New Hampshire American College of Surgeons 2002-2003 Chapter Meeting Minutes GOVERNORS REPORT 2003 The number one issue at the board of Governors Meeting in October was the liability crisis and tort reform. The ACS continues to push the problem but admits progress is slow. The California type bill HR 5 Help Efficient Accessible Low-cost Timely Healthcare (HEALTH) passed the House but stalled and is essentially dead in the Senate. The feeling is the battle needs to be fought on both the national and state levels. The primary message Fellows need to get out is that the liability problem leads to medical access issues as have already occurred in several states. The College will distribute information to members for patient distribution. They have also developed TV spots on the issue but have yet to decide how aggressively to air these. The next major concern is reimbursement. The proposed Medicare 4% cut is being lobbied extensively in Congress. The College is also trying to address the sustainable growth rate factor that Medicare uses in its calculations. The 80 hour work week rule is now in force and continues to generate a lot of discussion. Training programs are required to abide by it in order to be accredited and are living with the changes. There are attempts to adjust some of the provisions. The ACS is quite worried that the federal government will step in and actually legislate physician work hours as some European countries have. A major push in on to avoid this. At the moment none of this applies to practicing physicians, but the ultimate extension is clearly visible. Patient safety is a very high concern at the College. The main area of focus now is ambulatory center and especially office based surgery. The oversight here varies greatly across the country and in some places is almost non-existent. The ACS has a draft proposal “Patient Safety Principle for Office-Based Surgery utilizing moderate sedation/analgesia, deep sedation/analgesia or general anesthesia” that has also been approved by the AMA and 22 other medical organizations. The plan is for this document to serve as a standard to be used by state licensing boards in monitoring procedures. The ten core principles are sound and are what any good office/facility is already doing, but will establish standards that can be used to stop questionable patient care at marginal facilities. Chapter activities are variable across North America. Some are questioning the place of the chapter in today’s busy practice setting, but from the chapter through the Governor is how the College gets a great deal of its information. More data exchange needs to be done electronically. I remind all of our New Hampshire web site www.nhacs.org that was one of the first. The College will be updating its web site making it easier to navigate over the next year as medicine becomes more electronic. They will be adding PDA tools including practice management help. There is also a strong push to establish a broad outcome database. This would include a hand held surgery log in our PDA that could then interface with the College web site. The data would be blinded, but clearly has the ability to establish a broad array of outcome information that would be more realistic than a few university based studies. The “Giving Back” program has become quite successful. There is a great deal of volunteerism that Fellows perform and the College wishes to continue to support and encourage same. There will soon be a link from www.facs.org to a site called giving back. This will list a variety of volunteer opportunities, both local and worldwide including short and long term commitments that are available to surgeons. The Board of Governors added three more Regents at the adjourned meeting on Wednesday. The only designation on the Board of Regents is the requirement that two Regents be Canadian. However, the three new positions were created with an understanding to broaden the make up and included a Pediatric, a Vascular, and a Colo-rectal Surgeon. Roger A. Evans, M.D., FACS Governor's Report 2002 50th ANNIVERSARY of New Hampshire Chapter Charter Presented at Concord : 11/13/02 To: New Hampshire Chapter From: Roger A. Evans, M.D. F.A.C.S. NH ACS Governor( see Officer's page for email address) Subject: Governors Report The Board of Governors met in conjunction with The Clinical Congress. This consists of committee meetings Saturday afternoon, the full Board all day Sunday and the short “adjourned session” for elections and an open forum on Wednesday. I will try to cover the highlights briefly for you. The Board of Regents will add three more members to go to 22. Although the only “assigned seats” are at least two for Canadians, this will allow a bit of a broader representation of subspecialties. The reorganization of the College into four divisions is complete and the biggest change in the ACS in decades. There is a new 501 C 6 corporation. It will be seamless to members but the American College of Surgeons Professional Association is now the parent body with the ACS and a separate PAC entities under it. This allows College to more aggressively represent fellows but makes $17 of our dues not tax deductible. No dues sent to the College or PA goes to the Political Action Committee. Contributions to this body must be separate and from individuals not physician groups. The items of concern to members as brought forth to The Board of Governors in our reports reflect little change from last year. Physician reimbursement continues to be the biggest issue. The ACS is working to roll back the further cuts in Medicare planned for the next few years and to reform a flawed physician payment formula. Malpractice insurance is rapidly becoming a huge problem. Other states are much worse off than New Hampshire and if we can’t get tort reform with “caps" a la California we will really have a national crisis. It was stressed that we need to get the message to members of Congress when they are back home election time that it is the patients and government, via Medicare, that ultimately pay for this. Because of the large number of insurance carriers that have pulled out of the market the ACS has founded The Doctors Company, an insurance company that can write malpractice policies for fellows in any state. Physician work force issues moved to the forefront this year. There has clearly been a down turn in Medical Students seeking surgical programs and some residencies have gone unfilled. We discussed at great length the 80 hour work week. This is now a requirement of the American College of Graduate Medical Education. There is agreement we have to streamline Residents education but many surgeons feel there are certain situations where this may counterproductive. There is concern about teaching surgeons their responsibility for the continuity of care. Another question raised is will this rule by extension somehow encompass surgeons in practice. The ACS is suffering from some financial pressures as we all are. The Colleges does use 5% of endowment to fund operations each year. In spite of this with the market downturn and such a significant deficit is projected for 2003. The dues increase for last year that was delayed will go into effect, however a proposed inflation adjustment for future years was defeated by the Governors. Highlights from the committees include a concern about the various settings in which ambulatory surgery is preformed. Therefore, a course will be added at next years Congress on Patient Safety in The Ambulatory Setting. This will be multidisciplinary and include the surgeons responsibility for the anesthesia/anesthetist . There were no documented cases of HIV transmission to a health care worker last year but 4 cases of hepatitis C from surgeon to patient in the last few years. We need to continue to practice all precautions regularly. The committee on physician heath did a significant presentation on physician competency and especially physician aging. No easy answers on any of these or how to best measure them, but we all need to be aware of these issue both personally as well as colleagues. The impaired physician is frequently the disruptive physician and he/she needs to be addressed quickly. If this behavior is tolerated or covered up It will only get worse and lead to a bigger crisis. We all agreed that alcohol or other substance abuse are situations that cannot be tolerated but the Board defeated a proposal that the College support mandatory random drug testing of surgeons. Membership in the College is probably declining. The ACS needs to look for ways to attract all competent surgeons and especially minority and young surgeons. The ACS also needs to continue to search for ways to better answer the needs of both general surgeons and surgical specialists. I would be glad to hear from fellows with ideas on any of these issues.