VennDiagram Ad revise:M0638A 9/16/11 4:02 PM Page 1 ACS Higher National Quality Surgical Quality Care Lower Improvement Program Costs We’ve found common ground for health care. Our National Surgical Quality Improvement Program prevented 250-500 complications per year, per hospital. Improving care – and reducing costs. You can do both. The ACS National Surgical Quality Improvement Program – a national effort to improve surgical care and cut costs run by the American College of Surgeons – is helping to prevent thousands of surgical complications each year, according to a study of 118 hospitals. The hospitals experienced a reduction of 250-500 complications per hospital, per year. If these methods were used in every hospital in the nation, we could reduce health care costs by $13 to $25 billion every year, or $130 to $250 billion over the next decade – and help literally millions of patients avoid preventable complications. So let’s stop focusing on the issues that divide us, and work together to make sure Congress rewards providers who deliver better care at lower costs by using measures like these. Learn more about the ACS NSQIP® program at acsnsqip.org JANUARY 2012 Volume 97, Number 1 INSPIRING QUALITY: Highest Standards, Better Outcomes FEATURES Diane S. Schneidman Medical liability reform: Editor Evidence for legislative and alternative approaches 6 Lynn Kahn Ian S. Metzler and John G. Meara, MD, DMD, FACS Director, Division of Integrated Communications Sanctity and organ donation’s societal value 12 Tony Peregrin Michael R. Marvin, MD, FACS; Kenneth M. Prager, MD; Senior Editor Max V. Wohlauer, MD; and James G. Chandler, MD, FACS Stephen J. Regnier Invited commentary: Sanctity and organ donation’s Contributing Editor societal value in an opt-out country: The Austrian experience 24 Tina Woelke Matthias Biebl, MD, and Johann Pratschke, MD, PhD Graphic Designer CPT 2012 brings with it new codes and code changes 26 Charles D. Mabry, Linda Barney, MD, FACS; Mark Savarise, MD, FACS; MD, FACS and Jenny Jackson, MPH Leigh A. Neumayer, MD, FACS Highlights of the 97th Annual Clinical Congress 33 Marshall Z. Schwartz, MD, FACS ACS Officers,egents, R and Board of Governors’ Executive Committee 42 Mark C. Weissler, MD, FACS Editorial Advisors Tina Woelke DEPARTMENTS Front cover design Looking forward 4 Editorial by David B. Hoyt, MD, FACS, ACS Executive Director Future meetings HPRI data tracks 46 Clinical Congress Urology workforce trends 2012 Chicago, IL, Simon Neuwahl; Kristie Thompson; Erin Fraher, PhD, MPP; September 30– and Thomas Ricketts, PhD, MPH October 4 Advocacy advisor 50 2013 Washington, DC, 2011 lobby day wrap-up: Ohio, Massachusetts, and Alabama October 6–10 Charlotte Grill 2014 San Francisco, CA, October 26–30 Letters to the Editor should be sent with the writer’s name, ad- dress, e-mail address, and daytime telephone number via e-mail to [email protected], or via mail to Diane S. Schneidman, Editor, Bul- letin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or clarity. Permission to publish letters is assumed unless the On the cover: The history of organ transplantation reflects society’s struggle to come to terms author indicates otherwise. with the possibilities presented by medical technology in relation to religion, science, and law (see articles, pages 12 and 24). NEWS Bulletin of the American College of Surgeons (ISSN J. David Richardson, MD, FACS, 0002-8045) is published monthly elected Chair of ACS Board of Regents by the American College of Sur- 52 geons, 633 N. Saint Clair St., Call for nominations for the ACS Board of Regents 53 Chicago, IL 60611. It is distrib- uted without charge to Fellows, A message from the Editor 53 Associate Fellows, Resident and Medical Student Members, Af- Call for nominations for ACS Officers-Elect 54 filiate Members, and to medical libraries and allied health person- Nominations sought for 2012 volunteerism and humanitarian awards 55 nel. Periodicals postage paid at Chicago, IL, and additional mail- College seeks nominations for Jacobson Promising Investigator Award 57 ing offices. POSTMASTER: Send address changes to Bulletin of the A look at The Joint Commission: American College of Surgeons, New standard for surgical accountability measures 59 3251 Riverport Lane, Maryland Heights, MO 63043. Canadian Publications Mail Agreement No. Fellows in Archives photo identified 61 40035010. Canada returns to: Station A, PO Box 54, Windsor, International women in surgery symposium set for spring 2012 61 ON N9A 6J5. The American College of NTDB® data points: Surgeons’ headquarters is lo- Annual Report 2011: Eightfold over eight years 63 cated at 633 N. Saint Clair St., Richard J. Fantus, MD, FACS; and Michael L. Nance, MD, FACS Chicago, IL 60611-3211; tel. 312-202-5000; toll-free: 800- 621-4111; e-mail:postmaster@ facs.org; website: www.facs. org. Washington, DC, office is located at 20 F Street N.W. Suite 1000, Washington, DC. 20001- 6701; tel. 202-337-2701; web- site: www.tmiva.net/20fstreetcc/ home. Unless specifically stated oth- erwise, the opinions expressed 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. ©2012 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted in any form by any means without prior writ- ten permission of the publisher. Library of Congress num- ber 45-49454. Printed in the USA. Publications Agreement No. 1564382. The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Looking forward he nation’s medical liability system contin- ues to be one of the most troubling prob- lems that surgeons must contend with. This statement particularly applies to those of us Twho are in private practice and high-risk specialties. Many surgeons and other physicians believe that ’’ the current system of resolving medical malprac- tice claims—the tort system—provides incentives for patients, their families, and trial lawyers to sue and seek exorbitant financial awards, regardless of whether their cases have merit. In reality, though, most patients who are injured Because each state handles because of negligent care never file a lawsuit, and few patients who do sue ever receive compensation. medical liability issues in its So, this system is a failure from the perspectives of both patients and health care professionals. own way, patients and their Furthermore, the medical liability system has a negative effect on the nation’s sagging economy. physicians must deal with The Congressional Budget Office estimates that reforming the means of resolving medical liability the inequities that a lack of claims would reduce federal spending by $62.4 bil- lion over 10 years. These savings would come about federal legislation creates. largely because physicians would be less likely to practice defensive medicine and would order fewer tests and provide fewer unnecessary services. In an era of budget cuts, such savings should be quite ’’ meaningful to lawmakers. Moreover, as the number of liability cases and damage awards rise, physicians’ malpractice insur- ance premiums go up exponentially, adding to surgeons’ frustration. As a result, many surgeons avoid practicing in states where liability coverage of 1975. These reforms include a $250,000 cap on is costly and in specialties that are at a greater risk noneconomic damage awards, a statute of limita- for litigation, such as neurosurgery and obstetrics- tions, constraints on attorneys’ contingency fees, a gynecology. requirement that providers pay only their fair share Despite the fact that tort reform could reduce of damages, and collateral offsets that prevent du- health care spending and waste and improve access plicate payments to plaintiffs. to surgical care, efforts to pass federal legislation that Over the course of the nearly 37 years that have would change the system have repeatedly failed to passed since MICRA was enacted, many states have gain enough congressional support to pass. passed similar legislation with varying degrees of success. For example, several state Supreme Courts Traditional reforms have overturned noneconomic damage caps on In the article “Medical liability reform: Evidence constitutional grounds. for legislative and alternative approaches” (see page Because each state handles medical liability is- 6), Ian S. Metzler and John G. Meara, MD, DMD, sues in its own way, patients and their physicians FACS, provide a superb overview of all these issues. must deal with the inequities that a lack of federal They also address the benefits and limitations of tra- legislation creates. As Mr. Metzler and Dr. Meara ditional approaches to medical malpractice reform, note, until national standards are set, the treat- such as the provisions established in California’s ment of plaintiffs and defendants alike will remain 4 Medical Injury Compensation Reform Act (MICRA) inconsistent. VOLUME 97, NUMBER 1, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS Nonetheless, MICRA-like liability reforms are the basis of the guidelines they will need to follow unlikely to pass at the national level anytime soon. to be shielded from malpractice claims. Hence, many health policy experts have begun ex- I encourage each of you to read the article that amining alternative means of resolving malpractice Dr. Meara and Mr. Metzler have written as one step claims. One option highlighted in the article by Mr. toward becoming better educated about this impor- Metzler and Dr. Meara is the disclosure and offer tant issue. I also would urge you to contact the ACS approach. When this option is applied, the health Washington Office at [email protected] to find out how care provider and the liability insurer proactively you can more effectively advocate for the types of identify adverse outcomes, investigate them, and of- reforms that will enable all Americans to have access fer compensation without seeking to establish fault.