News From the College

The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.

Reports and resolutions

The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:

Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.

Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.

Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:

• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);

• Publish and routinely update pertinent information related to patient cost-sharing; and

• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.

AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.

An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.

Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:

• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.

• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.

• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.

• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.

In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.

For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.

Elections

AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education. 

Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.

Other officers elected are as follows:

President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.

Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.

Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.

ACS Delegation

The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.

In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.

The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at [email protected].

Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.

Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.

The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.

Reports and resolutions

The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:

Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.

Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.

Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:

• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);

• Publish and routinely update pertinent information related to patient cost-sharing; and

• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.

AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.

An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.

Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:

• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.

• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.

• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.

• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.

In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.

For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.

Elections

AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education. 

Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.

Other officers elected are as follows:

President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.

Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.

Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.

ACS Delegation

The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.

In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.

The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at [email protected].

Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.

Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.

The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.

Reports and resolutions

The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:

Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.

Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.

Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:

• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);

• Publish and routinely update pertinent information related to patient cost-sharing; and

• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.

AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.

An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.

Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:

• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.

• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.

• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.

• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.

In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.

For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.

Elections

AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education. 

Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.

Other officers elected are as follows:

President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.

Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.

Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.

ACS Delegation

The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.

In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.

The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at [email protected].

Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.

Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.

The Executive Committee of the Commission on Cancer (CoC) approved the formation of a full Committee on Advocacy to address legislative and regulatory issues that impact cancer care. The CoC Executive Committee will approve the slate of Committee leaders at its meeting on Oct. 6. Active members of the Member Organization Steering Committee’s Advocacy Subcommittee will continue their ongoing work as full Advocacy Committee members.

During the American College of Surgeons Clinical Congress in Washington, DC, the CoC will host a legislative briefing, Commission on Cancer: Ensuring High-Quality, Patient-Centered Cancer Care, Wednesday, Oct. 9, from 3:00-4:30 pm, at 2325 Rayburn House Office Building, A reception will follow at 5:00-6:30 pm. Space is limited. For more information and to reserve a place at the briefing, contact Kristin McDonald at 202-337-2701 or [email protected].

The Executive Committee of the Commission on Cancer (CoC) approved the formation of a full Committee on Advocacy to address legislative and regulatory issues that impact cancer care. The CoC Executive Committee will approve the slate of Committee leaders at its meeting on Oct. 6. Active members of the Member Organization Steering Committee’s Advocacy Subcommittee will continue their ongoing work as full Advocacy Committee members.

During the American College of Surgeons Clinical Congress in Washington, DC, the CoC will host a legislative briefing, Commission on Cancer: Ensuring High-Quality, Patient-Centered Cancer Care, Wednesday, Oct. 9, from 3:00-4:30 pm, at 2325 Rayburn House Office Building, A reception will follow at 5:00-6:30 pm. Space is limited. For more information and to reserve a place at the briefing, contact Kristin McDonald at 202-337-2701 or [email protected].

The Executive Committee of the Commission on Cancer (CoC) approved the formation of a full Committee on Advocacy to address legislative and regulatory issues that impact cancer care. The CoC Executive Committee will approve the slate of Committee leaders at its meeting on Oct. 6. Active members of the Member Organization Steering Committee’s Advocacy Subcommittee will continue their ongoing work as full Advocacy Committee members.

During the American College of Surgeons Clinical Congress in Washington, DC, the CoC will host a legislative briefing, Commission on Cancer: Ensuring High-Quality, Patient-Centered Cancer Care, Wednesday, Oct. 9, from 3:00-4:30 pm, at 2325 Rayburn House Office Building, A reception will follow at 5:00-6:30 pm. Space is limited. For more information and to reserve a place at the briefing, contact Kristin McDonald at 202-337-2701 or [email protected].

Members of the Steering Committee for the American College of Surgeons (ACS) Transition to Practice (TTP) Program in General Surgery will participate in a Town Hall Meeting on Wednesday, October 9, at 7:00 am in Room 206 of the Walter E. Washington Convention Center during the 2013 Clinical Congress. J. David Richardson, MD, FACS, a general thoracic and vascular surgeon, Louisville, KY, professor of surgery and vice chair of the department of surgery, University of Louisville School of Medicine, and Former Chair, ACS Board of Regents; and R. Phillip Burns, MD, FACS, a general surgeon, chairman and professor of surgery, department of surgery, University of Tennessee College of Medicine, Chattanooga, and First Vice-President, ACS Board of Regents, will co-moderate this interactive Town Hall Meeting. ACS leadership and TTP pilot program chiefs will answer questions and provide specific details to surgeons interested in bringing the TTP program to their institution or applying as a TTP associate.

The ACS Division of Education launched the TTP program earlier in 2013 in response to an identified need for additional surgical training for general surgeons coming out of residency. The program is intended to bridge the gap between residency and independent practice as well as to provide a pathway for those wishing to move into general surgery practice. TTP associates will experience increasing autonomy throughout the year in a broad-based clinical setting, build their competence and confidence in general surgery, develop practice management skills, and gain practical experience for the next phase of their careers.

For additional information, contact the Division of Education at 312-202-5491, [email protected] or visit the website at www.facs.org/ttp.

Members of the Steering Committee for the American College of Surgeons (ACS) Transition to Practice (TTP) Program in General Surgery will participate in a Town Hall Meeting on Wednesday, October 9, at 7:00 am in Room 206 of the Walter E. Washington Convention Center during the 2013 Clinical Congress. J. David Richardson, MD, FACS, a general thoracic and vascular surgeon, Louisville, KY, professor of surgery and vice chair of the department of surgery, University of Louisville School of Medicine, and Former Chair, ACS Board of Regents; and R. Phillip Burns, MD, FACS, a general surgeon, chairman and professor of surgery, department of surgery, University of Tennessee College of Medicine, Chattanooga, and First Vice-President, ACS Board of Regents, will co-moderate this interactive Town Hall Meeting. ACS leadership and TTP pilot program chiefs will answer questions and provide specific details to surgeons interested in bringing the TTP program to their institution or applying as a TTP associate.

The ACS Division of Education launched the TTP program earlier in 2013 in response to an identified need for additional surgical training for general surgeons coming out of residency. The program is intended to bridge the gap between residency and independent practice as well as to provide a pathway for those wishing to move into general surgery practice. TTP associates will experience increasing autonomy throughout the year in a broad-based clinical setting, build their competence and confidence in general surgery, develop practice management skills, and gain practical experience for the next phase of their careers.

For additional information, contact the Division of Education at 312-202-5491, [email protected] or visit the website at www.facs.org/ttp.

Members of the Steering Committee for the American College of Surgeons (ACS) Transition to Practice (TTP) Program in General Surgery will participate in a Town Hall Meeting on Wednesday, October 9, at 7:00 am in Room 206 of the Walter E. Washington Convention Center during the 2013 Clinical Congress. J. David Richardson, MD, FACS, a general thoracic and vascular surgeon, Louisville, KY, professor of surgery and vice chair of the department of surgery, University of Louisville School of Medicine, and Former Chair, ACS Board of Regents; and R. Phillip Burns, MD, FACS, a general surgeon, chairman and professor of surgery, department of surgery, University of Tennessee College of Medicine, Chattanooga, and First Vice-President, ACS Board of Regents, will co-moderate this interactive Town Hall Meeting. ACS leadership and TTP pilot program chiefs will answer questions and provide specific details to surgeons interested in bringing the TTP program to their institution or applying as a TTP associate.

The ACS Division of Education launched the TTP program earlier in 2013 in response to an identified need for additional surgical training for general surgeons coming out of residency. The program is intended to bridge the gap between residency and independent practice as well as to provide a pathway for those wishing to move into general surgery practice. TTP associates will experience increasing autonomy throughout the year in a broad-based clinical setting, build their competence and confidence in general surgery, develop practice management skills, and gain practical experience for the next phase of their careers.

For additional information, contact the Division of Education at 312-202-5491, [email protected] or visit the website at www.facs.org/ttp.

The American College of Surgeons (ACS), the American Society for Metabolic and Bariatric Surgery (ASMBS), and other medical societies recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) opposing the agency’s plan to reverse its certification requirement for bariatric surgery facilities. The organizations maintain that removing the certification requirement could place Medicare patients at risk and is based on an incomplete review and analysis of the evidence.

"Substantial gains have been made in the quality of bariatric surgery because of certified and accredited programs," said ACS Executive Director David B. Hoyt, MD, FACS. "This proposed decision by CMS could be a setback, particularly for the Medicare beneficiaries, who have a higher risk of morbidity and mortality than the general bariatric surgery population."

In its proposed decision memo, CMS wrote, "There is little evidence that the requirement for facility certification/COE (center of excellence) designation for coverage of approved bariatric surgery procedures impacts outcomes for Medicare beneficiaries." However, several studies point to the positive effects of facility certification. In fact, a new study conducted by researchers at the University of California-Irvine indicates that the in-hospital mortality rate at non-accredited bariatric centers is more than three times higher than at accredited centers (0.22% vs. 0.06%).

Other groups that signed the joint letter include The Obesity Society, the American Society of Bariatric Physicians, and the Society of American Gastrointestinal Endoscopic Surgeons. View the press release announcing the joint letter at http://www.facs.org/news/2013/medicare0813.html.

The American College of Surgeons (ACS), the American Society for Metabolic and Bariatric Surgery (ASMBS), and other medical societies recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) opposing the agency’s plan to reverse its certification requirement for bariatric surgery facilities. The organizations maintain that removing the certification requirement could place Medicare patients at risk and is based on an incomplete review and analysis of the evidence.

"Substantial gains have been made in the quality of bariatric surgery because of certified and accredited programs," said ACS Executive Director David B. Hoyt, MD, FACS. "This proposed decision by CMS could be a setback, particularly for the Medicare beneficiaries, who have a higher risk of morbidity and mortality than the general bariatric surgery population."

In its proposed decision memo, CMS wrote, "There is little evidence that the requirement for facility certification/COE (center of excellence) designation for coverage of approved bariatric surgery procedures impacts outcomes for Medicare beneficiaries." However, several studies point to the positive effects of facility certification. In fact, a new study conducted by researchers at the University of California-Irvine indicates that the in-hospital mortality rate at non-accredited bariatric centers is more than three times higher than at accredited centers (0.22% vs. 0.06%).

Other groups that signed the joint letter include The Obesity Society, the American Society of Bariatric Physicians, and the Society of American Gastrointestinal Endoscopic Surgeons. View the press release announcing the joint letter at http://www.facs.org/news/2013/medicare0813.html.

The American College of Surgeons (ACS), the American Society for Metabolic and Bariatric Surgery (ASMBS), and other medical societies recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) opposing the agency’s plan to reverse its certification requirement for bariatric surgery facilities. The organizations maintain that removing the certification requirement could place Medicare patients at risk and is based on an incomplete review and analysis of the evidence.

"Substantial gains have been made in the quality of bariatric surgery because of certified and accredited programs," said ACS Executive Director David B. Hoyt, MD, FACS. "This proposed decision by CMS could be a setback, particularly for the Medicare beneficiaries, who have a higher risk of morbidity and mortality than the general bariatric surgery population."

In its proposed decision memo, CMS wrote, "There is little evidence that the requirement for facility certification/COE (center of excellence) designation for coverage of approved bariatric surgery procedures impacts outcomes for Medicare beneficiaries." However, several studies point to the positive effects of facility certification. In fact, a new study conducted by researchers at the University of California-Irvine indicates that the in-hospital mortality rate at non-accredited bariatric centers is more than three times higher than at accredited centers (0.22% vs. 0.06%).

Other groups that signed the joint letter include The Obesity Society, the American Society of Bariatric Physicians, and the Society of American Gastrointestinal Endoscopic Surgeons. View the press release announcing the joint letter at http://www.facs.org/news/2013/medicare0813.html.

To the outside observer, the process of carrying out a well-orchestrated operation, no matter how complex, can appear routine almost to the point of boredom. Well-trained members of the team do their jobs, and, with the possible exception of a few moments that are more tense or difficult than others, things go smoothly.

When a crisis erupts, a different set of procedures comes into play. Well-prepared teams usually deal with surgical crises in the operating room (OR) just as effectively. Nevertheless, such teams may be unavailable under certain circumstances, and even the best teams may not be well-drilled in how to handle every crisis.

To ensure that surgical teams are capable of effectively responding to emergency situations, the American College of Surgeons (ACS), through its membership on the Council on Surgical and Perioperative Safety (CSPS), is participating in a campaign to introduce and implement crisis checklists in the OR and perioperative arena. 

The value of checklists

The use of checklists has migrated from the flight line to the operating room, but the surgical profession has only begun to appreciate the potential benefits and applications of this instrument. The purpose of checklists in the OR is to ensure that critical steps in preparing for and performing operations are taken and not left to memory. Situations most vulnerable to oversight are those that are, or are perceived to be, routine and those that arise during crises. Checklists provide a parachute.

Simulation laboratories have proliferated as a means of improving surgical training and as a way of testing and improving process in the OR. A number of simulation trials have tested the applicability and utility of crisis checklists. Clinicians who used them in simulated crises expressed a strong desire to have crisis checklists available, not just for training, but in the clinical setting. Initial implementation projects have been initiated at the Brigham and Women’s Hospital, Boston, MA; Stanford University, CA; and Cooper University Health System based in Camden, NJ.

The concept is hardly new. Educational programs, such as the Advanced Trauma Life Support® and Advanced Cardiac Life Support programs and the military Combat Casualty Care Course, have used checklists as an instructional expedient for many years.

The CSPS campaign

The CSPS, which the ACS was instrumental in establishing, has partnered with Ariadne Labs at the Harvard School of Public Health to launch and support a coordinated campaign to stimulate the availability and the implementation of crisis checklists. The CSPS is a unique collaborative of seven organizations representing health care professionals who are involved in perioperative care: the ACS, the American Association of Nurse Anesthetists, the American Association of Surgical Physician Assistants, the Association of PeriOperative Registered Nurses, the American Society of Anesthesiologists, the American Society of PeriAnesthesia Nurses, and the Association of Surgical Technologists. The combined membership exceeds 250,000, and the total number of individuals in the seven professions exceeds 2 million.

The CSPS intends to launch a campaign to inform its membership and the surgical community at large of the importance and effectiveness of crisis checklists and of strategies for introducing them into practice. Early experience points to the critical role of a local champion and a multidisciplinary implementation team dedicated to promoting checklist customization and adoption. Ideally, training in the use of crisis checklists would take place in a simulated operating room environment, with or without a formal simulation laboratory. Multidisciplinary staff involvement is an essential component, and so is recognition of local resources, needs, and circumstances.

The CSPS plans to expose all members of the perioperative team to the concept of crisis checklists through advocacy and education on a national level. The idea is to create a framework to implement a multidisciplinary, multi-institutional collaboration. A coordinated message from the seven organizations that comprise the CSPS will support efforts both nationally and locally.

The surgical community has the opportunity to lead in the development, adoption, and implementation of crisis checklists in collaboration with other professionals in the operating room and perioperative area. Checklists offer additional ways to improve patient care and surgical outcomes using a familiar tool. More information will be made available over the next few months.

Web resources for the implementation team are available at www.projectcheck.org and at http://emergencymanual.stanford.edu, or on the CSPS website at http://www.cspsteam.org.

Dr. Dagi is Distinguished Scholar and Professor, The School of Medicine, Dentistry Biomedical Sciences, Queen\'s University Belfast, Northern Ireland; and lecturer, department of global health and social medicine, Harvard Medical School, Boston, MA; Chair, ACS Committee on Perioperative Care; and member, CSPS Board of Directors.

Dr. Healy is Emeritus Gerald B. Healy Chair in Otolaryngology, Children\'s Hospital, Boston; professor of otology and laryngology, Harvard Medical School; ACS Past-President and Past-Chair of the Board of Regents; and member, CSPS Board of Directors.

To the outside observer, the process of carrying out a well-orchestrated operation, no matter how complex, can appear routine almost to the point of boredom. Well-trained members of the team do their jobs, and, with the possible exception of a few moments that are more tense or difficult than others, things go smoothly.

When a crisis erupts, a different set of procedures comes into play. Well-prepared teams usually deal with surgical crises in the operating room (OR) just as effectively. Nevertheless, such teams may be unavailable under certain circumstances, and even the best teams may not be well-drilled in how to handle every crisis.

To ensure that surgical teams are capable of effectively responding to emergency situations, the American College of Surgeons (ACS), through its membership on the Council on Surgical and Perioperative Safety (CSPS), is participating in a campaign to introduce and implement crisis checklists in the OR and perioperative arena. 

The value of checklists

The use of checklists has migrated from the flight line to the operating room, but the surgical profession has only begun to appreciate the potential benefits and applications of this instrument. The purpose of checklists in the OR is to ensure that critical steps in preparing for and performing operations are taken and not left to memory. Situations most vulnerable to oversight are those that are, or are perceived to be, routine and those that arise during crises. Checklists provide a parachute.

Simulation laboratories have proliferated as a means of improving surgical training and as a way of testing and improving process in the OR. A number of simulation trials have tested the applicability and utility of crisis checklists. Clinicians who used them in simulated crises expressed a strong desire to have crisis checklists available, not just for training, but in the clinical setting. Initial implementation projects have been initiated at the Brigham and Women’s Hospital, Boston, MA; Stanford University, CA; and Cooper University Health System based in Camden, NJ.

The concept is hardly new. Educational programs, such as the Advanced Trauma Life Support® and Advanced Cardiac Life Support programs and the military Combat Casualty Care Course, have used checklists as an instructional expedient for many years.

The CSPS campaign

The CSPS, which the ACS was instrumental in establishing, has partnered with Ariadne Labs at the Harvard School of Public Health to launch and support a coordinated campaign to stimulate the availability and the implementation of crisis checklists. The CSPS is a unique collaborative of seven organizations representing health care professionals who are involved in perioperative care: the ACS, the American Association of Nurse Anesthetists, the American Association of Surgical Physician Assistants, the Association of PeriOperative Registered Nurses, the American Society of Anesthesiologists, the American Society of PeriAnesthesia Nurses, and the Association of Surgical Technologists. The combined membership exceeds 250,000, and the total number of individuals in the seven professions exceeds 2 million.

The CSPS intends to launch a campaign to inform its membership and the surgical community at large of the importance and effectiveness of crisis checklists and of strategies for introducing them into practice. Early experience points to the critical role of a local champion and a multidisciplinary implementation team dedicated to promoting checklist customization and adoption. Ideally, training in the use of crisis checklists would take place in a simulated operating room environment, with or without a formal simulation laboratory. Multidisciplinary staff involvement is an essential component, and so is recognition of local resources, needs, and circumstances.

The CSPS plans to expose all members of the perioperative team to the concept of crisis checklists through advocacy and education on a national level. The idea is to create a framework to implement a multidisciplinary, multi-institutional collaboration. A coordinated message from the seven organizations that comprise the CSPS will support efforts both nationally and locally.

The surgical community has the opportunity to lead in the development, adoption, and implementation of crisis checklists in collaboration with other professionals in the operating room and perioperative area. Checklists offer additional ways to improve patient care and surgical outcomes using a familiar tool. More information will be made available over the next few months.

Web resources for the implementation team are available at www.projectcheck.org and at http://emergencymanual.stanford.edu, or on the CSPS website at http://www.cspsteam.org.

Dr. Dagi is Distinguished Scholar and Professor, The School of Medicine, Dentistry Biomedical Sciences, Queen\'s University Belfast, Northern Ireland; and lecturer, department of global health and social medicine, Harvard Medical School, Boston, MA; Chair, ACS Committee on Perioperative Care; and member, CSPS Board of Directors.

Dr. Healy is Emeritus Gerald B. Healy Chair in Otolaryngology, Children\'s Hospital, Boston; professor of otology and laryngology, Harvard Medical School; ACS Past-President and Past-Chair of the Board of Regents; and member, CSPS Board of Directors.

To the outside observer, the process of carrying out a well-orchestrated operation, no matter how complex, can appear routine almost to the point of boredom. Well-trained members of the team do their jobs, and, with the possible exception of a few moments that are more tense or difficult than others, things go smoothly.

When a crisis erupts, a different set of procedures comes into play. Well-prepared teams usually deal with surgical crises in the operating room (OR) just as effectively. Nevertheless, such teams may be unavailable under certain circumstances, and even the best teams may not be well-drilled in how to handle every crisis.

To ensure that surgical teams are capable of effectively responding to emergency situations, the American College of Surgeons (ACS), through its membership on the Council on Surgical and Perioperative Safety (CSPS), is participating in a campaign to introduce and implement crisis checklists in the OR and perioperative arena. 

The value of checklists

The use of checklists has migrated from the flight line to the operating room, but the surgical profession has only begun to appreciate the potential benefits and applications of this instrument. The purpose of checklists in the OR is to ensure that critical steps in preparing for and performing operations are taken and not left to memory. Situations most vulnerable to oversight are those that are, or are perceived to be, routine and those that arise during crises. Checklists provide a parachute.

Simulation laboratories have proliferated as a means of improving surgical training and as a way of testing and improving process in the OR. A number of simulation trials have tested the applicability and utility of crisis checklists. Clinicians who used them in simulated crises expressed a strong desire to have crisis checklists available, not just for training, but in the clinical setting. Initial implementation projects have been initiated at the Brigham and Women’s Hospital, Boston, MA; Stanford University, CA; and Cooper University Health System based in Camden, NJ.

The concept is hardly new. Educational programs, such as the Advanced Trauma Life Support® and Advanced Cardiac Life Support programs and the military Combat Casualty Care Course, have used checklists as an instructional expedient for many years.

The CSPS campaign

The CSPS, which the ACS was instrumental in establishing, has partnered with Ariadne Labs at the Harvard School of Public Health to launch and support a coordinated campaign to stimulate the availability and the implementation of crisis checklists. The CSPS is a unique collaborative of seven organizations representing health care professionals who are involved in perioperative care: the ACS, the American Association of Nurse Anesthetists, the American Association of Surgical Physician Assistants, the Association of PeriOperative Registered Nurses, the American Society of Anesthesiologists, the American Society of PeriAnesthesia Nurses, and the Association of Surgical Technologists. The combined membership exceeds 250,000, and the total number of individuals in the seven professions exceeds 2 million.

The CSPS intends to launch a campaign to inform its membership and the surgical community at large of the importance and effectiveness of crisis checklists and of strategies for introducing them into practice. Early experience points to the critical role of a local champion and a multidisciplinary implementation team dedicated to promoting checklist customization and adoption. Ideally, training in the use of crisis checklists would take place in a simulated operating room environment, with or without a formal simulation laboratory. Multidisciplinary staff involvement is an essential component, and so is recognition of local resources, needs, and circumstances.

The CSPS plans to expose all members of the perioperative team to the concept of crisis checklists through advocacy and education on a national level. The idea is to create a framework to implement a multidisciplinary, multi-institutional collaboration. A coordinated message from the seven organizations that comprise the CSPS will support efforts both nationally and locally.

The surgical community has the opportunity to lead in the development, adoption, and implementation of crisis checklists in collaboration with other professionals in the operating room and perioperative area. Checklists offer additional ways to improve patient care and surgical outcomes using a familiar tool. More information will be made available over the next few months.

Web resources for the implementation team are available at www.projectcheck.org and at http://emergencymanual.stanford.edu, or on the CSPS website at http://www.cspsteam.org.

Dr. Dagi is Distinguished Scholar and Professor, The School of Medicine, Dentistry Biomedical Sciences, Queen\'s University Belfast, Northern Ireland; and lecturer, department of global health and social medicine, Harvard Medical School, Boston, MA; Chair, ACS Committee on Perioperative Care; and member, CSPS Board of Directors.

Dr. Healy is Emeritus Gerald B. Healy Chair in Otolaryngology, Children\'s Hospital, Boston; professor of otology and laryngology, Harvard Medical School; ACS Past-President and Past-Chair of the Board of Regents; and member, CSPS Board of Directors.

The American College of Surgeons (ACS) and Commission on Cancer (CoC) on September 4 released separate lists of commonly ordered but not always necessary tests or procedures as part of the Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation.  The list from each of the 30 specialty society Choosing Wisely partners identifies five targeted, evidence-based recommendations for potentially unnecessary and sometimes harmful tests and procedures and that call for conversations between patients and physicians regarding essential care.

The American College of Surgeons’ list set forth the following five recommendations:

Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.

Avoid the routine use of "whole-body" diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.

Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.

Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.

Don’t do computed tomography for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

"These recommendations will help to enhance the patient-surgeon relationship and heighten the quality of care surgical patients receive, which is one of our highest priorities," said David B. Hoyt, MD, FACS, ACS Executive Director.

The Commission on Cancer established the following five recommendations:

Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.

Don’t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.

Don’t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life, or survival.

Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for post-operative pain control and pneumonia prevention.

Don’t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.

"This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians," said David P. Winchester, MD, FACS, Medical Director, ACS Cancer Programs.

The American College of Surgeons (ACS) and Commission on Cancer (CoC) on September 4 released separate lists of commonly ordered but not always necessary tests or procedures as part of the Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation.  The list from each of the 30 specialty society Choosing Wisely partners identifies five targeted, evidence-based recommendations for potentially unnecessary and sometimes harmful tests and procedures and that call for conversations between patients and physicians regarding essential care.

The American College of Surgeons’ list set forth the following five recommendations:

Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.

Avoid the routine use of "whole-body" diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.

Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.

Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.

Don’t do computed tomography for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

"These recommendations will help to enhance the patient-surgeon relationship and heighten the quality of care surgical patients receive, which is one of our highest priorities," said David B. Hoyt, MD, FACS, ACS Executive Director.

The Commission on Cancer established the following five recommendations:

Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.

Don’t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.

Don’t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life, or survival.

Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for post-operative pain control and pneumonia prevention.

Don’t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.

"This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians," said David P. Winchester, MD, FACS, Medical Director, ACS Cancer Programs.

The American College of Surgeons (ACS) and Commission on Cancer (CoC) on September 4 released separate lists of commonly ordered but not always necessary tests or procedures as part of the Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation.  The list from each of the 30 specialty society Choosing Wisely partners identifies five targeted, evidence-based recommendations for potentially unnecessary and sometimes harmful tests and procedures and that call for conversations between patients and physicians regarding essential care.

The American College of Surgeons’ list set forth the following five recommendations:

Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.

Avoid the routine use of "whole-body" diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.

Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.

Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.

Don’t do computed tomography for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

"These recommendations will help to enhance the patient-surgeon relationship and heighten the quality of care surgical patients receive, which is one of our highest priorities," said David B. Hoyt, MD, FACS, ACS Executive Director.

The Commission on Cancer established the following five recommendations:

Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.

Don’t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.

Don’t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life, or survival.

Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for post-operative pain control and pneumonia prevention.

Don’t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.

"This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians," said David P. Winchester, MD, FACS, Medical Director, ACS Cancer Programs.

The American Hospital Association (AHA) presented the Dick Davidson Quality Milestone Award, one of AHA’s top national awards, to hospital collaboratives in Tennessee and Florida participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®). In their nomination entries, the Tennessee Hospital Association (THA) and Florida Hospital Association (FHA) cited their states’ ACS NSQIP results as key quality achievements. THA helps lead the Tennessee Surgical Quality Collaborative (TSQC), the first ACS NSQIP collaborative that is a partnership between a hospital association, health plan, and an ACS local chapter. The 10 Tennessee hospitals participating in TSQC initially reduced complications by 36 percent and saved more than $5 million.. FHA partnered with ACS to create the Florida Surgical Care Initiative (FSCI), based on four ACS NSQIP measures. The 67 hospitals participating in FSCI reduced complications by 14.5 percent and saved $6.67 million in 15 months. Go to the AHA website at http://www.aha.org/about/awards/ davidson/index.shtml for more information about the Davidson Quality Awards.

The American Hospital Association (AHA) presented the Dick Davidson Quality Milestone Award, one of AHA’s top national awards, to hospital collaboratives in Tennessee and Florida participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®). In their nomination entries, the Tennessee Hospital Association (THA) and Florida Hospital Association (FHA) cited their states’ ACS NSQIP results as key quality achievements. THA helps lead the Tennessee Surgical Quality Collaborative (TSQC), the first ACS NSQIP collaborative that is a partnership between a hospital association, health plan, and an ACS local chapter. The 10 Tennessee hospitals participating in TSQC initially reduced complications by 36 percent and saved more than $5 million.. FHA partnered with ACS to create the Florida Surgical Care Initiative (FSCI), based on four ACS NSQIP measures. The 67 hospitals participating in FSCI reduced complications by 14.5 percent and saved $6.67 million in 15 months. Go to the AHA website at http://www.aha.org/about/awards/ davidson/index.shtml for more information about the Davidson Quality Awards.

The American Hospital Association (AHA) presented the Dick Davidson Quality Milestone Award, one of AHA’s top national awards, to hospital collaboratives in Tennessee and Florida participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®). In their nomination entries, the Tennessee Hospital Association (THA) and Florida Hospital Association (FHA) cited their states’ ACS NSQIP results as key quality achievements. THA helps lead the Tennessee Surgical Quality Collaborative (TSQC), the first ACS NSQIP collaborative that is a partnership between a hospital association, health plan, and an ACS local chapter. The 10 Tennessee hospitals participating in TSQC initially reduced complications by 36 percent and saved more than $5 million.. FHA partnered with ACS to create the Florida Surgical Care Initiative (FSCI), based on four ACS NSQIP measures. The 67 hospitals participating in FSCI reduced complications by 14.5 percent and saved $6.67 million in 15 months. Go to the AHA website at http://www.aha.org/about/awards/ davidson/index.shtml for more information about the Davidson Quality Awards.

The National Quality Forum (NQF) has appointed Arden Morris, MD, MPH, FACS, colorectal surgeon and professor of surgery at the University of Michigan, Ann Arbor, to serve on the NQF Consensus Standards Approval Committee (CSAC). For more information on the committee, go to http://www. qualityforum.org/Measuring_Performance/Consensus_Development_Process%E2%80%99s_Principle/Consensus_Standards_Approval_Committee_Decision.aspx. The American College of Surgeons nominated Dr. Morris to serve on the CSAC, which is responsible for reviewing and approving proposed consensus standards and periodically assessing and recommending enhancements to the NQF’s consensus development process. Her term began in July.

The National Quality Forum (NQF) has appointed Arden Morris, MD, MPH, FACS, colorectal surgeon and professor of surgery at the University of Michigan, Ann Arbor, to serve on the NQF Consensus Standards Approval Committee (CSAC). For more information on the committee, go to http://www. qualityforum.org/Measuring_Performance/Consensus_Development_Process%E2%80%99s_Principle/Consensus_Standards_Approval_Committee_Decision.aspx. The American College of Surgeons nominated Dr. Morris to serve on the CSAC, which is responsible for reviewing and approving proposed consensus standards and periodically assessing and recommending enhancements to the NQF’s consensus development process. Her term began in July.

The National Quality Forum (NQF) has appointed Arden Morris, MD, MPH, FACS, colorectal surgeon and professor of surgery at the University of Michigan, Ann Arbor, to serve on the NQF Consensus Standards Approval Committee (CSAC). For more information on the committee, go to http://www. qualityforum.org/Measuring_Performance/Consensus_Development_Process%E2%80%99s_Principle/Consensus_Standards_Approval_Committee_Decision.aspx. The American College of Surgeons nominated Dr. Morris to serve on the CSAC, which is responsible for reviewing and approving proposed consensus standards and periodically assessing and recommending enhancements to the NQF’s consensus development process. Her term began in July.

Online registration is now available for the American College of Surgeons’ (ACS) Surgical Research Committee 11th Clinical Trials Methods Course. The course will take place December 6-10 at ACS Headquarters in Chicago, IL.

The Clinical Trials Methods Course is a five-day intensive course based on four successfully conducted and published clinical trials. The course will provide surgeons concepts and skills in the following areas: design, implementation, and analysis of randomized clinical trials; observational studies; the use of large administrative databases; meta-analysis; funding mechanisms and budget development; outcomes (medical, patient-centered, cost); and dissemination of results. Participants will work in small groups mentored by leading surgeons and biostatisticians with expertise in clinical trials research.

Registration is limited to 50 participants, and ACS members will receive preference. The course is offered only every other year. Access the course website, registration, and additional course details at http://www.facs.org/cqi/src/clintrial.html, or contact Carla Manosalvas at [email protected].

Online registration is now available for the American College of Surgeons’ (ACS) Surgical Research Committee 11th Clinical Trials Methods Course. The course will take place December 6-10 at ACS Headquarters in Chicago, IL.

The Clinical Trials Methods Course is a five-day intensive course based on four successfully conducted and published clinical trials. The course will provide surgeons concepts and skills in the following areas: design, implementation, and analysis of randomized clinical trials; observational studies; the use of large administrative databases; meta-analysis; funding mechanisms and budget development; outcomes (medical, patient-centered, cost); and dissemination of results. Participants will work in small groups mentored by leading surgeons and biostatisticians with expertise in clinical trials research.

Registration is limited to 50 participants, and ACS members will receive preference. The course is offered only every other year. Access the course website, registration, and additional course details at http://www.facs.org/cqi/src/clintrial.html, or contact Carla Manosalvas at [email protected].

Online registration is now available for the American College of Surgeons’ (ACS) Surgical Research Committee 11th Clinical Trials Methods Course. The course will take place December 6-10 at ACS Headquarters in Chicago, IL.

The Clinical Trials Methods Course is a five-day intensive course based on four successfully conducted and published clinical trials. The course will provide surgeons concepts and skills in the following areas: design, implementation, and analysis of randomized clinical trials; observational studies; the use of large administrative databases; meta-analysis; funding mechanisms and budget development; outcomes (medical, patient-centered, cost); and dissemination of results. Participants will work in small groups mentored by leading surgeons and biostatisticians with expertise in clinical trials research.

Registration is limited to 50 participants, and ACS members will receive preference. The course is offered only every other year. Access the course website, registration, and additional course details at http://www.facs.org/cqi/src/clintrial.html, or contact Carla Manosalvas at [email protected].

Through the contributions of Fellows, Chapters, and friends, the American College of Surgeons (ACS) offers faculty research fellowships, effective July 1, 2014, to June 30, 2016, to surgeons entering academic careers in surgery or a surgical specialty. Applications are due November 1, 2013. The fellowship award of $40,000 annually is intended to assist a surgeon in establishing a new and independent research program. Applicants should have demonstrated their potential to work as independent investigators.

The Franklin H. Martin, MD, FACS, Faculty Research Fellowship honors the College’s founder. The C. James Carrico MD, FACS, Faculty Research Fellowship is dedicated to trauma and critical care research. The one-year Louis Argenta, MD, FACS, Faculty Research Fellowship is dedicated to wound care research.

The full requirements and application form are posted on the ACS website at http://www.facs.org/memberservices/acsfaculty.html. Questions may be directed to Kate Early, Scholarships Administrator, at [email protected].

Through the contributions of Fellows, Chapters, and friends, the American College of Surgeons (ACS) offers faculty research fellowships, effective July 1, 2014, to June 30, 2016, to surgeons entering academic careers in surgery or a surgical specialty. Applications are due November 1, 2013. The fellowship award of $40,000 annually is intended to assist a surgeon in establishing a new and independent research program. Applicants should have demonstrated their potential to work as independent investigators.

The Franklin H. Martin, MD, FACS, Faculty Research Fellowship honors the College’s founder. The C. James Carrico MD, FACS, Faculty Research Fellowship is dedicated to trauma and critical care research. The one-year Louis Argenta, MD, FACS, Faculty Research Fellowship is dedicated to wound care research.

The full requirements and application form are posted on the ACS website at http://www.facs.org/memberservices/acsfaculty.html. Questions may be directed to Kate Early, Scholarships Administrator, at [email protected].

Through the contributions of Fellows, Chapters, and friends, the American College of Surgeons (ACS) offers faculty research fellowships, effective July 1, 2014, to June 30, 2016, to surgeons entering academic careers in surgery or a surgical specialty. Applications are due November 1, 2013. The fellowship award of $40,000 annually is intended to assist a surgeon in establishing a new and independent research program. Applicants should have demonstrated their potential to work as independent investigators.

The Franklin H. Martin, MD, FACS, Faculty Research Fellowship honors the College’s founder. The C. James Carrico MD, FACS, Faculty Research Fellowship is dedicated to trauma and critical care research. The one-year Louis Argenta, MD, FACS, Faculty Research Fellowship is dedicated to wound care research.

The full requirements and application form are posted on the ACS website at http://www.facs.org/memberservices/acsfaculty.html. Questions may be directed to Kate Early, Scholarships Administrator, at [email protected].