Society News

More than 95 cents of every dollar raised by the CHEST Foundation goes toward advancing our mission-based programming, ranging from clinical research grants, to global and local community service projects, to patient education and disease awareness campaigns.
 

DONATIONS BY THE NUMBERS in 2017

300% INCREASE

A gift at any level SUPPORTS these EFFORTS.

$100

provides four asthma training sessions for a community-based asthma educator.

$10,000

can fund clinical research that leads to advances in the diagnosis and treatment of obstructive sleep apnea in women.

$15,000

supports a lung health screening event for an underserved population at higher risk for COPD and other lung ailments.

$25,000

can help fund research investigating the factors that contribute to racial disparities in early palliative care among elderly patients with lung cancer.

Learn more and donate foundation.chestnet.org.

More than 95 cents of every dollar raised by the CHEST Foundation goes toward advancing our mission-based programming, ranging from clinical research grants, to global and local community service projects, to patient education and disease awareness campaigns.
 

DONATIONS BY THE NUMBERS in 2017

300% INCREASE

A gift at any level SUPPORTS these EFFORTS.

$100

provides four asthma training sessions for a community-based asthma educator.

$10,000

can fund clinical research that leads to advances in the diagnosis and treatment of obstructive sleep apnea in women.

$15,000

supports a lung health screening event for an underserved population at higher risk for COPD and other lung ailments.

$25,000

can help fund research investigating the factors that contribute to racial disparities in early palliative care among elderly patients with lung cancer.

Learn more and donate foundation.chestnet.org.

More than 95 cents of every dollar raised by the CHEST Foundation goes toward advancing our mission-based programming, ranging from clinical research grants, to global and local community service projects, to patient education and disease awareness campaigns.
 

DONATIONS BY THE NUMBERS in 2017

300% INCREASE

A gift at any level SUPPORTS these EFFORTS.

$100

provides four asthma training sessions for a community-based asthma educator.

$10,000

can fund clinical research that leads to advances in the diagnosis and treatment of obstructive sleep apnea in women.

$15,000

supports a lung health screening event for an underserved population at higher risk for COPD and other lung ailments.

$25,000

can help fund research investigating the factors that contribute to racial disparities in early palliative care among elderly patients with lung cancer.

Learn more and donate foundation.chestnet.org.

W. Gerald Rainer, MD, FCCP, died November 14, 2017, one day after his 90th birthday Dr. Rainer was President of the American College of Chest Physicians in 1982-1983. He practiced thoracic and cardiovascular surgery for 50 years with St. Joseph Hospital in Denver as his professional home. He was a respected leader, researcher, and educator, helping and mentoring countless residents, fellows, and many other health-care professionals. Dr. Rainer was a distinguished clinical professor of surgery at the University of Colorado School of Medicine and served on many University boards and committees. He published prolifically in many respected surgical journals and was able to masterfully blend his private practice with strong academic involvement. As President of the American College of Chest Physicians and many other respected medical and surgical organizations, he was also actively involved in international professional societies. CHEST extends its condolences to Dr. Rainer’s wife of 67 years, Lois, and to his family and friends.

W. Gerald Rainer, MD, FCCP, died November 14, 2017, one day after his 90th birthday Dr. Rainer was President of the American College of Chest Physicians in 1982-1983. He practiced thoracic and cardiovascular surgery for 50 years with St. Joseph Hospital in Denver as his professional home. He was a respected leader, researcher, and educator, helping and mentoring countless residents, fellows, and many other health-care professionals. Dr. Rainer was a distinguished clinical professor of surgery at the University of Colorado School of Medicine and served on many University boards and committees. He published prolifically in many respected surgical journals and was able to masterfully blend his private practice with strong academic involvement. As President of the American College of Chest Physicians and many other respected medical and surgical organizations, he was also actively involved in international professional societies. CHEST extends its condolences to Dr. Rainer’s wife of 67 years, Lois, and to his family and friends.

W. Gerald Rainer, MD, FCCP, died November 14, 2017, one day after his 90th birthday Dr. Rainer was President of the American College of Chest Physicians in 1982-1983. He practiced thoracic and cardiovascular surgery for 50 years with St. Joseph Hospital in Denver as his professional home. He was a respected leader, researcher, and educator, helping and mentoring countless residents, fellows, and many other health-care professionals. Dr. Rainer was a distinguished clinical professor of surgery at the University of Colorado School of Medicine and served on many University boards and committees. He published prolifically in many respected surgical journals and was able to masterfully blend his private practice with strong academic involvement. As President of the American College of Chest Physicians and many other respected medical and surgical organizations, he was also actively involved in international professional societies. CHEST extends its condolences to Dr. Rainer’s wife of 67 years, Lois, and to his family and friends.

Original Research

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes. By Dr. C. P. Upchurch, et al.

Commentary

CHEST: Home of the Clinician-Educator. By Dr. W. F. Kelly and Dr. A. S. Niven, on behalf of the CHEST Education Committee.

Original Research

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes. By Dr. C. P. Upchurch, et al.

Commentary

CHEST: Home of the Clinician-Educator. By Dr. W. F. Kelly and Dr. A. S. Niven, on behalf of the CHEST Education Committee.

Original Research

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes. By Dr. C. P. Upchurch, et al.

Commentary

CHEST: Home of the Clinician-Educator. By Dr. W. F. Kelly and Dr. A. S. Niven, on behalf of the CHEST Education Committee.

Eileen Metzger Bulger, MD, FACS, chief of trauma and trauma medical director for adults and pediatrics, Harborview Medical Center, Seattle, WA, begins serving as the new Chair of the American College of Surgeons (ACS) Committee on Trauma (COT) this month. Dr. Bulger was appointed as the next COT Chair in October 2017 by the ACS Board of Regents. She is the 20th Chair of the COT, succeeding Ronald M. Stewart, MD, FACS, of San Antonio, TX.

“We look forward to Dr. Bulger’s exceptional vision and leadership as she directs the COT into its 96th year of working to improve the care of the injured patient. She is the perfect person to lead the COT into its next century of transforming care and reducing injuries across the globe,” Dr. Stewart said.

A diplomate of the American Board of Surgery, Dr. Bulger also is board certified in surgical critical care. She earned a medical doctorate at Cornell University Medical College, New York, NY (1992). She completed a residency in general surgery at the University of Washington (UW), Seattle (1992–1999), where she concurrently completed a two-year National Institutes of Health Trauma Research Fellowship during her years of residency training (1995–1997), and then went on to complete a surgical critical care fellowship at UW in 2000.
 

Recognized leadership

Throughout her career, Dr. Bulger has mentored many surgical residents in paper and scholarship competitions. For nearly two decades, she has served as the co-principal or principal investigator of a variety of innovative, grant-funded research projects related to trauma care, some of which focus on improving outcomes for crash injury victims, pediatric patients, and older adults.

Since her initial involvement with the COT in 2002, Dr. Bulger has contributed to many COT activities, often serving in a leadership role. She is a Course Instructor for the internationally recognized Advanced Trauma Life Support® (ATLS®) program, and she served as the COT Washington State Chair (2003–2006); Region X Chief (2006–2012); Chair of the Emergency Medical Services Committee (2011–2015); Chair of the Membership Committee (2014–2017); and Executive Committee member (2014–2017).

The COT is dedicated to all phases of injury care, from prevention to rehabilitation. The committee is supported by a network of 65 state and provincial committees, 11 international committees, and five military committees, and the majority of members are ACS Fellows.

Eileen Metzger Bulger, MD, FACS, chief of trauma and trauma medical director for adults and pediatrics, Harborview Medical Center, Seattle, WA, begins serving as the new Chair of the American College of Surgeons (ACS) Committee on Trauma (COT) this month. Dr. Bulger was appointed as the next COT Chair in October 2017 by the ACS Board of Regents. She is the 20th Chair of the COT, succeeding Ronald M. Stewart, MD, FACS, of San Antonio, TX.

“We look forward to Dr. Bulger’s exceptional vision and leadership as she directs the COT into its 96th year of working to improve the care of the injured patient. She is the perfect person to lead the COT into its next century of transforming care and reducing injuries across the globe,” Dr. Stewart said.

A diplomate of the American Board of Surgery, Dr. Bulger also is board certified in surgical critical care. She earned a medical doctorate at Cornell University Medical College, New York, NY (1992). She completed a residency in general surgery at the University of Washington (UW), Seattle (1992–1999), where she concurrently completed a two-year National Institutes of Health Trauma Research Fellowship during her years of residency training (1995–1997), and then went on to complete a surgical critical care fellowship at UW in 2000.
 

Recognized leadership

Throughout her career, Dr. Bulger has mentored many surgical residents in paper and scholarship competitions. For nearly two decades, she has served as the co-principal or principal investigator of a variety of innovative, grant-funded research projects related to trauma care, some of which focus on improving outcomes for crash injury victims, pediatric patients, and older adults.

Since her initial involvement with the COT in 2002, Dr. Bulger has contributed to many COT activities, often serving in a leadership role. She is a Course Instructor for the internationally recognized Advanced Trauma Life Support® (ATLS®) program, and she served as the COT Washington State Chair (2003–2006); Region X Chief (2006–2012); Chair of the Emergency Medical Services Committee (2011–2015); Chair of the Membership Committee (2014–2017); and Executive Committee member (2014–2017).

The COT is dedicated to all phases of injury care, from prevention to rehabilitation. The committee is supported by a network of 65 state and provincial committees, 11 international committees, and five military committees, and the majority of members are ACS Fellows.

Eileen Metzger Bulger, MD, FACS, chief of trauma and trauma medical director for adults and pediatrics, Harborview Medical Center, Seattle, WA, begins serving as the new Chair of the American College of Surgeons (ACS) Committee on Trauma (COT) this month. Dr. Bulger was appointed as the next COT Chair in October 2017 by the ACS Board of Regents. She is the 20th Chair of the COT, succeeding Ronald M. Stewart, MD, FACS, of San Antonio, TX.

“We look forward to Dr. Bulger’s exceptional vision and leadership as she directs the COT into its 96th year of working to improve the care of the injured patient. She is the perfect person to lead the COT into its next century of transforming care and reducing injuries across the globe,” Dr. Stewart said.

A diplomate of the American Board of Surgery, Dr. Bulger also is board certified in surgical critical care. She earned a medical doctorate at Cornell University Medical College, New York, NY (1992). She completed a residency in general surgery at the University of Washington (UW), Seattle (1992–1999), where she concurrently completed a two-year National Institutes of Health Trauma Research Fellowship during her years of residency training (1995–1997), and then went on to complete a surgical critical care fellowship at UW in 2000.
 

Recognized leadership

Throughout her career, Dr. Bulger has mentored many surgical residents in paper and scholarship competitions. For nearly two decades, she has served as the co-principal or principal investigator of a variety of innovative, grant-funded research projects related to trauma care, some of which focus on improving outcomes for crash injury victims, pediatric patients, and older adults.

Since her initial involvement with the COT in 2002, Dr. Bulger has contributed to many COT activities, often serving in a leadership role. She is a Course Instructor for the internationally recognized Advanced Trauma Life Support® (ATLS®) program, and she served as the COT Washington State Chair (2003–2006); Region X Chief (2006–2012); Chair of the Emergency Medical Services Committee (2011–2015); Chair of the Membership Committee (2014–2017); and Executive Committee member (2014–2017).

The COT is dedicated to all phases of injury care, from prevention to rehabilitation. The committee is supported by a network of 65 state and provincial committees, 11 international committees, and five military committees, and the majority of members are ACS Fellows.

On February 9, Congress passed and President Trump signed into law the Bipartisan Budget Act of 2018. The law addresses many key physician and patient issues, including important technical corrections to the Merit-based Incentive Payment System (MIPS) that the American College of Surgeons (ACS) strongly favors.

The law addresses several other ACS priorities, including:

The addition of a long-term funding extension (10 years) for the Children’s Health Insurance Program (CHIP), ensuring that children continue to have access to surgical care

The inclusion of language that eases electronic health record system meaningful use requirements, alleviating some of the burdens imposed on physicians and their practices

Additional funding to address the opioid epidemic and to support the work of the National Institutes of Health Repeal of the Independent Payment Advisory Board

For more information, contact Mark Lukaszewski, ACS Congressional Lobbyist, at [email protected].






 

On February 9, Congress passed and President Trump signed into law the Bipartisan Budget Act of 2018. The law addresses many key physician and patient issues, including important technical corrections to the Merit-based Incentive Payment System (MIPS) that the American College of Surgeons (ACS) strongly favors.

The law addresses several other ACS priorities, including:

The addition of a long-term funding extension (10 years) for the Children’s Health Insurance Program (CHIP), ensuring that children continue to have access to surgical care

The inclusion of language that eases electronic health record system meaningful use requirements, alleviating some of the burdens imposed on physicians and their practices

Additional funding to address the opioid epidemic and to support the work of the National Institutes of Health Repeal of the Independent Payment Advisory Board

For more information, contact Mark Lukaszewski, ACS Congressional Lobbyist, at [email protected].






 

On February 9, Congress passed and President Trump signed into law the Bipartisan Budget Act of 2018. The law addresses many key physician and patient issues, including important technical corrections to the Merit-based Incentive Payment System (MIPS) that the American College of Surgeons (ACS) strongly favors.

The law addresses several other ACS priorities, including:

The addition of a long-term funding extension (10 years) for the Children’s Health Insurance Program (CHIP), ensuring that children continue to have access to surgical care

The inclusion of language that eases electronic health record system meaningful use requirements, alleviating some of the burdens imposed on physicians and their practices

Additional funding to address the opioid epidemic and to support the work of the National Institutes of Health Repeal of the Independent Payment Advisory Board

For more information, contact Mark Lukaszewski, ACS Congressional Lobbyist, at [email protected].






 

The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.

The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
 

ACS cosponsored issues

The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.

Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.

Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.

Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
 

Other HOD-adopted resolutions of interest

BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.

Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.

Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.

Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
 

Surgical caucus

In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
 

Leadership transition

After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
 

Next meeting

The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail [email protected]
 

ACS Delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents

Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).



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

The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.

The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
 

ACS cosponsored issues

The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.

Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.

Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.

Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
 

Other HOD-adopted resolutions of interest

BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.

Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.

Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.

Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
 

Surgical caucus

In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
 

Leadership transition

After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
 

Next meeting

The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail [email protected]
 

ACS Delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents

Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).



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

The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.

The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
 

ACS cosponsored issues

The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.

Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.

Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.

Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
 

Other HOD-adopted resolutions of interest

BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.

Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.

Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.

Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
 

Surgical caucus

In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
 

Leadership transition

After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
 

Next meeting

The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail [email protected]
 

ACS Delegation at the AMA HOD

John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL

Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH

Jacob Moalem, MD, FACS, general surgery, Rochester, NY

Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents

Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA

Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).



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

Registration is open to attend an American College of Surgeons (ACS) 2018 General Surgery Coding Workshop. With Medicare and third-party payor policy and coding changes taking effect this year, it is imperative that surgeons have accurate and up-to-date information to protect their reimbursements and optimize efficiency.

During the coding workshop, you will learn how to report surgical procedures and medical services and will have access to the tools necessary to succeed, including a coding workbook to keep for future reference with checklists, resource guides, templates, and examples. Physicians receive up to 6.5 AMA PRA Category 1 Credits™ for each day of participation. In addition, each day of the workshop meets AAPC guidelines for 6.5 continuing education units.

The ACS will offer the following five remaining coding workshops in 2018:

Chicago, IL, April 12–13

New York, NY, May 17–19

Nashville, TN, August 9–10

Chicago, IL, November 1–3

The ACS also will offer a three-day course, including a day devoted to trauma and critical care coding at the New York City and (November) Chicago workshops.

Register for a course at www.karenzupko.com/workshops2/gensurg-workshops/. For more information about the 2018 ACS coding workshops, visit the ACS website www.facs.org/advocacy/practmanagement/workshops or e-mail [email protected].

Registration is open to attend an American College of Surgeons (ACS) 2018 General Surgery Coding Workshop. With Medicare and third-party payor policy and coding changes taking effect this year, it is imperative that surgeons have accurate and up-to-date information to protect their reimbursements and optimize efficiency.

During the coding workshop, you will learn how to report surgical procedures and medical services and will have access to the tools necessary to succeed, including a coding workbook to keep for future reference with checklists, resource guides, templates, and examples. Physicians receive up to 6.5 AMA PRA Category 1 Credits™ for each day of participation. In addition, each day of the workshop meets AAPC guidelines for 6.5 continuing education units.

The ACS will offer the following five remaining coding workshops in 2018:

Chicago, IL, April 12–13

New York, NY, May 17–19

Nashville, TN, August 9–10

Chicago, IL, November 1–3

The ACS also will offer a three-day course, including a day devoted to trauma and critical care coding at the New York City and (November) Chicago workshops.

Register for a course at www.karenzupko.com/workshops2/gensurg-workshops/. For more information about the 2018 ACS coding workshops, visit the ACS website www.facs.org/advocacy/practmanagement/workshops or e-mail [email protected].

Registration is open to attend an American College of Surgeons (ACS) 2018 General Surgery Coding Workshop. With Medicare and third-party payor policy and coding changes taking effect this year, it is imperative that surgeons have accurate and up-to-date information to protect their reimbursements and optimize efficiency.

During the coding workshop, you will learn how to report surgical procedures and medical services and will have access to the tools necessary to succeed, including a coding workbook to keep for future reference with checklists, resource guides, templates, and examples. Physicians receive up to 6.5 AMA PRA Category 1 Credits™ for each day of participation. In addition, each day of the workshop meets AAPC guidelines for 6.5 continuing education units.

The ACS will offer the following five remaining coding workshops in 2018:

Chicago, IL, April 12–13

New York, NY, May 17–19

Nashville, TN, August 9–10

Chicago, IL, November 1–3

The ACS also will offer a three-day course, including a day devoted to trauma and critical care coding at the New York City and (November) Chicago workshops.

Register for a course at www.karenzupko.com/workshops2/gensurg-workshops/. For more information about the 2018 ACS coding workshops, visit the ACS website www.facs.org/advocacy/practmanagement/workshops or e-mail [email protected].

To help address the severe shortage of surgeons in Sub-Saharan Africa, the American College of Surgeons (ACS) and the College of Surgeons of East, Central, and Southern Africa (COSECSA) have developed a scholarship program to support women in surgical residency, help them complete their training, and encourage other women in medicine to consider surgery as a profession. 

The program is open to senior female surgical residents enrolled in the COSECSA region. Each $2,500 scholarship will go toward educational expenses, including accreditation, the fellowship examination, and five-years of membership dues to COSECSA and the ACS.  Applicants should include a personal statement indicating future goals, a current curriculum vitae, and a letter of support from the surgical training program director.  Completed applications should be sent via e-mail to [email protected] and will be reviewed in conjunction with the Operation Giving Back committee. 

Applications are due no later than April 1.  Contact [email protected] with any questions. 

To help address the severe shortage of surgeons in Sub-Saharan Africa, the American College of Surgeons (ACS) and the College of Surgeons of East, Central, and Southern Africa (COSECSA) have developed a scholarship program to support women in surgical residency, help them complete their training, and encourage other women in medicine to consider surgery as a profession. 

The program is open to senior female surgical residents enrolled in the COSECSA region. Each $2,500 scholarship will go toward educational expenses, including accreditation, the fellowship examination, and five-years of membership dues to COSECSA and the ACS.  Applicants should include a personal statement indicating future goals, a current curriculum vitae, and a letter of support from the surgical training program director.  Completed applications should be sent via e-mail to [email protected] and will be reviewed in conjunction with the Operation Giving Back committee. 

Applications are due no later than April 1.  Contact [email protected] with any questions. 

To help address the severe shortage of surgeons in Sub-Saharan Africa, the American College of Surgeons (ACS) and the College of Surgeons of East, Central, and Southern Africa (COSECSA) have developed a scholarship program to support women in surgical residency, help them complete their training, and encourage other women in medicine to consider surgery as a profession. 

The program is open to senior female surgical residents enrolled in the COSECSA region. Each $2,500 scholarship will go toward educational expenses, including accreditation, the fellowship examination, and five-years of membership dues to COSECSA and the ACS.  Applicants should include a personal statement indicating future goals, a current curriculum vitae, and a letter of support from the surgical training program director.  Completed applications should be sent via e-mail to [email protected] and will be reviewed in conjunction with the Operation Giving Back committee. 

Applications are due no later than April 1.  Contact [email protected] with any questions. 

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.  Slide sets of the guidelines, useful as educational tools, also are available online.

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.  Slide sets of the guidelines, useful as educational tools, also are available online.

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.  Slide sets of the guidelines, useful as educational tools, also are available online.

Registration and housing for the 2018 Vascular Annual Meeting are now open. Register today for VAM, June 20 to 23 in Boston, including looking over housing options. Following a full day of postgraduate courses, VESS abstracts, workshops and international programming on Wednesday, June 20, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.

Registration and housing for the 2018 Vascular Annual Meeting are now open. Register today for VAM, June 20 to 23 in Boston, including looking over housing options. Following a full day of postgraduate courses, VESS abstracts, workshops and international programming on Wednesday, June 20, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.

Registration and housing for the 2018 Vascular Annual Meeting are now open. Register today for VAM, June 20 to 23 in Boston, including looking over housing options. Following a full day of postgraduate courses, VESS abstracts, workshops and international programming on Wednesday, June 20, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.