New Hampshire American College of Surgeons 2000-2001 Chapter Meeting Minutes New Hampshire Chapter American College of Surgeons Minutes of the Executive Council Meeting December 5, 2001 The Executive Council of the New Hampshire Chapter of the American College of Surgeons met on the evening of Wednesday, December 5, 2002. Governor Evans, President Tilney, Vice President Lambert, Secretary-Treasurer Eberly, and Councilors Wilmot and Howe were in attendance. Roger Evans reported on the Board of Governors’ meeting at the Clinical Congress in New Orleans. The Governors applauded the College’s efforts in representing surgeons’ interests in reimbursement and coding issues with Medicare and Managed care. The College continues to expand its educational services spanning all aspects of professional growth; clinical courses, written and electronic communication, practice management seminars, credentialling and certification guidelines. Several members of the NH Executive Council have attended the College’s Coding Seminar and strongly endorse it as a very beneficial program. Bob Lambert reported on the Annual Meeting of the Commission on Cancer. Alfred Cohen, M.D. FACS, the new Chair of the Commission, has outlined strategic initiatives to enhance the National Cancer Data Bank by expanding the Liaison Program and facilitating reporting, focusing on quality outcomes. Work is in progress to develop interactive Website access for local cancer liaisons and groups. Clare Wilmot discussed the changing paradigm of rural trauma care. As Emergency Room physicians and Emergency Medical Systems have become more proficient in diagnosing, triaging, transporting and treating trauma victims, the primary role of the general surgeon at small rural hospitals overseeing trauma care has diminished. Yet, the demands for trauma call coverage continue to escalate as the number of surgeons serving rural areas decreases. To help address these issues at the national level, the Executive Committee has requested the Committee on Trauma consider Paul Kispert, M.D. to serve as New Hampshire Chapter’s representative. The Medical Review Subcommittee of the New Hampshire Board of Medicine is seeking surgical representation through our Chapter. The Subcommittee meets in Concord in the afternoon of the third Thursday of each month. Any Fellow interested in serving the Board’s review process is asked to contact the Executive Council. Bob Tilney and Bob Lambert have agreed to share the commitment of serving as the NH-ACS Council of the New Hampshire Medical Society. This should assure representation at the bimonthly meeting of the Society Council members. In the spring, 2002 – late April or early May, we will have our Annual meeting commemorating the 50th Anniversary of the New Hampshire Chapter. In recognition, the College will present a Commemorative Charter, perhaps by Dr. Russell, Executive Director. Meeting venue is in evolution and the Executive Council welcomes any input from Chapter members. Respectfully submitted, Donald A. Eberly, M.D., FACS GOVERNOR'S REPORT 2001 The Board of Governors met at the Clinical Congress in New Orleans in early October. As this was not long after the events of September 11, 2001 quite a bit of discussion revolved around the response of the College. The action was quick, both from Chicago with offers trauma expertise, and multiple offers of help in varied ways from individual members. There was an immediate update at the Congress on terrorism preparedness and plans for further information to be distributed to the fellows in the near future. The “Strategic Plan for 2001 and Beyond” was discussed at some length. This was published in the September Bulletin and available to all Fellows . The primary changes involve reorganizing the College into four areas, Education, Research and Optimal Patient Care, Advocacy and Health Policy, and Member Services. I think this should streamline some of the functions and is viewed as a work in progress with other changes likely. The college finances are reasonablely good even with a major loss in the endowment as one would expect. Part of the new program will allocate 5% of the endowment income to expenses annually. Contrary to two years ago we did approve, rather overwhelmingly, the first dues increase in about 11 years from $375 to $440. Note: This was approved by the Board of Regents at its meeting in New Orleans but they then later delayed it for another year because of the terrorism, economy and medicare cuts. The summary of the Reports of the Chapter Governors is as follows. We commended the College in several areas including: education especially hands on courses, Journal of the College of Surgeons (JACS), web communication, and the Chapter visit program in DC. The College is emphasizing the “giving back” program with many example of community benefit by surgeons and chapters. The primary concerns and recommendations of the Governors were the following: 1. Physician reimbursement, Medicare, assistants at surgery, Managed care organizations, etc. - The college will work on prompt payment issues, EMTALA concerns and problems with “on call panels”. They also continue to work on coding issues and have been successful in upgrading a variety if them. 2. Professional liability, malpractice and tort reform - This is an escalating problem again and little headway has been made. 3. Graduate medical education, funding and work force issues - There is concern that surgery is not as ‘glamorous” as once viewed and that we need to mentor students to continue to attract the cream of the medical school crop. The college will continue to try and improve education efficiency and practice efficiency to facilitate this. 4. Credentialing, new technology and hospital privileges - Will continue hands on courses and leadership in examining new technology and monitor recertification by the various boards. This is a major concern in ambulatory centers where regulations, if they exist at all, vary enormously. The highlights of the various committee reports include the Bloodborne infection and Environmental risk. They urge continued care to keep problems low and again reported no documented cases of surgeon to patient HIV infection. Given the terrorism concerns they are meeting jointly with the Trauma committee. Chapter activities vary greatly with no formula that will work in all areas. I remind all that New Hampshire is one of 34 with a web site. Physician health and competency are major concerns including worries about the “hassle” factor in practice. The college was urged to help out here as best as it could. We had an afternoon session on Re-engineering the Distribution of Surgical Care. There was no unanimity of the presenters, or Governors and we considered things as varied as the Leapfrog Report (Corporate plans to use only “qualified hospitals”) partly based on volume requirements, the Veterans Administration Quality Improvement plan, and care for the urban poor and rural patients. I think the Governors are making a contribution to the College and to practicing surgeons. I urge fellows to contact me with concerns as I believe The Board of Regents and the staff are listening significantly more than in the past. Also please also let me know of examples of surgeons giving back so we can continue to document these activities. Roger A. Evans, M.D., FACS ANNUAL MEETING June 27th, 2001 MINUTES OF MEETING: JUNE 27, 2001 The meeting was called to order after the Dartmouth-Hitchcock Medical Center CME program and during the luncheon. The minutes of the August 23, 2000 meeting were distributed, even though those minutes are on the New Hampshire ACS web site and those minutes were anticipated. It is noted that Dr. Eberly was unavailable for this meeting however, his report was read and I have recognized that there are 208 active surgeons in the New Hampshire Chapter of the College and over half are paying dues to the state chapter. The current treasury balance is $6772.98. Our expenses are $35 per month for web site support and annual meeting costs and travel expenses to members who attend the officer's meetings, which adds up to about $5000 per year. It was moved, seconded and passed to keep the dues at $50 per year. For the Governor-At-Large, Roger Evans was re-nominated for a second three year term and Governor Evans gave his report, which will be published on the web site. Kenneth Howe's nomination for Counselor, to replace Nicola J. Miragliuolo, was moved, seconded and passed for that position. It was moved, seconded and passed that Robert Lambert as Vice President of the the Chapter be asked to attend the meeting of the New Hampshire Medical Society. The meeting is on September 8th from 8AM-12PM for the House of Delegates at the Concord Hospital. It was recognized that Clare Wilmot is doing a great job on our web site and is trying to add names of new physicians and telephone numbers of their offices, if possible. It appeared that the membership did not want their e-mail addresses placed on this web site. Clare Wilmot was then nominated and elected to fill the position of the Chairman of the Committee on Trauma, since she has also been nominated to the New Hampshire EMS Coordinating Board and this would thereby coordinate the College trauma activities and New Hampshire EMS activities at the same time. In addition, we need five other physicians to fill openings on the Applicant to Fellowship Committee. Doctors who volunteered included Dr. Robert Zwolak from Dartmouth-Hitchcock, Dr. Ann Looseman from Bedford and Dr. Christopher Glenney from Berlin. We still need two other physicians and Dr. Evans is going to look for two other subspecialty physicians to fill those positions. Further discussion was held as to whether or not we should have a Fall meeting and if we should have one, where it should be. It was recommended that we would try to have a Fall meeting in Concord, being more centrally located, however, since there are no Concord physicians at the time of this meeting, there could be no local comment relative to that. Consequently, we will ask Dr. Sutton to discuss this with physicians at Concord Hospital and see if they are interested. It was also announced that Paul Kispert, M.D. has taken over the ATLS course from Ken Burchard at Dartmouth-Hitchcock and is looking for physicians to help instruct that course if he can add more courses to their schedule. Dr. Lambert's report from the leadership conference in Chicago was also read and accepted. No Commission on Cancer report was available. There being no further business, the meeting was adjourned. Respectfully Submitted, Robert Tilney, III, M.D. President New Hampshire Chapter, ACS RWT/amw re-typed msh /Dr. Wilmot's manager MINUTES EXECUTIVE COUNCIL MEETING January 17, 2001 The Executive Council of the New Hampshire Chapter of the American College of Surgeons met on the evening of Wednesday, January 17, 2001. Members present included; President Sutton, Vice president Tilney, Secretary/Treasurer Eberly, Councilors Wilmot and Lambert and Governor Evans. The treasurer reviewed the financial status of the chapter. We currently have $5162.37 in our account. Our membership base is fairly stable at 269 Fellows of whom 105 are retired and not subject to membership dues. Expenses have climbed somewhat over the past few years, primarily reimbursing costs for representation at national committee meetings, Young Surgeons, Officers’ Seminar, Committee on Trauma and the Board of Governors meetings. Service for our Web site is an additional expense. After review of the budget, the Council approved the treasurer’s recommendation to increase annual dues to $50.00. Thanks to Clare Wilmot, MD, FACS, our Chapter Webmaster, an application for membership and dues form can be printed from our Website – http://www.nhacs.org./. The Council discussed Fellow representation and participation in both state and national ACS activities. Mark Elias, MD, FACS of Rochester has accepted our nomination to attend the Young Surgeons Meeting in Chicago this spring and Robert Lambert, MD, FACS will attend the Officers’ meeting. We reviewed the roster of members for consideration of leadership roles within the Chapter and encourage input from any interested Fellows. The Executive Council has several vacancies: we seek two Councilors as Nick Miragliulo, MD, FACS has completed his term and Robert Lambert, MD, FACS will be moving up to serve as Vice-President, the Chapter’s Committee on Applicants has several openings and the Chapter lacks a representative to the College’s Committee on Trauma. Roger Evans, MD, FACS presented his report of the Board of Governors meeting held during the fall Clinical Congress (the full text is reprinted on the NH ACS Website). The College continues to represent our interests in the ongoing struggles with Medicare regulation and reimbursement, malpractice and tort reform and issues surrounding training and certification. The position of Regent-at-Large for the College remains unfilled and our Governor has resubmitted New Hampshire’s nominee, Warren Emely, MD, FACS. Holding our Annual Chapter meeting in conjunction with an educational session sponsored by DHMC Department of Surgery has met with favorable comments and success: all seem interested in continuing the relationship. To try to shorten the day, we may follow the lead of the State Medical Society by holding the Chapter business meeting in the morning or during the luncheon. John Sutton, MD, FACS will act as liaison with the Chapter to make arrangements for a late spring or early summer date. We also discussed future plans for holding a mid-winter educational/recreational meeting in the North Country or a summer session at the Seacoast. A logistical issue where the NH ACS might exert some influence is to clarify and hopefully expedite the certification process our hospitals face to perform isotope directed sentinel node biopsy. The Council will work with the NH Sate Physicist to help standardize the process. As a final order of business and after numerous previous failed attempts, John Sutton, MD, FACS successfully passed the gavel of Presidency of the Chapter to Robert Tilney, MD, FACS. Our heartfelt thanks go to John for his extended commitment and leadership. Respectfully submitted, Donald A. Eberly, MD, FACS GOVERNOR'S REPORT 2000 To: New Hampshire Chapter From: Roger A. Evans, MD, FACS The 2000 Board of Governors met in Chicago in conjunction with The Clinical Congress. This consists of an all day meeting Sunday and an "adjourned meeting" Wednesday morning. This later session is to elect members to the Board of Regents and a free floating open forum. This year there was a very frank exchange of concerns. There were many, but two major ones are how to meaningful to both General Surgery (46% of the Fellows) and the various other specialties and how to address the fragmentation of General Surgery itself. The American College of Surgeons is alive and active. Dr Thomas R. Russell has been Executive Director for nearly a year now. There is a new Mission Statement, published in full in the August Bulletin, that stresses Quality, Education, Research, Service and Advocacy for all. They are going through the ubiquitous Strategic Planning Review. This will include survey data from some specific and random Fellows as well as all Governors. The bulk of items that the college deals with come from the input that the members give through the annual reports we Governors submit. This year there were 228 reports to the board from 131 domestic chapters, 29 foreign chapters and 68 specialty societies. This obviously encompasses an eclectic group and various ideas are brought forth. However, many of the concerns are similar and the recurring themes are preferentially addressed. Physician Reimbursement has been the number one item for several years. This is a broad category including problems with Medicare, HMO's and assistants at surgery. The College has help with coding courses (it is sad but it really has come to be necessary for docs to understand this) and soon this should be on line. They will continue with the ongoing dialogues with Medicare and other payors as before. There is no perfect answer here but a lot of energy is spent on these problems. Graduate Medical Education funding is an issue. Some Academic Medical Centers are really feeling the crunch and some have concerns with various state laws that limit residents hours on call. Professional Liability, Malpractice and Tort Reform are perennials on the list and the College is doing no better than other organization with help in this arena. The whole area of New technology, Credentialing and Peer Review is becoming a major interest area for the Fellows. The College was complimented for projects like the sentinel node biopsy program. Further suggestions include more courses on a regional basis and support for development of privilege guidelines for institutions. They are even questioning whether the Clinical Congress is a good forum for Fellow education and if not what other or others might be better. There were other items of information. The College now sends the Journal of the American College of Surgeons to all members. The new transition "Associate Group" (those just entering practice) has been very well received. There was discussion about the $20 fee for the Candidate Group. Some feel this should be eliminated and all residents in an approved program be members to get them familiar with the College. The ACS remains in good financial condition and no dues increase was suggested this year The College continues to review "manpower" needs in surgery. Board recertification is undergoing extensive review by the ACS and many Boards. There is a lot of concern that the written exam is not a one size fits all even in various specialties as practice patterns vary widely. No one yet has a good answer for the hands on skill part that has so far been ignored. Sunday afternoon was devoted to a session entitled Error Reduction and Testing Physician Competency: Why? What? How? The highlight presentation was William C. Nugent, MD, FACS of Dartmouth-Hitchcock Medical Center showing the northern New England cardiovascular data. This continues to be the premier example of how surgeons sharing information can and do significantly improve patient care. I urge all New Hampshire Fellows to contact me with any concerns they wish the College to address. I think all Fellows should be sure the are electronically connected to the College by logging on at http://www.facs.org. This will get you a weekly newsletter on ACS activity. We also have a chapter site at http://www.nhacs.org for exchange of ideas. We thank Clare Wilmot, MD, FACS for maintaining this site. REPORT ON ANNUAL MEETING: HANOVER INN, HANOVER, NH 23rd AUGUST 2000 President Dr John Sutton addressed the membership at dinner following a full day of SURGICAL LECTURES at the Dartmouth Medical Centre Hospital. Governor Dr Roger A. Evans reported on the October 1999 Governors meeting in San Francisco. (1) Managed Care Organisations and Physician reimbursement (2) Medicare/Medicaid Reimbursements (3) Professional Liability (4) Graduate Medical Education Funding (5) Credentialing for new Technologies (6) Program for Residents and Associate Fellows (7) Encouraging Women and Minorities to join the College (8) HIV and Universal precautions especially in OR (9) Kept dues at $375 for Fellows (10) Computers entering all aspects of medicine; NH is one of early chapters to have a web site. v MINUTES of EXECUTIVE COUNCIL MEETING March 17, 2000 The Executive Council of the New Hampshire Chapter of the American College of Surgeons met at the Centennial Inn in Concord, NH on the evening of March 17, 2000. In spite of a late Winter storm, all members were able to attend: President Sutton, Vice-President Tilney, Secretary Eberly, Governor Evans, Councilors Wilmot, Miragliuolo, and Lambert, and Committee on Trauma representative Burchard. The Treasurer reported a current balance of $3276.61 and advised the dues structure for the year 2000 to remain at $40.00. The recommendation was approved. Dr Burchard reported on the ACS Committee on Trauma meeting in Reno March 9-11, 2000. He noted that the College is moving beyond the verification process for designating Trauma Center levels and encouraging the evolution of Trauma Systems. This is consistent with the activity of the New Hampshire State Trauma Review Committee and the suggestion that we might form a Northern New England Cooperative Group much like the Cardiovascular Group to study the delivery of trauma care in the rural setting. Dr. Evans reported on the Fall meeting of the Board of Governors noting that the College is quite concerned about the long term effects reducing reimbursement for major surgical procedures will have, possibly limiting availability and utilization. He also pointed out that the Governors still carry weight with the Regents by dissuading them from raising annual dues. The Council has asked Michael Remar, M.D. of Nashua to attend the Young Surgeons’ Meeting in April and Donald Eberly, M.D. of New London to attend the Officers’ Meeting in May. Several Fellows of the New Hampshire Chapter are under consideration for nomination to fill vacancies in the ACS Regent-at-Large seats. Joining a one day educational session with the NH-ACS Annual meeting has met with success and approval over the past two years. Dr. Sutton has spoken with Dr. Dow, Chairman of the Department of Surgery at DHMC about a venue for 2000 similar to that of 1999. With current time constraints and the possibility of introducing new staff members who will be joining the Department this summer, we agreed that the annual meeting might be deferred until late August or early September – any suggestions for format, topics or case presentations would be welcomed. Contact John Sutton at John.E.Sutton.Jr@Hitchcock.ORG or Donald.Eberly@nlh.crhc.org. More information will be forthcoming. Respectively submitted, Donald A. Eberly, M.D., FACS NH-ACS Secy/Treas