons has organized the Sixth Biennial Young Surgical Investigators' Conference to assist surgeon-scientists who are entering the process of obtaining extramural, peer-reviewed grant support for their work. The goal of these conferences, held Young with staff members of the National Institutes of Health (NIH) in attendance, is to introduce young surgeons to the process, the content, the style, and the people Surgical involved in successful grant-writing and interactions with the NIH.

Investigators' The program will include intensive exposure to: —NIH programs and policies Conference —Information from NIH Institutes —What programs are best and available for your research project and how to apply March 8-10, 2002 —Workshops in hypothesis testing, methodology, background, and preliminary results Lansdowne Resort —Grant-writing strategies Conference Center —Mock study sections reviewing model grants Leesburg, VA The program and registration form are available online at http://www.facs.org/ Sponsored by the Surgical Research dept/serd/srec/youngsurg.html. For further information, contact Ms. Donna Coulombe, Education and Surgical Services Dept., American College of Sur- and Education Committee of geons, 633 N. Saint Clair St., Chicago, IL 60611; phone 312/202-5488; fax 312/ the American College of Surgeons 202-5013; e-mail [email protected] 56

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS 57

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS The Journal page

Message from the Editor

by Seymour I. Schwartz, MD, FACS, Rochester, NY

The January issue of the Journal of the Ameri- stetrics, Charles G. Child, MD, and associates re- can College of Surgeons will usher in a new year ported the first case in which an unobstructed por- and also lead to a consideration of the past. tal vein was deliberately resected during a During the year 2002, the 250th anniversary of pancreaticoduodenectomy. Also in the same issue the opening of the Pennsylvania Hospital, the first Rene Leriche concluded that aortography had lim- hospital to function in the current United States, ited diagnostic applicability, and should be used will occur. One hundred years ago, at the 1902 only in a patient in whom resection or reconstruc- meeting of the American Surgical Association, tion of a vascular lesion was to be considered. Rudolph Matas, MD, FACS, presented his monu- Which article in the January 2002 issue of the mental paper describing “An Operation for the Journal of the American College of Surgeons will Radical Cure of Aneurism Based on Ar- be quoted 50 years hence is unpredictable. teriorraphy.” Also at that meeting, “A New Method of Pyloro- Dr. Schwartz is Distinguished Alumni Professor, Uni- plasty” was presented by J. M. T. Finney, MD, versity of Rochester (NY) School of Medicine and Den- FACS, who would become the first President of the tistry. He is also Editor-in-Chief of the Journal of the American College of Surgeons. Fifty years ago, in American College of Surgeons and a Past-President of the January issue of Surgery, Gynecology & Ob- the College.

INTRODUCTORY ABSTRACT from the January lead article The American Urological Association Lec- cessfully. The merger of these two institutions and ture: Evolution of an Academic Medical Cen- the creation of a broad metropolitan-wide health ter to an Academic Health System. David B system facilitated and enhanced the success of Skinner, MD, FACS. From Weill Medical College these efforts and led to a gradual switch in em- of Cornell University, New York, NY. phasis from that of the individual hospital and During the course of more than a decade, the practitioner to the successes that can be achieved problems encountered by New York-Cornell Medi- by a large number of academic and community cal Center and Columbia-Presbyterian Medical physicians and hospitals working together for a Center have been addressed individually and suc- common purpose.

Visit the ACS Web site! @ ...... http://www.facs.org

58

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Bulletin index: Volume 86, numbers 1-12 Author index

–In defense of the surgical cancer patient: Nutrition A may be key, 86, 1:18 DANTO, LAWRENCE A., Dealing with managed care ACS BOARD OF GOVERNORS, Statement on un- organizations: A second opinion, 86, 4:23 conventional acts of civilian terrorism, 86, 11:11 DESMARAIS, HENRY R., The 106th Congress: A ACS COMMITTEE ON TRAUMA, Disasters from review of the second session, 86, 3:20 biological and chemical terrorism—What should the DURTSCHI, MARTIN B., and HOWISEY, ROB- individual surgeon do? 86, 11:9 ERT L., Surgeons offer survival strategy for the new ALLEN, JEFF W., and MARTIN, ROBERT G.C. millennium, 86, 11:24 II, KLODELL, CHARLES T., and POLK, HIRAM C., JR., Advanced surgical technology ex- perience valuable to the basic education of general F surgery residents, 86, 6:11 ASHLEY, STANLEY W., Report from a Travelling FISCHER, JOSEF E., Current status of the National Fellow, 86, 1:37 Practitioner Data Bank, 86, 9:20 –“Laying on of the hands,” 86, 1:24 –What we can and can’t do: One surgeon’s perspec- B tive, 86, 8:19 BAKER, WILLIAM H., Medical meetings: The real value, 86, 11:13 G BASS, BARBARA L., Report of the Chair of the Board of Governors, 86, 12:32 GALLAGHER, CHRISTOPHER, Scrutiny of BODAI, ERNIE, In their own words: One man’s mis- EMTALA grows as its scope expands, 86, 9:15 sion against cancer, 86, 2:28 GREENE, WILLIAM R., Hôpital Lumière, Haiti: A BROWN, CYNTHIA A., What surgeons should know call to care, 86, 8:8 about: The OIG’s compliance guidance for individual and small group practices, 86, 3:8 –What surgeons should know about: The 2001 Medi- H care fee schedule, 86, 1:8 HANLON, C. ROLLINS, Philip Sandblom, MD, PhD, FACS, dies, 86, 6:25 C HARRIS, JEAN A., What surgeons should know about: Uniform standards for electronic claims, 86, 10:9 CAMPBELL, SYLVIA, E-mail from Africa connects –(and PRESKITT, JOHN T.), CPT changes in 2001, surgeon and teen, 86, 7:13 86, 1:14 CANVER, CHARLES C., Young surgeon represen- HARRISON, LYNN H., JR., Tracing the “roots of tatives gather in Chicago, 86, 8:31 philanthropy” at the chapter level, 86, 5:35 CARRICO, C. JAMES, Report of the Chair of the HEALY, GERALD B., Citation for Prof. Minoru Board of Regents, 86, 12:30 Hirano, MD, PhD, 86, 11:36 CORNWELL, MICHAEL J., Operation Argentina: HOWISEY, ROBERT L., and DURTSCHI, MAR- A surgical partnership across the Americas, 86, 2:13 TIN B., Surgeons offer survival strategy for the new millennium, 86, 11:24 D J DALY, JOHN M., Governors’ committee takes on competency challenges, 86, 1:29 JONASSON, OLGA, A day at the Clinical Congress: 59

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS –Program targets minority youths, 86, 7:43 steers surgeon to discovery, 86, 2:21 JONES, R. SCOTT, A review of the Presidential Ad- dress: Medicine, government, and capitalism, 86, 12:8 P PARKER, GEORGE A., Governors’ committee en- K ergizes chapters, 86, 9:25 KERIN, ROBERT, Save the charts: For whom and PEEBLES, RHONDA, Chapter news, 86, 2:46; 4:54; for what?, 86, 6:18 6:34; 8:38; 10:44; 12:54 KLODELL, CHARLES T., and MARTIN, ROBERT POLK, HIRAM C., JR., and ALLEN, JEFF W., G.C. II, ALLEN, JEFF W., and POLK, HIRAM MARTIN, ROBERT G.C. II, and KLODELL, C., JR., Advanced surgical technology experience CHARLES T., Advanced surgical technology expe- valuable to the basic education of general surgery rience valuable to the basic education of general sur- residents, 86, 6:11 gery residents, 86, 6:11 KRIER-MORROW, DIANE, What surgeons should PRESKITT, JOHN T., and HARRIS, JEAN A., CPT know about: Late, partial, or denied payment or lost changes in 2001, 86, 1:14 claims, 86, 5:8 Q L QUINLAN, ROBERT M., The ACS chapters: Where LaFLAIR, ERIN J., Federal programs providing do we go from here? 86, 12:10 health insurance to children: A review, 86, 12:14 –Key health care policymakers in the 107th Congress, 86, 4:16 R –(and SHALGIAN, CHRISTIAN), Making Washing- ton work for you: “All politics is local,” 86, 10:25 RHODES, ROBERT S., New technology and new ap- LINDSEY, RICHARD, Keeping current: What’s new proaches to surgical education, 86, 6:16 in ACS Surgery: Principles and Practice?, 86, 12:39 RITCHIE, WALLACE P., JR., The measurement of LONGO, MARGARET F., Citation for Prof. Albrecht competence: Current plans and future initiatives of F. W. Encke, MD, FACS, 86, 11:34 the American Board of Surgery, 86, 4:10 LYNCH, JOHN P., Highlights of the Board of Regents ROBERTS, ADRIENNE, and SUTTON, JON H., meeting, February 9-10, 2001, 86, 5:41 Scope of practice for nonsurgeons keeps expanding, –Highlights of the Board of Regents meeting, June 8- 86, 8:15 10, 2001, 86, 9:49 ROE, BENSON B., Physicians and the war on drugs: –Highlights of the Board of Regents meeting, October The case for legalization, 86, 10:16 20-22, 27, 2000, 86, 2:40 RUSSELL, THOMAS R., From my perspective, 86, 1:3 (College programs); 2:4 (College chapters); 3:3 (RRC/dermatology); 4:4 (Health Policy Steering Committee); 5:3 (collective bargaining); 6:3 (surgi- M cal training); 7:3 (future of College chapters); 8:3 MABRY, CHARLES D., Physicians and the war on (strategic planning); 9:4 (ACS strategic plan); 10:3 drugs: The case against legalization, 86, 10:17 (9/11/01); 11:4 (bioterrorism); 12:3 (fee schedule con- MANUEL, BARRY M., Double-digit premium hikes: version factor) The latest crisis in professional liability, 86, 12:19 –Report of the Executive Director, 86, 12:34 MARTIN, ROBERT G.C. II, and KLODELL, –Unconventional civilian disasters: What the surgeon CHARLES T., ALLEN, JEFF W., and POLK, should know, 86, 11:8 HIRAM C., JR., Advanced surgical technology ex- perience valuable to the basic education of general surgery residents, 86, 6:11 S SANDRICK, KAREN, Cybersurgeon: Internet broad- ens surgical education environment, 86, 8:25 N –Cybersurgeon: Virtual reality surgery: Has the future arrived?, 86, 3:42 60 NEELY, JAMES C., A reminiscence: Serendipity

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS SASSER, WILLIAM F., Governors’ committee re- SUTTON, JON H., Office-based surgery regulation: ports College remains fiscally sound, 86, 4:28 Improving patient safety and quality care, 86, 2:8 SCHNEIDMAN, DIANE S., The changing land- –Patient privacy and health information confidential- scape of rural surgery: The view from Oklahoma, ity, 86, 7:8 86, 5:14 –Physician data profiling proliferates, 86, 5:20 –Chapter Leadership Conference: Participants look –State legislatures 2001: The year in review, 86, 11:19 to the future, 86, 7:47 –(and ROBERTS, ADRIENNE), Scope of practice SCHWARTZ, SEYMOUR I., The Journal page: Mes- for nonsurgeons keeps expanding, 86, 8:15 sage from the Editor, 86, 1:47; 2:48; 3:64; 4:56; 5:47; 6:40; 7:52; 8:40; 9:56; 10:48; 11:40; 12:58 SHALGIAN, CHRISTIAN, Patient safety initia- U tives following the IOM report, 86, 6:8 –(and LaFLAIR, ERIN), Making Washington work UPPERMAN, JEFFREY S., The CAS-ACS: Commu- for you: “All politics is local,” 86, 10:25 nication is the key, 86, 10:34 SHAOTUNG, WU, Working in the dark, 86, 12:45 SPENCER, FRANK C., John H. Gibbon, Jr., Lec- ture: Introductory remarks, 86, 3:14 V STARZL, THOMAS E., Citation for Prof. Pekka Häyry, 86, 11:35 VINCENT, GAY L., Take a look at the activities of STOLLER, ADRIENNE M., Keeping current: Ad- the ACS Insurance Program, 86, 12:43 vances in organ transplantation: The bioartificial liver, 86, 9:33 –Keeping current: An interview with Nathaniel J. W Soper, MD, FACS: State-of-the-art minimally in- vasive surgery, 86, 7:36 WALDHAUSEN, JOHN, John H. Gibbon, Jr., Lec- –Keeping current: Introducing ACS Surgery: Prin- ture: Leadership in medicine, 86, 3:13 ciples and Practice, 86, 10:28 WARSHAW, ANDREW L., Committee strives to bal- –Keeping current: On the fast track, 86, 11:27 ance “socio” and socioeconomic issues, 86, 5:25 –Keeping current: Using ACS Surgery: Online tips WILMORE, DOUGLAS W., Keeping current: Today and tools, 86, 6:21 in surgical practice: A conversation with Prof. Henrik STRAUCH, GERALD O., Seventh Triennial ACS Kehlet, 86, 8:27 ® Latin American Congress: Un gran espectáculo, 86, –Keeping current: Scientific American Surgery: A con- 8:33 versation with the founding editor, 86, 4:43

Subject index

–Dateline: Washington: Medicare issues proposal for A outpatient PPS, 86, 10:8 –Dateline: Washington: Medicare revises “inpatient ALLIED HEALTH only” list, 86, 1:7 Dateline: Washington: ACS comments on supervision AMERICAN COLLEGE OF SURGEONS of CRNAs, 86, 10:7 Activities Dateline: Washington: CMS releases proposed rule on –ACS scores success at AMA House of Delegates meet- CRNAs, 86, 11:7 ing, 86, 8:29 Scope of practice for nonsurgeons keeps expanding –College delegation active at AMA House of Delegates (Roberts and Sutton), 86, 8:15 meeting, 86, 2:35 AMBULATORY CARE –Dateline: Washington: College submits comments on –Dateline: Washington: College comments on hospital 2002 fee schedule, 86, 11:6 OPPS rule, 86, 11:7 –Dateline: Washington: ACS comments on Medicare 61

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS five-year review, 86, 9:7 Congress, New Orleans, LA, October 7-12, 2001: Pre- –Dateline: Washington: ACS urges level playing field liminary Program, 86, 7:17 in Patients’ Bill of Rights, 86, 4:9 –At Clinical Congress: CESTE to feature exhibit on sur- –Dateline: Washington: College comments on hospital gical simulators, 86, 9:47 OPPS rule, 86, 11:7 –Clinical Congress 2001: Highlights, 86, 12:21 –Dateline: Washington: Massachusetts General hosts –Congress exhibit to track effects of aging on cogni- Day in Surgery, 86, 10:7 tive performance (Greenfield), 86, 9:40 –FYI: STAT, 86, 3:5, 4:7, 5:5, 6:5, 7:5, 8:5, 9:6, 10:6, –Contributions to the 2002 Surgical Forum are re- 12:5 quested, 86, 12:48 Advocacy and health policy –A day at the Clinical Congress: Program targets mi- –College adds legislative action center to Web site, 86, nority youths (Jonasson), 86, 7:43 3:59 –Free consultation available at Clinical Congress, 86, –Committee strives to balance “socio” and socioeco- 8:29 nomic issues (Warshaw), 86, 5:25 –Liability and patient safety issues to be addressed at –Dateline: Washington: ACS adds “Legislative Action Congress, 86, 9:46 Center” to Web site, 86, 2:7 –Official notice: Annual Meeting of Fellows, American –From my perspective (Russell), 86, 1:3, 2:4, 3:4 College of Surgeons, 86, 9:38 –Making Washington work for you: “All politics is lo- –Scientific contributions sought for 2002 Clinical Con- cal” (Shalgian and LaFlair), 86, 10:25 gress, 86, 12:50 Annual meeting (see Clinical Congress) –Trauma Motion Picture Session: Call for videotapes, Awards 86, 2:39 –David L. Narhwold receives top ACS honor, 86, 11:32 Clinical trials and evidence-based medicine –Dr. Fogarty receives Jacobson Award, 86, 7:40 –College establishes Office of Evidence-Based Surgery, Bulletin 86, 10:30 –Corrections, 86, 8:35 –From my perspective (Russell), 86, 1:3 –Letters, 86, 4:50, 5:38, 6:29, 8:34, 9:42, 10:39 Development Business and finance –Tracing the “roots of philanthropy” at the chapter –Dues structure to be reviewed, 86, 9:48 level (Harrison), 86, 5:35 –Governors’ committee reports College remains fiscally Disciplinary actions sound (Sasser), 86, 4:28 –Disciplinary actions taken, 86, 2:38, 6:31, 9:45 –Take a look at the activities of the ACS Insurance Pro- Education gram (Vincent), 86, 12:43 –College launches CME Joint Sponsorship Program, Candidate and Associate Society-American Col- 86, 6:31 lege of Surgeons –From my perspective (Russell), 86, 1:3, 2:4 –CAS-ACS addresses concerns of future surgeons, 86, –Surgeons as Educators course to be held in early 2002, 10:31 86, 7:51 –The CAS-ACS: Communication is the key Executive Director (Upperman), 86, 10:34 –Report of the Executive Director (Russell), 86, 12:34 –From my perspective (Russell), 86, 1:3 Fellows Chapters –Biography of Richard J. Field, Jr., MD, FACS, pub- –The ACS chapters: Where do we go from here? lished, 86, 6:27 (Quinlan), 86, 12:10 –College leaders awarded honorary Fellowship in Royal –Chapter Leadership Conference: Participants look to College of Surgeons, 86, 2:33 the future (Schneidman), 86, 7:47 –Correction, 86, 8:35 –Chapter news (Peebles), 86, 2:46, 4:54, 6:34, 8:38, –Fellows and facts, 86, 6:26, 12:53 10:44, 12:54 –Philip Sandblom, MD, PhD, FACS, dies (Hanlon), 86, –From my perspective (Russell), 86, 2:4, 7:3 6:25 –Governors’ committee energizes chapters (Parker), Fellowship 86, 9:25 –From my perspective (Russell), 86, 1:3 –Seventh Triennial ACS Latin American Congress: Un –Update your information online, 86, 1:41, 3:59, 6:33 gran espectáculo (Strauch), 86, 8:33 Governors, Board of –Tracing the “roots of philanthropy” at the chapter –Committee strives to balance “socio” and socioeco- level (Harrison), 86, 5:35 nomic issues (Warshaw), 86, 5:25 Clinical Congress –Governors’ committee energizes chapters (Parker), 62 –American College of Surgeons 87th annual Clinical 86, 9:25

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS –Governors’ committee reports College remains fiscally –2001 International Guest Scholars selected, 86, 3:57 sound (Sasser), 86, 4:28 –2002 Australia and New Zealand Travelling Fellow- –Governors’ committee takes on competency chal- ship available, 86, 1:40 lenges (Daly), 86, 1:29 –2003 Travelling Fellowship available, 86, 11:37, 12:46 –Report of the Chair of the Board of Governors (Bass), –ACS Scholarships, Fellowships, Award available, 86, 1:43 86, 12:33 –Clowes research award given, 86, 12:46 Honorary Fellowships –Faculty career development award available, 86, 5:32 –Citation for Prof. Albrecht F.W. Encke, MD, FACS –Faculty Research Fellowships awarded by College, 86, (Longo), 86, 11:34 4:47 –Citation for Prof. Pekka Häyry (Starzl), 86, 11:35 –International Guest Scholarships available for 2002, –Citation for Prof. Minoru Hirano, MD, PhD (Healy), 86, 1:39 86, 11:36 –Research scholarships and award for 2001 granted, –College names three Honorary Fellows, 86, 11:33 86, 3:54 Informatics –Report from a Travelling Fellow (Ashley), 86, 1:37 –College adds legislative action center to Web site, 86, –Wyeth-Ayerst to sponsor ACS scholarship, 86, 4:49 3:59 Spring Meeting –Dateline: Washington: ACS adds “Legislative Action –April 22-25, 2001: Toronto to host Spring Meeting, Center” to Web site, 86, 2:7 86, 3:46 –Fellows may register online for Spring Meeting, 86, –Fellows may register online for Spring Meeting, 86, 2:36 2:36 –Spring Meeting to be held in Toronto, 86, 1:36 –From my perspective (Russell), 86, 1:3 Statements –Interactive Web-based program initiated in Journal, –Statement in support of motorcycle helmet laws, 86, 86, 7:41 2:27 –JACS now available on the Internet, 86, 1:41 –Statement on diversity, 86, 8:24 –Update your information online, 86, 1:41, 3:59, 6:33 Strategic planning Journal of the American College of Surgeons –American College of Surgeons: Strategic plan for 2001 –Interactive Web-based program initiated in Journal, and beyond, 86, 9:9 86, 7:41 –From my perspective (Russell), 86, 1:3, 8:3, 9:4 –JACS now available on the Internet, 86, 1:41 Testimony –The Journal Page, 86, 1:47, 2:48, 3:64, 4:56, 5:47, 6:36, –Dateline: Washington: ACS testifies in support of 7:52, 8:40, 9:56, 10:48, 11:40, 12:58 trauma funding system, 86, 4:8 Officers and staff –Dateline: Washington: Former ACS President testi- –ACS Officers and Regents, 86, 3:38, 7:32, 9:29, 12:35 fies before Congress, 86, 6:7 –Dr. Collicott named to ACS executive staff, 86, 12:42 Trauma –College establishes Office of Evidence-Based Surgery, –ACS joins public health initiative to reduce firearms- 86, 10:30 related injuries, 86, 4:53 –New members join ACS executive staff, 86, 5:34 –Committee on Trauma issues call for papers, 86, 7:49 –New members join ACS executive staff, 86, 9:37 –Dateline: Washington: ACS testifies in support of –R. Scott Jones installed as 82nd ACS President, 86, 11:31 trauma funding system, 86, 4:8 Presidential Address –Trauma and critical care meeting to be held in May, –A review of the Presidential Address: Medicine, gov- 86, 2:34 ernment, and capitalism (Jones), 86, 12:8 –Trauma papers competition winners announced, 86, Publications/public relations 7:42 –College materials prepare surgeons for defense trial, –Trauma seminar to be held in Kansas City, 86, 10:35 86, 5:37 Young surgeons (see also Candidate and Associ- Regents, Board of ate Society of the American College of Sur- –Highlights of the Board of Regents meeting, Febru- geons) ary 9-10, 2001 (Lynch), 86, 5:41 –2002 surgical investigators conference will focus on –Highlights of the Board of Regents meeting, June 8- NIH programs and policies, 86, 7:51 10, 2001 (Lynch), 86, 9:49 –From my perspective (Russell), 86, 1:3 –Highlights of the Board of Regents meeting, October –Young surgeon representatives gather in Chicago 20-22, 27, 2000 (Lynch), 86, 2:40 (Canver), 86, 8:31 –Report of the Chair of the Board of Regents (Carrico), AMERICAN MEDICAL ASSOCIATION 86, 12:30 ACS scores success at AMA House of Delegates meet- Scholarships/fellowships ing, 86, 8:29 63

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS College delegation active at AMA House of Delegates The bioartificial liver (Stoller), 86, 9:33 meeting, 86, 2:35 Keeping current: An interview with Nathaniel J. Soper, From my perspective (Russell), 86, 8:3 MD, FACS: State-of-the-art minimally invasive sur- ANESTHESIA gery (Stoller), 86, 7:36 Dateline: Washington: HCFA announces change in an- Keeping current: Introducing ACS Surgery: Principles esthesia supervision rules, 86, 3:7 and Practice (Stoller), 86, 10:28 Keeping current: Today in surgical practice: A conver- Keeping current: On the fast track (Stoller), 86, 11:27 sation with Prof. Henrik Kehlet (Wilmore), 86, 8:27 Keeping current: Scientific American Surgery: A con- ANTI-TRUST ISSUES versation with the founding editor, 86, 4:43 Dateline: Washington: HHS issues final Stark II rules, Keeping current: Today in surgical practice: A conver- 86, 2:6 sation with Prof. Henrik Kehlet (Wilmore), 86, 8:27 Keeping current: What’s new in ACS Surgery: Prin- ciples and Practice? (Lindsey), 86, 12:39 C Keeping current: Using ACS Surgery: Online tips and tools (Stoller), 86, 6:21 CANCER CURRENT PROCEDURAL TERMINOLOGY Dateline: Washington: Former ACS President testifies (CPT) (see also PRACTICE MANAGEMENT, before Congress, 86, 6:7 REIMBURSEMENT) In defense of the surgical cancer patient: Nutrition may Correction, 86, 3:59 be key (Daly), 86, 1:18 CPT changes in 2001 (Preskitt and Harris), 86, 1:14 In their own words: One man’s mission against cancer Socioeconomic tips of the month: Answers to common (Bodai), 86, 2:28 hotline questions, 86, 7:39 Surgical oncology bibliography available online, 86, Socioeconomic tips of the month: Coding for 2:38 endovascular abdominal aortic aneurysm repair, 86, COLLECTIVE BARGAINING 3:44 From my perspective (Russell), 86, 5:3 Socioeconomic tips of the month: Correct use of modi- Surgeons offer survival strategy for the new millen- fier -59, 86, 5:32 nium (Howisey and Durtschi), 86, 11:24 Socioeconomic tips of the month: Filing for Medicare COMPETENCE services, 86, 12:40 Congress exhibit to track effects of aging on cognitive Socioeconomic tips of the month: Frequently asked cod- performance (Greenfield), 86, 9:40 ing questions, 86, 11:29 Governors’ committee takes on competency challenges Socioeconomic tips of the month: Reporting an altered (Daly), 86, 1:29 surgical field, modifer -60, 86, 4:46 The measurement of competence: Current plans and future initiatives of the American Board of Surgery (Ritchie, Jr.), 86, 4:10 CONFIDENTIALITY E Dateline: Washington: Final regs issued on medical records confidentiality, 86, 2:6 EDITORIAL Patient privacy and health information confidential- From my perspective (Russell), 86, 1:3 (College pro- ity (Sutton), 86, 7:8 grams), 2:4 (College chapters), 3:3 (RRC/dermatology), CONTINUING MEDICAL EDUCATION 4:4 (health policy issues), 5:3 (collective bargaining), $2 million grant awarded for technology education pro- 6:3 (surgical training) 7:3 (future of College chapters), gram, 86, 3:61 8:3, 9:4 (strategic planning), 10:3 (9/11/01), 11:4 At Clinical Congress: CESTE to feature exhibit on sur- (bioterrorism), 12:3 (fee schedule conversion factor) gical simulators, 86, 9:47 “Laying on of the hands” (Fischer), 86, 1:24 College launches CME Joint Sponsorship Program, 86, What we can and can’t do: One surgeon’s perspective 6:31 (Fischer), 86, 8:19 From my perspective (Russell), 86, 1:3 EDUCATION AND TRAINING (see also CON- Guidelines for collaboration of industry and surgical TINUING MEDICAL EDUCATION and organizations in support of research and continuing GRADUATE MEDICAL EDUCATION) education, 86, 5:30 AWS Foundation announces Visiting Professor Pro- Interactive Web-based program initiated in Journal, gram, 86, 3:57, 10:37 86, 7:41 NIH course on human research protections goes online, 64 Keeping current: Advances in organ transplantation: 86, 3:59

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS ETHICS Dateline: Washington: Patients’ Bill of Rights contin- Guidelines for collaboration of industry and surgical ues to rank high on policy agenda, 86, 3:6 organizations in support of research and continuing Dateline: Washington: PROs ordered to disclose infor- education, 86, 5:30 mation, 86, 9:8 Physicians and the war on drugs: The case against le- Dateline: Washington: Senate prepares to debate man- galization (Mabry), 86, 10:17 aged care reform, 86, 7:6 Physicians and the war on drugs: The case for legal- Federal programs providing health insurance to chil- ization (Roe), 86, 10:16 dren: A review (LaFlair), 86, 12:14 Physicians and the war on drugs: Dr. Mabry’s rebuttal (Mabry), 86, 10:24 Physicians and the war on drugs: Dr. Roe responds (Roe), 86, 10:23 I IN MEMORIAM Philip Sandblom, MD, PhD, FACS, dies (Hanlon), 86, G 6:25 INFORMATICS GRADUATE MEDICAL EDUCATION CyberSurgeon: Internet broadens surgical education Advanced surgical technology experience valuable to environment (Sandrick), 86, 8:25 the basic education of general surgery residents CyberSurgeon: Virtual reality surgery: Has the future (Klodell, Martin II, Allen, and Polk, Jr.), 86, 6:11 arrived? (Sandrick), 86, 3:42 Dateline: Washington: MedPAC recommends GME re- NIH course on human research protections goes online, forms to Congress, 86, 5:7 86, 3:59 From my perspective (Russell), 86, 3:3, 6:3 What surgeons should know about...Uniform standards New technology and new approaches to surgical edu- for electronic claims (Harris), 86, 10:9 cation (Rhodes), 86, 6:16 Surgeons as Educators course to be held in early 2002, 86, 7:51 GUIDELINES AND RECOMMENDATIONS Guidelines for collaboration of industry and surgical L organizations in support of research and continuing education, 86, 5:30 LECTURES What surgeons should know about...The OIG’s com- John H. Gibbon, Jr., Lecture: Introductory remarks pliance guidance for individual and small group prac- (Spencer), 86, 3:14 tices (Brown), 86, 3:8 John H. Gibbon, Jr., Lecture: Leadership in medicine (Waldhausen), 86, 3:13 LEGISLATIVE/GOVERNMENT ISSUES Federal H The 106th Congress: A review of the second session (Desmarais), 86, 3:20 HEALTH CARE REFORM College adds legislative action center to Web site, 86, Dateline: Washington: Bush unveils 2002 budget plan, 3:59 86, 5:6 Dateline: Washington: ACS adds “Legislative Action Dateline: Washington: President approves Medicare Center” to Web site, 86, 2:7 give-back legislation, 86, 2:7 Dateline: Washington: ACS urges level playing field in Dateline: Washington: Health care spending growth Patients’ Bill of Rights, 86, 4:9 remains low, 86, 5:6 Dateline: Washington: Congressional “casualties” Dateline: Washington: House passes Patients’ Bill of mount, 86, 10:8 Rights, 86, 9:7 Dateline: Washington: House passes Patients’ Bill of Dateline: Washington: Labor Department issues rules Rights, 86, 9:7 regarding patients’ rights, 86, 1:6 Dateline: Washington: Many changes foreseen at Dateline: Washington: Many changes foreseen at HCFA, 86, 7:7 HCFA, 86, 7:7 Dateline: Washington: Physician relief and education Dateline: Washington: OIG releases work plan for 2002, package introduced, 86, 4:8 86, 11:7 Dateline: Washington: President approves Medicare 65

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS give-back legislation, 86, 2:7 Dateline: Washington: HHS issues final Stark II rules, Federal programs providing health insurance to chil- 86, 2:6 dren: A review (LaFlair), 86, 12:14 Dateline: Washington: Hospital payment increases an- Key health policymakers in the 107th Congress nounced, 86, 6:7 (LaFlair), 86, 4:16 Dateline: Washington: House committee approves Making Washington work for you: “All politics is lo- regulatory reform bill, 86, 12:7 cal” (Shalgian and LaFlair), 86, 10:25 Dateline: Washington: Medicare agency announces Physicians and the war on drugs: The case against changes, 86, 8:6 legalization (Mabry), 86, 10:17 Dateline: Washington: Medicare approves new cover- Physicians and the war on drugs: The case for legal- age expansions, 86, 7:6 ization (Roe), 86, 10:16 Dateline: Washington: Medicare issues five-year review Physicians and the war on drugs: Dr. Mabry’s rebuttal proposal, 86, 8:7 (Mabry), 86, 10:24 Dateline: Washington: Medicare issues new coverage Physicians and the war on drugs: Dr. Roe responds decisions, 86, 5:7 (Roe), 86, 10:23 Dateline: Washington: MedPAC raises concerns about Scrutiny of EMTALA grows as its scope expands physician payment update, 86, 8:6 (Gallagher), 86, 9:15 Dateline: Washington: MedPAC recommends GME re- State forms to Congress, 86, 5:7 Federal programs providing health insurance to chil- Dateline: Washington: Physician relief and education dren: A review (LaFlair), 86, 12:14 package introduced, 86, 4:8 State legislatures 2001: The year in review (Sutton), Dateline: Washington: President approves Medicare 86, 11:19 give-back legislation, 86, 2:7 Federal programs providing health insurance to chil- dren: A review (LaFlair), 86, 12:14 M What surgeons should know about...The 2001 Medi- care fee schedule (Brown), 86, 1:8 MANAGED CARE Dateline: Washington: House passes Patients’ Bill of Rights, 86, 9:7 Dateline: Washington: Labor Department issues rules N regarding patients’ rights, 86, 1:6 Dateline: Washington: Patients’ Bill of Rights contin- NATIONAL PRACTITIONER DATA BANK ues to rank high on policy agenda, 86, 3:6 Current status of the National Practitioner Data Bank Dateline: Washington: PROs ordered to disclose infor- (Fischer), 86, 9:20 mation, 86, 9:8 Dateline: Washington: GAO releases report critical of Dateline: Washington: Senate prepares to debate man- NPDB, 86, 1:6 aged care reform, 86, 7:6 Dateline: Washington: Health plans rarely report to Dealing with managed care organizations: A second the NPDB, 86, 7:7 opinion (Danto), 86, 4:23 Physician data profiling proliferates (Sutton), 86, MEDICAL ERRORS (see also QUALITY OF 5:20 CARE) MEDICAL MEETINGS Medical meetings: The real value (Baker), 86, 11:13 MEDICARE/MEDICAID (see also CURRENT O PROCEDURAL TERMINOLOGY) Dateline: Washington: ACS comments on Medicare OFFICE-BASED SURGERY five-year review, 86, 9:7 Office-based surgery regulation: Improving patient Dateline: Washington: CMS publishes rule on 2002 safety and quality care (Sutton), 86, 2:8 Medicare fee schedule, 86, 12:6 OUTREACH MEDICAL CARE Dateline: Washington: College submits comments on E-mail from Africa connects surgeon and teen 2002 fee schedule, 86, 11:6 (Campbell), 86, 7:13 Dateline: Washington: GAO criticizes Medicare pro- Hôpital Lumière, Haiti: A call to care (Greene), 86, 8:8 vider communications, 86, 11:6 Operation Argentina: A surgical partnership across the Dateline: Washington: HCFA announces new Medicare Americas (Cornwell), 86, 2:13 Working in the dark (Shaotung), 86, 12:45 66 survey, 86, 3:6

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Office-based surgery regulation: Improving patient P safety and quality care (Sutton), 86, 2:8 Patient safety initiatives following the IOM report PRACTICE MANAGEMENT (see also CURRENT (Shalgian), 86, 6:8 PROCEDURAL TERMINOLOGY and REIM- BURSEMENT) Save the charts: For whom and for what? (Kerin), 86, R 6:18 Socioeconomic tips of the month: Adding new associ- REIMBURSEMENT (see also CURRENT PRO- ates to practices, 86, 1:33 CEDURAL TERMINOLOGY and PRACTICE Socioeconomic tips of the month: Filing for Medicare MANAGEMENT) services, 86, 12:40 Dateline: Washington: CMS proposes changes in pay- Socioeconomic tips of the month: Filing Medicare ment policies, 86, 9:8 claims, 86, 9:36 Dateline: Washington: CMS publishes rule on 2002 Socioeconomic tips of the month: Planning for retire- Medicare fee schedule, 86, 12:6 ment, 86, 2:31 Dateline: Washington: College submits comments on Socioeconomic tips of the month: Record retention, 86, 2002 fee schedule, 86, 11:6 6:23 Dateline: Washington: GAO criticizes Medicare pro- What surgeons should know about...The OIG’s com- vider communications, 86, 11:6 pliance guidance for individual and small group prac- Dateline: Washington: HCFA renews “Centers of Ex- tices (Brown), 86, 3:8 cellence” demo project, 86, 1:7 PROFESSIONAL LIABILITY Dateline: Washington: Hospital payment increases an- College materials prepare surgeons for defense trial, nounced, 86, 6:7 86, 5:37 Dateline: Washington: Medicare issues five-year review Double-digit premium hikes: The latest crisis in pro- proposal, 86, 8:7 fessional liability (Manuel), 86, 12:19 Dateline: Washington: MedPAC raises concerns about Liability and patient safety issues to be addressed at physician payment update, 86, 8:6 Congress, 86, 9:46 From my perspective (Russell), 86, 12:3 PROFILING What surgeons should know about...The 2001 Medi- Physician data profiling proliferates (Sutton), 86, care fee schedule (Brown), 86, 1:8 5:20 What surgeons should know about...Late, partial, or denied payment or lost claims (Krier-Morrow), 86, 5:8 What surgeons should know about...Uniform standards Q for electronic claims (Harris), 86, 10:9 RESIDENT WORK HOURS QUALITY OF CARE Dateline: Washington: OSHA petitioned to regulate Dateline: Washington: ACS urges level playing field in resident work hours, 86, 6:6 Patients’ Bill of Rights, 86, 4:9 RURAL SURGERY Dateline: Washington: College awarded AHRQ patient Biography of Richard J. Field, Jr., MD, FACS, published, safety grants, 86, 12:7 86, 6:27 Dateline: Washington: HHS holds summit on patient The changing landscape of rural surgery: The view safety, 86, 6:6 from Oklahoma (Schneidman), 86, 5:14 Dateline: Washington: HHS issues guidance on patient privacy protections, 86, 8:7 Dateline: Washington: New IOM report on quality re- leased, 86, 4:9 Governors’ committee takes on competency challenges S (Daly), 86, 1:29 “Laying on of the hands” (Fischer), 86, 1:24 SCHOLARSHIPS Liability and patient safety issues to be addressed at AWS issues call for grant applications, 86, 3:63 Congress, 86, 9:46 Surgical Research Clearinghouse available online, 86, The measurement of competence: Current plans and 3:63 future initiatives of the American Board of Surgery SPECIALTIES (Ritchie, Jr.), 86, 4:10 American Board of Colon and Rectal Surgery 67

DECEMBER 2001 BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS (Abcarian), 86, 3:27 American Board of Neurological Surgery (Giannotta), T 86, 3:30 American Board of Obstetrics and Gynecology (Cefalo), TECHNOLOGY 86, 3:31 $2 million grant awarded for technology education pro- American Board of Ophthalmology (Benson), 86, gram, 86, 3:61 3:35 Advanced surgical technology experience valuable to American Board of Orthopaedic Surgery (Cofield), 86, the basic education of general surgery residents 3:37 (Klodell, Martin II, Allen, and Polk, Jr.), 86, 6:11 American Board of Otolaryngology (Healy), 86, 4:32 New technology and new approaches to surgical edu- American Board of Plastic Surgery (Riley, Jr.), 86, cation (Rhodes), 86, 6:16 4:33 TERRORISM American Board of Surgery (Lewis, Jr.), 86, 4:35 Disasters from biological and chemical terrorism— American Board of Thoracic Surgery (Crawford, Jr.), What should the individual surgeon do? (ACS Com- 86, 4:38 mittee on Trauma), 86, 11:9 American Board of Urology (Resnick), 86, 4:41 From my perspective, 86, 10:3, 11:5 Dateline: Washington: Specialties comment on critical Statement on unconventional acts of civilian terror- care issues, 86, 10:7 ism (ACS Board of Governors), 86, 11:11 Ten specialty boards report accomplishments and Unconventional civilian disasters: What the surgeon plans: Part I, 86, 3:26 should know (Russell), 86, 11:8 Ten specialty boards report accomplishments and TRANSPLANTATION plans: Part II, 86, 4:31 Keeping current: Advances in organ transplantation: STATEMENTS The bioartificial liver (Stoller), 86, 9:33 Statement in support of motorcycle helmet laws, 86, TRAUMA (see also TERRORISM) 2:27 ACS joins public health initiative to reduce firearms- Statement on diversity, 86, 8:24 related injuries, 86, 4:53 SURGERY Dateline: Washington: ACS testifies in support of John H. Gibbon, Jr., Lecture: Introductory remarks trauma funding system, 86, 4:8 (Spencer), 86, 3:14 Dateline: Washington: OIG releases reports on John H. Gibbon, Jr., Lecture: Leadership in medicine EMTALA, 86, 3:6 (Waldhausen), 86, 3:13 Dateline: Washington: President approves $3 million Keeping current: An interview with Nathaniel J. Soper, for trauma systems, 86, 2:6 MD, FACS: State-of-the-art minimally invasive sur- Scrutiny of EMTALA grows as its scope expands gery (Stoller), 86, 7:36 (Gallagher), 86, 9:15 Keeping current: On the fast track (Stoller), 86, 11:27 “Laying on of the hands” (Fischer), 86, 1:24 A reminiscence: Serendipity steers surgeon to discov- ery (Neely), 86, 2:21 A review of the Presidential Address: Medicine, gov- ernment, and capitalism (Jones), 86, 12:8 What we can and can’t do: One surgeon’s perspective (Fischer), 86, 8:19 SURGICAL RESEARCH 2002 surgical investigators conference will focus on NIH programs and policies, 86, 7:51 AWS issues call for grant applications, 86, 3:63 Guidelines for collaboration of industry and surgical organizations in support of research and continuing education, 86, 5:30 The Journal Page, 86, 1:47, 2:48, 3:64, 4:56, 5:47, 6:36, 7:52, 8:40, 9:56, 10:48, 11:40, 12:58 NIH course on human research protections goes online, 86, 3:59 Surgical Research Clearinghouse available online, 86, 68 3:63

VOLUME 86, NUMBER 12, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS