Bulletin April 2010

APRIL 2010 Volume 95, Number 4 FEATURES Stephen J. Regnier Surgical lifestyles: An orthopaedic surgeon in space: Editor An interview with Robert Satcher, MD, PhD 11 Linn Meyer Tony Peregrin Director, Division of Rural surgeons—We must grow our own 16 Integrated Communications Paul J. Huffstutter, MD, FACS Tony Peregrin Associate Editor Rural surgeons—We must grown our own: A response 19 Joseph B. Cofer, MD, FACS Diane S. Schneidman Contributing Editor Medicare physician reimbursement: Is the SGR’s end in sight? 20 Tina Woelke Shawn Friesen Graphic Design Specialist Alden H. Harken, Is the generalist surgeon obsolete? The impact of the general surgeon shortage on global health 24 MD, FACS Jeremy Hedges, MD, MPH; Kimberly A. Ruscher, MD, MPH; Charles D. Mabry, and Kathryn Chu, MD, MPH MD, FACS Jack W. McAninch, MD, FACS Editorial Advisors DEPARTMENTS Tina Woelke Front cover design Looking forward 4 Editorial by David B. Hoyt, MD, FACS, ACS Executive Director Future meetings What surgeons should know about... 6 Clinical Congress PQRI reporting in 2010 2010 Washington, DC, Caitlin Burley October 3-7 Advocacy advisor 27 2011 San Francisco, CA, Lobbyists—Who needs them? October 23-27 Melinda Baker 2012 Chicago, IL, September 30– October 4 Letters to the Editor should be sent with the writer’s name, address, e-mail address, and daytime tele- phone number via e-mail to [email protected], or via mail to Stephen J. Regnier, Editor, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or On the cover: Last year, Robert Satcher, MD, PhD, became the first orthopaedic clarity. Permission to publish letters is assumed unless the surgeon to orbit the earth as a member of the Space Shuttle Atlantis crew. (See author indicates otherwise. article, page 11.) NEWS Bulletin of the American College of Surgeons (ISSN Kamangar Awards help create 0002-8045) is published ethics training for residents 28 monthly by the American Col- Stuart D. Yoak, PhD lege of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It Did you know... 28 is distributed without charge to Fellows, Associate Fellows, Emergency rooms treated 3.5 million MVAs in 2006 31 Resident and Medical Student Members, Affiliate Members, ACS Foundation receives and to medical libraries and al- lied health personnel. Periodi- educational grant for patient skill kit 33 cals postage paid at Chicago, IL, and additional mailing College to present leadership skills course in May 35 offices. POSTMASTER: Send address changes to Bulletin of A look at The Joint Commission: Annual report the American College of Sur- on hospital quality and safety shows steady improvement 36 geons, 633 N. Saint Clair St., Chicago, IL 60611-3211. Cana- Comprehensive general surgery review course slated for June 36 dian Publications Mail Agree- ment No. 40035010. Canada ACOSOG news: Changing multidisciplinary returns to: Station A, PO Box cancer treatment through ACOSOG trials 38 54, Windsor, ON N9A 6J5. David M. Ota, MD, FACS; and Heidi Nelson, MD, FACS The American College of Surgeons’ headquarters is Letters 41 located at 633 N. Saint Clair St., Chicago, IL 60611-3211; NTDB® data points: Children are our future 43 tel. 312-202-5000; toll-free: Richard J. Fantus, MD, FACS 800-621-4111; fax: 312-202- 5001; e-mail:postmaster@ Chapter news 46 facs.org; Web site: www.facs. Rhonda Peebles org. Washington, DC, office is located at 1640 Wisconsin Ave., NW, Washington, DC 20007; tel. 202-337-2701, fax 202-337-4271. Unless specifically stated otherwise, the opinions ex- pressed and statements made in this publication reflect the authors’ personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2010 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmit- ted in any form by any means without prior written permission of the publisher. Library of Congress number 45-49454. Printed in the USA. The American College of Surgeons is dedicated to improving the care of the sur- Publications Agreement No. gical patient and to safeguarding standards of care in an optimal and ethical 1564382. practice environment. Looking forward mproving the care of the surgical patient has always been the mission of the American Col- lege of Surgeons. In fact, the founders of the IACS were among the first medical profession- als to assert that quality can be objectively and sci- entifically measured, thus leading to improvements in patient care. This guiding philosophy resulted ’’ in the College’s Hospital Standardization Program, the progenitor of today’s Joint Commission. Over the last 100 years or so, this organization has consistently modernized its means for monitoring and measuring quality of care. The The College has consistently Commission on Cancer (CoC) created the National Cancer Data Base (NCDB), and the Committee on demonstrated its commitment Trauma (COT) developed the National Trauma Data Bank® (NTDB®). In addition, both the CoC to quality and the surgical and COT have set standards for accrediting oncology and trauma centers, and, more recently, the patient through its quality College has been accrediting bariatric and breast care centers. A little more than five years ago, the of care programs. ACS took responsibility for bringing the National Surgical Quality Improvement Program (ACS NSQIP) into the private sector, so that hospitals ’’ across throughout the U.S. could start analyzing in ACS NSQIP, which generates observed/expected and comparing their outcomes. (O/E) outcome ratios for 45 measures. Eligible in- The College has consistently demonstrated its stitutions receive a PowerPoint presentation with commitment to quality and the surgical patient auto-populated site-specific data and an individual through its quality of care programs. They have hospital summary sheet containing all of the site’s been instrumental in helping us to objectively O/E data. ACS NSQIP participants also have ac- evaluate, define, and articulate the meaning of cess to the Participant Use Data File, which they quality surgical care in the institutional setting. are finding to be a valuable research tool. What’s next? Models in place In the spirit of looking forward, I believe we To make ACS NSQIP even more useful, I need to expand these efforts and determine what maintain that we should apply many of the same else we should do to ensure that surgical patients techniques that have worked well for our can- receive optimal care in a changing health care en- cer and trauma programs. The NCDB is a joint vironment. What does quality mean today? How program of the CoC and the American Cancer we do help institutions ensure that every surgical Society and produces outcomes data for more patient receives optimal care in the future? than 1,400 CoC-accredited cancer programs in The ACS Board of Regents, the Board of Gover- the U.S. and Puerto Rico. About 70 percent of all nors, our Officers, and I believe the College needs newly diagnosed oncology cases are captured at to do more to maintain and further develop the the institutional level and reported to the NCDB. organization’s commitment to quality by helping The repository now contains approximately surgeons and hospitals put the information that is 25 million records on all types of cancer. The being generated through ACS NSQIP to practical data are tracked and analyzed to explore trends use. This program continues to gain widespread in cancer care, to create regional and state bench- recognition as a surgical outcomes measurement marks for participating hospitals, and to serve as and quality improvement instrument. Presently, the basis for quality improvement. In addition, the 244 U.S. and six international hospitals participate CoC has launched the Rapid Quality Reporting 4 VOLUME 95, NUMBER 4, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS System, which provides real clinical time assess- discovering to be the necessary components of ments of hospital-level performance using quality high-quality care. For example, our experiences of cancer care measures approved by the National with the trauma and cancer programs, as well Quality Forum for breast and colorectal cancers. as ACS NSQIP, have demonstrated that quality With respect to trauma, the COT’s Consultation/ improvement requires certain resources, leader- Verification Program assists hospitals in the ship and governance structures, quality-focused evaluation and improvement of emergency care processes, and so on. and provides objective external peer review of institutional capability and performance. The Striving for improvement consulting team is composed of clinicians who are A prominent role model for effective health care experienced in trauma care and assesses commit- delivery, Geisinger Health System, has achieved ment, readiness, resources, policies, patient care, its success largely through its sophisticated performance improvement, and other relevant mechanisms for measuring outcomes and devel- features, as outlined in the College’s Resources oping and applying evidence-based best practices. for Optimal Care of the Injured Patient. Geisinger uses various criteria to target certain The COT also recently launched the Trauma services for redesign, specifically those specialties Quality Improvement Program (TQIP), which that affect the largest patient population, use will use the NTDB to collect valid and reliable the most resources, are marked by unjustified

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