JUNE 2007 Volume 92, Number 6 FEATURES Stephen J. Regnier Indian Health Service: Editor Providing care to Native Americans and Alaska Natives 12 Thomas K. Stempel, MD, FACS, CAPT USPHS(Ret) Linn Meyer The ACS Case Log System: A key tool for surgical self-evaluation, Director of privileging, and maintenance of certification 17 Communications M. Michael Shabot, MD, FACS, and Howard Tanzman The ACS Surgical Quality Alliance: Karen Stein Specialty societies improving quality for the surgical patient 21 Associate Editor Frank Opelka, MD, FACS, and Julie Lewis Diane S. Schneidman Surgical research and the new privacy laws 26 Peter K. Henke, MD, FACS; Misty Fewel, MPH; and Matt Fewel, MD Contributing Editor The COT’s Resident Papers Competition: Tina Woelke Promoting careers in trauma surgery 30 Graphic Design Specialist Gregory J. Jurkovich, MD, FACS Alden H. Harken, MD, FACS DEPARTMENTS Charles D. Mabry, MD, FACS Jack W. McAninch, MD, From my perspective 4 Editorial by Thomas R. Russell, MD, FACS, ACS Executive Director FACS Editorial Advisors Dateline: Washington 6 Division of Advocacy and Health Policy Tina Woelke What surgeons should know about... 8 Front cover design Medicare’s Physician Quality Reporting Initiative Jean A. Harris Socioeconomic tips 36 ACS Coding Hotline: Unusual coding questions Future meetings Division of Advocacy and Health Policy Clinical Congress 2007 New Orleans, LA, October 7-11 2008 San Francisco, CA, October 12-16 2009 Chicago, IL, October 11-15 On the cover: Surgical research—in particular, large registry studies—is likely to be affected, sometimes negatively, by the Health Insurance Portability and Ac- countability Act (see article, page 26). Photos courtesy of Punchstock. NEWS Bulletin of the American College of Surgeons (ISSN In memoriam: 0002-8045) is published Remembering Edwin W. Gerrish 37 monthly by the American Col- Barbara L. Dean lege of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It COT 2007 Resident Trauma Papers Competition is distributed without charge to Fellows, to Associate Fellows, winners announced 39 to participants in the Candi- date Group of the American NQF endorses measures developed College of Surgeons, and to by the ACS Commission on Cancer 40 medical libraries. Periodicals postage paid at Chicago, IL, ACS endorses National Time Out Day 41 and additional mailing offices. POSTMASTER: Send address Surgeons Diversified Investment Fund’s (SDIF) changes to Bulletin of the first quarter 2007 performance report 43 American College of Surgeons, 633 N. Saint Clair St., Chicago, ACS resident research scholarships available 45 IL 60611-3211. Canadian Pub- lications Mail Agreement No. ACOSOG news: 40035010. Canada returns to: Neoadjuvant aromatase inhibitor trial for breast cancer 47 Station A, PO Box 54, Windsor, David Ota, MD, FACS, and Heidi Nelson, MD, FACS ON N9A 6J5. The American College of A look at The Joint Commission: Patient safety Surgeons’ headquarters is and health care quality performance of U.S. hospitals 49 located at 633 N. Saint Clair St., Chicago, IL 60611-3211; Disciplinary actions taken 50 tel. 312/202-5000; toll-free: 800/621-4111; fax: 312/202- NTDB® data points: 5001; e-mail:postmaster@ What a disaster 51 facs.org; Web site: www.facs. org. Washington, DC, office Richard J. Fantus, MD, FACS, and Jeffrey S. Hammond, MD, MPH, FACS is located at 1640 Wisconsin Ave., NW, Washington, DC Operation Giving Back: 20007; tel. 202/337-2701, fax Volunteer opportunities available 52 202/337-4271. Unless specifically stated Chapter news 53 otherwise, the opinions ex- Rhonda Peebles pressed and statements made in this publication reflect the authors’ personal observations and do not imply endorse- ment by nor official policy of the American College of Sur- geons. ©2007 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 permis- sion 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. AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION • SYLLABI SELECT: The content of select ACS Clinical Congress postgraduate courses is available on CD-ROM. BASIC ULTRASOUND COURSE: This course has been developed on CD-ROM to provide the practicing surgeon and surgical resident with a basic core of education and train- ing in ultrasound imaging as a foundation for specific clinical applications. It replaces the basic course offered at the Clinical Congress and is available for CME credit. PROFESSIONALISM IN SURGERY: CHAL- LENGES AND CHOICES: This CD presents 12 case vignettes, each including a scenario followed by multiple-choice questions related to professional responsibilities of the surgeon within the context of the case. The program provides a printable CME certificate upon successful completion. PERSONAL FINANCIAL PLANNING AND MANAGEMENT for Residents and Young Sur- geons: This CD uses an interactive/lecture format to equip residents and young surgeons with the knowledge to manage their personal financial future, including debt management and financial planning for surgical practice. This program provides a printable CME certificate upon successful completion. PRACTICE MANAGEMENT for Residents and Young Surgeons: This CD uses an interactive/lecture format to equip residents and young surgeons with the knowledge to manage their surgical future, including how to select a practice type and location, the mechanics of setting up or running a pri- vate practice, the essentials of an academic practice and career pathways, and surgical coding basics. This program provides a printable CME certificate upon successful completion. BARIATRIC SURGERY PRIMER: This CD addresses various aspects of bariatric surgery, including the biochemistry and physiology of obesity, appropriate candidates, basic bariatric procedures, comorbidity and outcomes, and surgical training, as well as facilities, managed care, liability NEW: DISCLOSING SURGICAL ERROR: issues, and ethics. VIGNETTES FOR DISCUSSION: This DVD demonstrates two approaches used by a surgeon to disclose to the patient’s ONLINE CME: Courses from the ACS’ Clinical Con- family a major technical error that occurred in the operating room. gresses are available online for surgeons. Each online course The vignettes demonstrate effective disclosure techniques, as well features a video introduction, slideshow presentations with as approaches that need improvement. This project was supported synchronized audio of session, printable written transcripts, by a grant from the Agency for Healthcare Research and Quality and printable CME certificate upon successful completion. The and is available at no cost. courses are accessible at www.acs-resource.org. For purchase and pricing information, call ACS Customer Service at 312/202-5474 or visit our E-LEARNING RESOURCE CENTER at www.acs-resource.org For more information contact Olivier Petinaux, MS, at [email protected], or tel. 866/475-4696. All-Products-Ad-Bulletin-(revise1 1 3/15/2007 3:50:16 PM From my perspective he financial constraints and administra- tive burdens associated with our current health care system are clearly untenable Tto many surgeons. With considerable frequency, members of this organization contact me to talk about “the good old days” before man- aged care, before government intervention, before ’’ Medicare instituted the resource-based relative value scale, and so on. Their sentiments are com- pletely understandable. The existing structure is riddled with financial inequities for health care professionals and with access disparities for pa- We also cannot ignore the tients. In the effort to reduce health care spend- ing and redistribute payments across specialties, reasons why we went into surgeons have been particularly hard-hit. The good news is that our health care system, surgery in the first place. albeit slowly and incrementally, is being reformed in ways that we anticipate will lead to greater fairness for all. Clearly, the upcoming presidential ’’ election will only focus the spotlight more intently on the need for positive change. We cannot, and will not, ignore the problems facing surgeons and their patients, and the Col- has perceived us as being consumed with concerns lege will continue to do all it can to make sure the about money and disinterested in their health upcoming changes will have positive outcomes for and well being. This erosion of mutual trust has our members so that their practices will not just been to the detriment of both surgeons and their survive, but will thrive. However, we also cannot patients. ignore the reasons why we went into surgery in Fortunately, the nation appears to be on the the first place, and we need to begin to turn a good brink of instituting changes that will lead to a part of our attention away from the spreadsheet new method for reimbursing surgeons for the and refocus on the hospital bed sheet. We need to services they provide. As discussed previously concentrate on the joys of patient care and worry a in this column and in many Bulletin articles, bit less about whether and how we will be paid. If the health care system of the future will center we concentrate on the core mission of our profes- on value-based care. Patients and payors alike sion, which