The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.

Oct. 11, 2009
Oct. 14, 2009
Oct. 15, 2009

Contents:
• Opening Ceremony kicks off Clinical Congress
• Professionalism and the 21st century
• Board of Regents and ACS Officers annual luncheon
• Fellows honored for volunteerism in care of underserved
• Health system reforms are needed, regardless of what government does
• Association of Women Surgeons presents awards
• Medical Student Program provides education, networking opportunities
• Improving education in general surgery
• Surgery: Then and now

Health system reforms are needed, regardless of what government does

Some of the key concerns in the current health care reform debate include rising costs, workforce shortages, and regional variations in care, according to George F. Sheldon, MD, FACS, Director of the American College of Surgeons (ACS) Health Policy Research Institute. Dr. Sheldon, who is also Zack D. Owens Distinguished Professor of Surgery at the University of North Carolina-Chapel Hill, led the panel session, Health Policy 2009: How It May Affect You, on Monday morning.

Addressing these issues will require a total reengineering of the health care system, Glenn D. Steele, Jr., MD, FACS, president and chief executive officer of Geisinger Health System, Danville, PA, said, “It doesn’t matter what happens in Washington.” Regardless of whether Congress passes health care reform legislation this year, the current system is unsustainable and must be overhauled.

Dr. Steele noted that 40 to 45 percent of the care that patients receive in the U.S. either has a neutral or negative effect on their health. Furthermore, “there is no correlation between costs and quality of care in this country.”

Specific problems that must be addressed, Dr. Steele said, include: (1) unjustified geographic and systems-based variations in care; (2) fragmentation in the delivery of care; (3) perverse payment incentives that shift the provider focus toward increased volume rather than improved quality; and (4) patients who play a passive role in their own care. Goals for the next generation of health care in the U.S. include universal access to affordable health care insurance, value-based payment, coordinated care, continued innovation, and the establishment of uniform national goals.

Richard A. Cooper, MD, professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, discussed geographic variations in health care quality and cost. According to Dr. Cooper, dense urban centers and areas of the south that have high concentrations of people living in poverty have the highest levels of spending.

In addition, “The mass of readmissions occurs among poor people,” Dr. Cooper said. “We will never solve the problem [of regional variations in health care spending] until we can say the word ‘poverty’ out loud.”

Dr. Cooper said that if the government chooses to make payment changes based on geographic differences, the nation runs the risk of doing “major harm to the urban poor and others living in areas of poverty. There is a desperate need for strategies that could reduce costs and improve outcomes for the poorest and most disadvantaged patients,” he concluded.

Thomas Ricketts, PhD, MPH, Managing Director of the ACS Health Policy Research Institute and professor, University of North Carolina-Chapel Hill Gillings School of Global Public Health, said that rural states are playing a key role in the health care reform debate. Many of the leading legislators on the Senate Finance Committee, which has developed a health care reform package under the leadership of chairman Max Baucus (D-MT), represent states with large rural populations.

Dr. Ricketts discussed the unique challenges of rural surgery. Rural surgeons tend to be slightly older, and as they retire, fewer young surgeons are stepping in to their shoes. Additionally, rural states have markedly higher rates of mortality due to motor vehicle accidents and other types of trauma. Currently, more than 500 U.S. hospitals have no surgeons on staff, and residents of 925 counties have no local access to surgical care. These counties tend to be small and largely comprise low-income households, Dr. Ricketts added.

Jon Chilingerian, PhD, associate professor of human services management at Bradeis University’s Heller School for Social Policy and Management, Waltham, MA, focused on the managerial and leadership challenges of health care reform. “The old theory of hospital management doesn’t work anymore,” he said. Under this paradigm, hospitals focused providing surgical services because they often brought in the most profits. But in the coming years, payments to health care institutions and professionals will likely be bundled. Consequently, heightened emphasis will be placed on accuracy in coding and improved efficiency.

Health care organizations will need to improve outcomes, provide more coordinated and collaborative care, and reduce variations in quality. Dr. Chilingerian also suggested that institutions “find people with an appetite for change” and who will promote innovative solutions. He encouraged young surgeons to learn about health policy and to develop their leadership and strategic-thinking skills.

Charles D. Mabry, MD, FACS, ACS Regent and a general surgeon in private practice in Pine Bluff, AR, led a brief question-and-answer session at the end of the program.