FEATURES - f ACS

FEATURES

Introducing e-FACS.org: College launches Web portal for its members 12 George F. Sheldon, MD, FACS

Current Procedural Terminology: Changes for 2006 17 Albert Bothe, Jr., MD, FACS, and Jean A. Harris

Highlights of the 91st annual Clinical Congress 20

Report of the Chair of the Board of Regents 31 Edward M. Copeland III, MD, FACS

Report of the Chair of the Board of Governors 33 Courtney M. Townsend, Jr., MD, FACS

Report of the Executive Director 34 Thomas R. Russell, MD, FACS

ACS Officers and Regents 36

DEPARTMENTS

From my perspective 4 Editorial by Thomas R. Russell, MD, FACS, ACS Executive Director

Dateline: Washington 6 Division of Advocacy and Health Policy

What surgeons should know about... 8 The 2006 Medicare fee schedule Cynthia A. Brown

JANUARY 2006Volume 91, Number 1

Stephen J. RegnierEditor

Linn MeyerDirector of

Communications

Karen SteinAssociate Editor

Diane S. SchneidmanContributing Editor

Tina WoelkeGraphic Design Specialist

Alden H. Harken, MD, FACS

Charles D. Mabry, MD, FACS

Jack W. McAninch, MD, FACS

Editorial Advisors

Tina WoelkeFront cover design

Future meetings

Clinical Congress2006Chicago,IL, October8-122007NewOrleans,LA, October7-112008SanFrancisco,CA, October12-16

Spring Meeting2006Dallas,TX, April23-262007LasVegas,NV, April21-242008Tobeannounced

On the cover: The College launches e-FACS.org, the new Web portal (see article, page 12). Photo courtesy of Getty Images.

Bulletin of the AmericanCollege of Surgeons (ISSN 0002-8045) is published monthly by the American Col-lege of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It is distributed without charge to Fellows, to Associate Fellows, to participants in the Candi-date Group of the American College of Surgeons, and to medical libraries. Periodicals postage paid at Chicago, IL, and additional mailing offices. POSTMASTER: Send address changes to Bulletin of theAmericanCollegeofSurgeons,633 N. Saint Clair St., Chicago, IL 60611-3211. Canadian Pub-lications Mail Agreement No. 40035010. Canada returns to: Station A, PO Box 54, Windsor, ON N9A 6J5. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. 312/202-5000; toll-free: 800/621-4111; fax: 312/202-5001; e-mail:postmaster@ facs.org; Web site: www.facs. org. Washington, DC, office is located at 1640 Wisconsin Ave., NW, Washington, DC 20007; tel. 202/337-2701, fax 202/337-4271. Unless specifically stated otherwise, the opinions ex-pressed and statements made in this publication reflect the authors’ personal observations and do not imply endorse-ment by nor official policy of the American College of Sur-geons.

©2006 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmit-ted in any form by any means without prior written permis-sion of the publisher. Library of Congress number 45-49454. Printed in the USA. Publications Agreement No. 1564382.

NEWS

A “thank you” from Louisiana 40 Lester W. Johnson, MD, FACS

A look at JCAHO: The Joint Commission and the ACS 40

April 23-26: 34th Spring Meeting to be held in Dallas, TX 41

Association of Women Surgeons meets in San Francisco 53

ACS seeking nominations for Officers-Elect and the Board of Regents 54

Trauma and Critical Care 2006 scheduled for March 54

Trauma meetings calendar 55

Health policy scholarships available for 2006 56

ACS seeking nominations for ACS/PMHI volunteerism award 58

Letters 60

NTDB™ data points: Annual report 2005, dataset version 5.0 64 Richard J. Fantus, MD, FACS, and John Fildes, MD, FACS

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

For more information contact Linda Stewart at [email protected], or tel. 312/202-5354.

SYLLABI SELECT: The content of select ACS Clinical Congress postgraduate courses is available on CD-ROM. These CD-ROMs run in the PC and Mac environments and offer you the ability to keyword-search throughout the CD.

ONLINE CME: Courses from the ACS’ Clinical Con-gresses are available online for surgeons. Each online course features video of the introduction, audio of session, printable written transcripts, post-test and evaluation, and printable CME certificate upon successful completion. Several courses are of-fered FREE OF CHARGE. The courses are accessible at: www.acs-resource.org.

BASIC ULTRASOUND COURSE: The ACS and the National Ultrasound Faculty have developed this course on CD-ROM to provide the practicing surgeon and surgical resi-dent with a basic core of education and training in ultrasound imaging as a foundation for specific clinical applications. It replaces the basic course offered by the ACS and is available for CME credit.

BARIATRIC SURGERY PRIMER: The primer addresses the biochemistry and physiology of obesity; identifies appropriate candidates for bariatric surgery; and discusses the perioperative care of the bariatric patient, basic bariatric procedures, comorbidity and outcomes, surgical training, and the bariatric surgical and allied sciences team, along with facilities, aspects of managed care, liability issues, and ethics.

PERSONAL FINANCIAL PLANNING AND MANAGEMENT for Residents and Young Sur-geons: The CD uses an interactive/lecture format to equip young surgeons with the knowledge to manage their personal financial future, including debt management, preparation for significant life events (such as retirement or college education of their chil-dren), and financial planning for surgical practice.

PRACTICE MANAGEMENT for Residents and Young Surgeons: The CD uses an interactive/lecture format to equip residents and young surgeons with the knowledge to manage their personal surgical future, including: how to select a practice type and location; the mechanics of setting up or run-ning a private practice; the essentials of an academic practice and career pathways; and surgical coding basics.

AMERICAN COLLEGE OF SURGEONS

• DIVISION OF EDUCATION •

For purchase and pricing information, call ACS Customer Service at 312/202-5474 or visit our E-LEARNING RESOURCE CENTER at www.acs-resource.org

NEW! PROFESSIONALISM IN SURGERY: CHALLENGES AND CHOICES: Professionalism is an essential component of surgical practice, and one of the six core competencies defined by the American Board of Medical Special-ties and the Accreditation Council for Graduate Medical Education. This CD-ROM presents 12 case vignettes, each including a sce-nario followed by multiple choice questions relating to professional responsibilities of the surgeon within the context of the case. The program provides the opportunity to earn online CME credit, with a printable certificate upon successful completion.

It is time to break out of the mode of quiet modesty and let people know who we are, what we do, and what we stand for.

Frommyperspective

’’“

This organization has always been fairlydiscreet about its accomplishments, re-frainingfromactivitiesthatsmackofself-promotion.Inthepast,thissortofquiet

modesty was admirable and helped the Collegemaintainahighlyprofessionalimage.

However,itmaybetimeforustorethinkwhetheritisreallytothebenefitofourprofessionandourpatientstocontinuetomaintainalow-keypostureaboutwhatwearedoingtoimprovequalityofcare.TheCollegeisstrivingtobearecognizedleaderinthequalitymovement,andcertainlysomemembersofthefederalgovernmentarerealizinghowusefulourexperienceanddatacanbeinrebuildingthiscountry’shealthcaresystem.Similarly,itbehoovesustohelpconsumersbetterunderstandthevalueofsurgicalcareandtohelpthemdeterminewhichprovidersarebestabletomeettheirneeds.

The pastSomeofyoumayrecallthatformanyyearsthe

AmericanCollegeofSurgeonssponsoredanationalconsumeradvertisingprogram.Thepurposeofwhatwascalledthe“SurgerybySurgeons”campaignwassixfold:tocommunicatetothepublictheCollege’spositionthatoperationsshouldbeperformedonlybyqualifiedsurgicalspecialists;toprovidethepub-licwithinformationneededtoassessasurgeon’squalifications; to explain the surgeon’s overallroleinpatientcare;toemphasizetheimportanceofpatientchoice intheselectionofasurgeon;toincreasepublicawarenessoftheAmericanCollegeofSurgeons;andtoemphasizeACSFellowshipasasurgicalcredentialthepublicshouldlookforwhenfacingthepossibilityofhavinganoperation.

Although this was a long-term program spon-soredbytheCollege,itwasconductedinwhatmanyofusnowmightconsidertobealow-keyway.Full-pageadswereplacedinconsumermagazines,andcommercialswereairedontheradio.Dailynationalandlocalnewspapersandtelevisionwerenotusedfor this program because of cost considerationsandbecause,atthetime,usingsuchhighlyvisiblecommunicationsvehicleswasnotconsideredtobeanappropriatethingfortheCollegetodo.

IshouldpointoutthattheCollegehasnotbeenunique in itsreluctanceto“blowitsownhorn.”Until recently, it was considered unprofessionalfor physicians, hospitals, and national medicalandhealthcareorganizationstoovertlyadvertise

themselvesortheirservices.Infact,manymedi-cal organizations, including the College and theAmericanMedicalAssociation(AMA),prohibitedordissuadedtheirmembersfromadvertising.In1975,however,theFederalTradeCommission(FTC)filedan antitrust lawsuit against the AMA, chargingthatitsbanonphysicianadvertisingdiscouragedcompetitionandunfairlydisadvantagedconsum-ers.Afteryearsoflegalwrangling,theFTCwonthelawsuitin1982,andsincethen,theAMAhaslifteditsban,andphysicianshavebeenfreetopromotetheirservicesinwhateverwaytheyfindcomfort-able.Thesedays,it’salmostimpossibletoopenanewspaperorwatchatelevisionprogramwithoutseeinganadpromotingtheservicesofaphysicianorahealthcarecenter.Andnationalorganizationshavealsobecomemoreaggressiveinthatregard.Asmanyofyoumayknow,theAMAiscurrentlyrunninganationaladvertisingprogramontelevi-sion;asMichaelD.Maves,MD,FACS,executivevice-president and chief operating officer of theAMA,explainedduringtheAmericanUrologicalAssociationLectureatthe2005ClinicalCongress,thisisjustoneaspectofits“branding”effort.

What we offerTheAmericanCollegeofSurgeonshasalways

stoodforpromotingthehigheststandardsofpa-tientcare.Unfortunately,withthecancellationof

VOLUME91,NUMBER1,BULLETINOFTHEAMERICANCOLLEGEOFSURGEONS

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Ifyouhavecommentsorsuggestionsaboutthisorotherissues,[email protected].

Thomas R. Russell, MD, FACS

ourlong-termadvertisingprogram,welostevenalow-keymechanismforprovidingthesurgicalpro-fessionandtheCollegewithconsistentpublicvis-ibility.Thus,thepublicingeneraldoesnotknowwhatwedoandhowourworkbenefitsthem.

Myguess is thatmostpeople areunaware ofthehighstandardsthatsurgeonsmustmeettobepartofthisFellowship.Weneedtoonceagaineducate the public about what it means to beboard certified and why board certification is aprerequisiteforACSFellows.Weneedtoexplainhowandwhywedisciplinethoseindividualswhoengageinunethicalornegligentactivities.

Wealsoneedtotellconsumersaboutsomeoftheprogramsweoffertoensurethattheyreceivesafeandappropriatecare.Forinstance,thepublicshouldbemadeawareoftheCollege’sAdvancedTraumaLifeSupport®(ATLS®)program,whichhastrainedthousandsofhealthcareprofessionalshereandoverseasinthesafeandeffectiveprovi-sionofurgentcare.

Our Committee on Trauma (COT), which in-troduced the ATLS program, also operates theNationalTraumaDataBankTM,whichtracksin-formationaboutpatientswhoreceiveemergencytreatmentforpurposesofimprovingthecareofinjured patients through systematic efforts inprevention, treatment, and rehabilitation. Al-thoughreportersroutinelymentionourtraumaprograms in their reports on emergency care,patientsshouldknowmoreabouthowweverifythese centers andwhat itmeans to receive theCOTstampofapproval.

Likewise, the public should be more familiarwiththeeffortsledbyourCommissiononCancer(CoC).TheyshouldknowhowtheCoC’sApprovalsProgramencourageshospitals,treatmentcenters,and other facilities to improve oncological carethroughprevention,earlydiagnosis,pretreatmentevaluation,staging,optimaltreatment,rehabilita-tion,surveillanceforrecurrentdisease,supportservices,andend-of-lifecare.PatientsshouldbeawareofhowtheNationalCancerDataBaseisworkingtoimprovecancertreatmentbyprovidingphysicians,cancerregistrars,andotherswithameansofcomparinghowtheymanagecancerpa-tientswithcancercareprofessionalselsewhere.

Thepublicshouldalsoknowaboutourclinicaltrialsprogramsandhowtheseeffortsmayleadtomoreeffectiveandsafertreatmentoptionsfor

individualssufferingfromvarioustypesofcancerandhernias.

Getting the word outUnquestionably, the American College of Sur-

geonsisengagedinnumerousactivitiesaimedatensuringthatsurgicalpatientsreceivethesafestandbestpossiblesurgicalcare.Thequestionis,howdoweletthemknowaboutourefforts?

ManyofusbelievethatthetimehascomefortheCollege to reinstituteapublic relationspro-gram—andtotakeamoreaggressiveandvisibleapproach than we have used in the past. SomesuggestionsforimprovingtheCollege’spublicvis-ibilitythatwe’vereceivedincludehiringapublicrelationsfirm,developinganadvertisingprogram,andworkingwithapublicist.Perhapsweshouldbecomemorevocalregardingpublichealthissuesand speak out on the physical repercussions ofobesity,smoking,andalcoholanddrugabuse.Asanothermeansofcommunicatingwiththepublic,effortsareunderwaytodevelopandpublishabookthatexplainsthesurgicalexperienceandwhatisinvolvedinhavinganoperationinawaythatthegeneralpopulationcanunderstand.

Nodoubt,manyFellowshaveverystrongopin-ions about whether and how we should employtheseapproaches.That’swhyIwantedtousethismonth’scolumntoinitiateadialogueaboutthissubject.Weneedtostartmovingaheadwithwhat-everstrategieswedecidetoimplementsothatourpatientswillbebetterequippedtodealwiththeimminentchanges thatwillbeoccurringas thiscountryrebuildsourhealthcaresystem.

Itistimetobreakoutofthemodeofquietmod-estyandletpeopleknowwhoweare,whatwedo,andwhatwestandfor.Asalways,yourcommentsregardinghowweaccomplishthisobjectivewouldbemostwelcome.

JANUARY2006BULLETINOFTHEAMERICANCOLLEGEOFSURGEONS

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DatelineWashingtonprepared by the Division of Advocacy and Health Policy

OnNovember1,theCentersforMedicare&MedicaidServices(CMS)releasedafinalruleonMedicarephysicianpaymentpoli-cies for2006.Thenewregulations—which, atpress time,werescheduledtotakeeffectJanuary1—addressseveralkeyissuesfirstraisedinaproposedrulepublishedinAugust2005.Ofparticularimportance, CMS announced an across-the-board 4.4 percentreductioninphysicianpayments,withafeescheduleconversionfactorof$36.1770(comparedwith$37.8975in2005).Thepaycutisattributabletothefeeschedule’suseofthesustainablegrowthrate(SGR)asaprospectivelydeterminedexpendituretargetforrestrainingtherateofgrowthinMedicarespendingforphysicianservices.Formoreinformationaboutthe2006feeschedule,seethearticleonpage8.

Atpresstime,Congresswasstilldebatinglegislationcenteredonissuesofconcerntosurgeons.Followingisabriefsummaryofsomeofthemorepertinentbillsawaitingpassagebytheendoftheyear.

• Medicare. DuringthelastweekofOctober,theSenateFinanceCommitteeapprovedabroadbudgetbillthatincludesa1percentincreaseinMedicarepaymenttophysiciansin2006.The1percentincreasewouldreplacethe4.4percentcutin2006describedpre-viously.However,thebudgetpackagefailstoaddressprospectivecutsof4to5percentperyearin2007andbeyondbecauseitallowsMedicaretoretaintheSGR.Inaddition,thebudgetbillincludesquality-reportingrequirementsforphysicians in2007and2008andestablishesapay-for-performance(P4P)programstartingin2009.

Arelatedbill,H.R.3617,theMedicareValue-BasedPurchasingforPhysicians’ServicesActof2005,wouldnotonlystopMedicarepaymentcutsin2006butwouldrepealtheSGRtoavertcutsin2007andsubsequentyearsandwouldbasefutureMedicarepay-mentsonrisingpracticecosts.Inaddition,thislegislationwouldimplementP4PbasedonqualitymeasuressuchasthosedevelopedthroughtheSurgicalCareImprovementProjectandtheACSNa-tionalSurgicalQualityImprovementProgram.

• Trauma funding. OnOctober27,2005,theSenateapprovedits version of the fiscal year (FY) 2006 Labor-Health and Hu-manServices (HHS)-Educationappropriationsbill (H.R. 3010),whichallocates$3.5milliontotheHealthResourcesandServicesAdministration’s Trauma-Emergency Medical Services (EMS)Program. However, this program remained in jeopardy becausetheHouseversion,passedJune24,2005,providedno financialsupportforit.Atpresstime,thelegislationwasunderreviewinaconferencecommitteechargedwithreconcilingthedisparitiesbetween theSenateandHouseversionsof the legislation,bothofwhichprovide$141.7billionindiscretionaryspendingfortheDepartmentsofLabor,HHS,andEducation.

Moreup-to-dateinformationontheseandotherbillswaspub-lishedinDecember2005issuesofACS NewsScope.

CMS issues 2006 Medicare fee schedule

Congress poised to act on Medicare and trauma funding


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CMShasestablishedavoluntaryprogramtoreportevidence-based,consensusqualitymeasuresforMedicarebeginningJanuary1.Duringthefirstphaseofimplementation,CMSiscollectinginformationonasetof36measuresusingadedicatedsetofHealthcareCommonProcedureCodingSystem (HCPCS) codes, calledG-codes,whichwill supplement the claims data physicians currently submit toCMSwithclinicaldata.Thegoaloftheprogramistointroduceaprocessforparticipatingphysicianstobeginreportingqualitydataandreceivingfeedbackontheirperformance.Participationintheprogramorrelativeperformanceonthemeasureswillnotaffectreimbursement,norwilltheinformationbepubliclyreported.Afactsheetdescribingboththeprogramandthemeasuresispostedathttp://www.cms.hhs.gov/media/press/release.asp?Counter=1701.

TheEmergencyMedicalTreatmentandActiveLaborAct(EMTALA)technicaladvisorygroup(TAG)metOctober26–28,2005,toconsiderproposalsaimedataddressingtheshortageofspecialistswhotakeemergencycall.TheTAGalsodiscussedinappropriatetransfersandtheeffectofspecialtyhospitalsonEMTALA-mandatedcare.Afterhearingtestimonyfromseveralorganizations,theTAGofferedthefollowingrecommendationstoCMS:(1)hospitalswithspecializedcapabilitiesshouldnotberequiredtomaintaindedicatedemergencydepartments (DEDs), and (2)hospitalswith specialized capabili-tiesthatdonothaveDEDsshouldhavethesameresponsibilitiesunderEMTALAasthosewithDEDs.TheTAGalsocalledforCMStomovefromtheEMTALAregulationstoMedicarearequirementthat hospital emergency departments maintain a list of on-callphysicians.

The EMTALA TAG advises CMS on regulations related toEMTALAandtheirapplicationtophysiciansandhospitals.Itcom-prises19members,includingfourCollegeFellows:generalsurgeonRichardPerry,MD,FACS,Phoenix,AZ;pediatric surgeonDavidTuggle,MD,FACS,OklahomaCity,OK;orthopaedictraumasurgeonJamesNepola,MD,FACS,IowaCity,IA;andneurosurgeonJohnKusske,MD,FACS,Orange,CA.FormoreinformationabouttheTAG,gotohttp://www.cms.hhs.gov/faca/emtalatag/default.asp.

HHS Secretary Mike Leavitt recently announced adoption of“foundationstandards”fortheelectronicprescribing(e-prescribing)ofPartDdrugscoveredbyMedicare.Thefinalruleregardingthestandards was published in the Federal Register on November 7,calling for e-prescribing to coincide with the implementation ofMedicare’s new prescription drug benefit beginning January 1.E-prescribingenablesaphysiciantotransmitaprescriptionelec-tronicallytoapatient’spharmacyofchoice. It isnotonlyeasierthanpaperprescriptionsbutmayalsoimprovepatientsafetyandreducecostsbydecreasingprescriptionerrorsandautomatingtheprocessofcheckingfordruginteractionsandallergies.E-prescribingalsowillallowphysicians,pharmacies,andpatientstoobtaintimelyevidence-basedinformationondrugsandonpatienteligibility.

CMS establishes voluntary quality-reporting program

EMTALATAG makes recommendations

HHS to issuee-prescribing rule


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On November 1, 2005, the Centers forMedicare&MedicaidServices(CMS)re-leasedafinalrulerevisingtheMedicare

physicianpaymentpoliciesfor2006.*Thenewregulations, which took effect January 1, ad-dressseveralkeyissuesfirstraisedinaproposedrulepublished inAugust2005,onwhichCMSreceivedapproximately15,000commentsfrommedical and surgical specialty organizations,includingtheCollegeaswellasindividualphysi-cians,patientadvocategroups,andothers.

Following are answers to questions surgeonsmayhaveaboutprovisionsintherulethataffectthemmostdirectly.

What is the 2006 fee schedule conversion factor, and how was it calculated?

Followingaformulaestablishedbylaw,CMSannouncedthatthephysicianfeescheduleup-dateforcalendaryear2006is–4.4percent,pro-ducingaconversionfactorof$36.1770(comparedwith$37.8975in2005).Theupdatewasderivedby applying an “update adjustment factor” of–7percenttoaMedicareEconomicIndex(MEI)of2.8percent,alongwitha–0.6percentbudgetneutrality adjustment to account for changesmadetocertainrelativevalueunits(RVUs).

Why was a negative update adjustment fac-tor applied to the MEI?

The–7.0percentadjustmentisrequiredbylawbecauseof thesustainablegrowthrate (SGR),which was created as a means of restrainingthe rate of growth in Medicare spending forphysicianservices.TheSGRisaprospectivelydeterminedexpendituretargetthatistiedtothesizeofthebeneficiarypopulationandoveralleco-nomicgrowth.Ifspendinggrowthunderthefee

scheduleinagivenyearisbelowtheSGRtargetrate,commensurate“bonus”percentagepointsareaddedtotheMEItodeterminetheannualupdateinasubsequentyear.Ontheotherhand,whenaggregatespendingexceedstheSGR,theexcessivepercentageamount isdeductedfromtheMEI.Regardlessofhowmuchactualspend-ingfallsshortoforexceedstheSGR,MedicarelawlimitspenaltydeductionstonomorethansevenpercentagepointsbelowtheSGRandbo-nusincreasestonomorethanthreepercentagepointsabovetheMEI.

Inaddition, theSGR isacumulative target,meaning that adjustments are based on thedifference between the cumulative amount ofactual spending on physician services and thecumulativespendingtargetsincethebaseyearof1996.Asaresult,thesystemrequiresthatexcessspendinginanysingleyearberecoupedinfutureyears.Theonlywaytoachievethisobjectiveistoreducethefeescheduleupdatesenoughtooffsettheexcessspending.Witha“floor”onpaymentupdatesofMEIat–7percent,itcantakequiteafewyearstooffsetaperiodofhighspendinggrowth(seeTable1,page9).

Throughout 2005, much was said in the Administration and in Congress about ef-forts to reform the payment system that is producing these across-the-board pay-ment cuts. Why hasn’t the system been changed?

Becausethephysicianpaymentsystemwases-tablishedaccordingtolawspassedbyCongress,CMShaslimitedoptionsforreformingthesys-temonitsown.However,theCollegeandothershave argued that the agency has authority totakestepsthatwouldhelpeasetheproblem.

Forexample, incalculatingphysicianspend-ing under the SGR, CMS includes the cost ofcertain physician-administered drugs (such aschemotherapydrugs).Becauseoftheprolifera-tionofthesedrugs inrecentyears,thispolicy

Whatsurgeonsshouldknowabout…The 2006 Medicare fee schedule by Cynthia A. Brown, Director, Division of Advocacy and Health Policy

*Atpresstime,theregulationwasscheduledforpublicationintheFederal RegisteronNovember21,2005.Thefull textcan be viewed on the CMS Web site at http://www.cms.hhs.gov/physicians/.


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has exacerbated the problem of “excessive”spending growth under the SGR. Arguably,ratesofspendinggrowthfortheseservicesdonotbelongunderthespendingtargetbecausetheircostsarenotpaidunderthefeescheduleandtheirpricesarenotinfluencedbytheSGR.Inthefinalruleon2006paymentpolicies,how-ever,theagencyrejectedcommentsrequestingtheremovalofdrugexpendituresfromtheSGRcalculations.

Congress has been considering legislationtoeliminatetheSGRentirelyandbasefuturephysician payment updates on the MEI. But,becausethebudgetary“baseline”reflectsfuturereductionsinphysicianpaymentsmandatedbycurrent law, the 10-year cost of enacting thiscommon-sense reform has been estimated ashighas$180billion.Atpresstime,Congresshadnotyetidentifiedspendingcutsitwaswillingtoenactinordertooffsetthecostsofcomprehen-sivereform,norhadaone-ortwo-yearsolutionbeenenactedalongthelinesofthoseshort-termsolutionspassedtomaintainpositiveupdatesin2003,2004,and2005(seeFigure1,right).

Table 1: Physician performance under the SGR

Period

Cumulative allowed

expenditures (in $ billions)

Cumulative actual expenditures (in $ billions) SGR (%)

Actual growth rate (%)

4/1/96-3/31/97 48.9 48.9 N/A N/A4/1/97-3/31/98 99.4 98.4 3.2 –2.24/1/98-3/31/99 152.0 148.9 4.2 –4.01/1/99-3/31/99 * 148.9 4.2 –1.5

4/1/99-12/31/99 * 188.4 6.9 –6.21/1/99-12/31/99 194.0 188.4 * –4.91/1/00-12/31/00 253.4 246.5 7.3 –2.21/1/01-12/31/01 315.4 312.8 4.5 6.91/1/02-12/31/02 382.6 383.8 8.3 5.71/1/03-12/31/03 454.6 460.6 7.3 6.51/1/04-12/31/04 531.5 549.3 6.6 13.51/1/05-12/31/05 611.8 642.5 4.6 16.01/1/06-12/21/06 693.6 N/A 1.7 N/A

*LegislationwaspassedthatchangedtheperiodusedforcalculatingtheSGRandmeasuringperformance,makingthesefiguresimmaterial.

Figure 1: Recent Medicare fee schedule updates


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Table 2: Diagnostic imaging services subject to multiple procedure payment reduction

Family Description

2004Medicare

allowed charges (in $ millions)

Payment impact of multiple

procedure policy (%)

01 Ultrasound(chest/abdomen/pelvis;non-obstetrical) 138 –3.4

02 CTandCTA(chest/thorax/abdomen/pelvis) 563 –9.5

03 CTandCTA(head/brain/orbit/maxillofacial/neck) 97 –1.3

04 MRIandMRA(chestabdomen/pelvis) 105 –2.4

05 MRIandMRA(head/brain/neck) 532 –3.1

06 MRIandMRA(spine) 540 –2.2

07 CT(spine) 24 –2.1

08 MRIandMRA(lowerextremities) 166 –1.6

09 CTandCTA(lowerextremities) 5 –1.0

10 MRandMRI(upperextremitiesandjoints) 107 –1.4

11 CTandCTA(upperextremities) 2 –0.7

Totalforallproceduressubjecttomultipleimagingreductions 2,276 –4.2

CT=computedtomographyCTA=coronarycomputedtomographyangiographyMRI=magneticresonanceimagingMRA=magneticresonanceangiographyMR=magneticresonance

Table 3: Change in payments for key surgical services

CPT/procedure

2005payment

($)

2006payment

($)Percentchange

19240,Removalofbreast 996 952 –4.4

27130,Totalhipreplacement 1,396 1,336 –4.3

27447,Totalkneereplacement 1,508 1,443 –4.3

31255,Removalofethmoidsinus 447 427 –4.5

33512,CABG,vein,three 2,044 1,956 –4.3

35301,Rechannelingofartery 1,129 1,078 –4.5

44140,Partialremovalofcolon 1,223 1,170 –4.3

49505,Repairinguinalhernia 468 448 –4.3

52601,Prostatectomy(TURP) 694 663 –4.5

63047,Removalofspinallamina 1,047 1,004 –4.1

66984,Removecataract,insertlens 684 653 –4.5

CABG=coronaryarterybypassgraftTURP=transurethralresectionoftheprostate


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CMSimplementedaminorbutpositivechangeinthemethodologyusedtocalculatethemalprac-ticeRVUslistedintheMedicarefeeschedule.Indetermining which liability risk factors to useincreatingRVUsforanindividualservice,theagencynowappliesa“5percentthreshold.”So,beginningin2006,CMSwillviewasanaberrantoccurrenceanyserviceperformedbyindividualspecialtiesthatprovidethatservicelessthan5percent of the time. Their associated risk fac-torwillberemovedfromthemalpracticeRVUcalculation,inanefforttoimprovetheaccuracyandstabilityofthisfeeschedulecomponent.Anexceptiontotheruleisbeingmadefortheevalu-ationandmanagement(E/M)codesbecauseallspecialtiesdo,infact,providetheseservices.

What changes were made to relative work RVUs in the fee schedule?

CMSreceivedrelativeworkvaluerecommen-dationsfromtheAmericanMedicalAssociation/Specialty Society RVS Update Committee, orRUC,for175newandrevisedCurrentProceduralTerminology (CPT) codes,H and approximately94percentofthemwereaccepted.Unfortunately,the agency rejected requests to consider codesdescribing backbench preparation of variousorgansfortransplantationonthegroundsthatthese are hospital organ acquisition costs thatarenoteligibleforpaymentunderthephysicianfeeschedule.

In August 2005, CMS proposed to imple-ment a new payment policy for multiple diagnostic imaging procedures that is simi-lar to the rules applied to multiple surgical procedures. Was that policy adopted?

CMSadoptedanewpaymentreductionpolicyforthetechnicalcomponentofcertaindiagnosticimagingprocedureswhenmorethanoneproce-dureisprovidedinasinglesession.For11servicefamilies (see Table 2, page 10), Medicare willmakefullfeeschedulepaymentsforonlythefirstserviceprovided ina single session;additional

What is the SGR for 2006?

TheinitialestimatefortheSGRforcalendaryear 2006 is 1.7 percent. This number is wellbelowratessetinpreviousyearsbecauseitre-flectsthe4.4percentacross-the-boardpaymentreductionannouncedfor2006payments.

Were any significant changes made in the fee schedule relative values?

InAugust2005,CMSproposedusingsupple-mental practice cost data submitted by theradiology, cardiology, radiation oncology, urol-ogy, dermatology, allergy/immunology, andgastroenterology specialties to refine certainpracticeexpenseRVUsinthefeeschedule.Theagencyalsoproposedrevisingthemethodologyused to allocate indirect practice costs downto individual physician services. Because ofbudget neutrality requirements, payment in-creasesthatwouldhavebeenproducedbythesechangesinpracticeexpenseRVUswouldhavebeenoffsetbyreductionsinvaluesassignedtoservicesprovidedbyotherspecialties,causingpaymentredistribution.Inthefinalrule,CMSwithdrew these proposals with the followingthreeexceptions:

• InterimpracticeexpenseRVUsassignedfornewservicecodesintroducedin2006;

• Practice expense values developed usingsupplementary data submitted by urology fordrugadministrationcodesusedbythatspecialty;and

• Aredistributionofsavingsfromimplemen-tationofapaymentpolicychangepertainingtomultipleradiologyprocedures,describedlaterinthisarticle.

Theagencyplanstoholdmeetingsearlythisyeartoobtaininputonitsproposedmethodol-ogychanges.Inaddition,itplanstoworkwithphysiciangroupstodevelopastrategyforfund-ingandfieldingamultispecialtyindirectpracticecostssurveythatwillhelptoensurethedataareuptodateandthatthemethodologytreatsallspecialtiesequally.

Were any changes made in the fee schedule to reflect the escalating costs of profes-sional liability insurance?

continued on page 63HAllspecificreferencestoCPT(CurrentProceduralTerminology)terminology and phraseology are © 2005 American MedicalAssociation.Allrightsreserved.


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Duringthepastdecade,theAmericanCollegeof Surgeons has increased and expandedits communications with its members byembracingandemployingelectroniccom-

munications vehicles—the weekly electronicnewsletter,ACS NewsScope,andregular“spe-cial alerts” sent via e-mail. In addition, theCollege’s Web site—www.facs.org—generatesnearly1millionhitspermonth.Asoursocietybecomesmorecomputerliterateandtechnologicadvances provide new collaborative tools, theCollege is finding even greater opportunitiestointeractwithitsmembers.Insummer2004,atthesuggestionoftheResidentandAssociateSocietyandtheCommitteeonYoungSurgeons,theBoardofRegentsapprovedinconceptandwith financial support the creation of a Webportalforthispurpose.

ThemissionoftheAmericanCollegeofSur-geons Web portal—e-FACS.org—is to expandtheCollege’sroleasaninformationresourceonpatientcareforthevarioussurgicalspecialtiesand on advances in bioscience, research, andhealthpolicybyprovidingitsmemberswithapersonalizedgatewaytotheInternetthatwill(1)filterandfacilitatetheiraccesstoWeb-basedinformation;(2)initiateandfacilitatecollabora-tionandexchangeofideasamongmembers;and(3)provideasecure,singlesign-onservicethatwill be the entry point of access to organizedWebinformationcomingfromtheCollegeandothervalidatedandreputablesources.

A project of the College’s Informatics andCommunicationsCommittees,theportalhasbeen in development for approximately 18months. A Web Portal Steering Committeeprovidesoverallguidancewithrespecttotheportal’s vision,while aWebPortalEditorialBoardadvisesandassists theeditor-in-chiefin selecting material appropriate for theportal’susers,whichincludeFellows,Associ-ate Fellows, surgical residents, and medicalstudents.

What is a portal?For those unfamiliar with the term, a Web

portal is a secure, single-point-of-entry Website configured for a specific community ororganization.Manypeopleuseportalswithouteven knowing they are doing so—well-known

examples include Amazon.com, “My Yahoo,”and“MyMSN.”PortalsarebuiltonthesametechnologyusedforWebsites,buttheyenhancethefunctionalityandflexibilitytocatertothedemandsofitsusers.Therearefivemajordiffer-encesbetweenaWebsiteandaWebportal—au-thentication, personalization, customization,integration,andcontentmanagement.

• Authentication—Inadditiontorequiringalogintoenteraportal,theportalalsoknowswhoyouarethroughanauthenticationprocess.Au-thenticationviasingle-sign-onalsoeliminatesthe need to remember many usernames andpasswords when entering other sites throughtheportal.

• Personalization—Aportal’shighlyfocusedcontenteliminatestheneedtovisitmanydif-ferentWebsitesforinformation.

• Customization—Usersselectandorganizetheirowncontentinaportalbasedonindividualpreferences.

Getting started

Note: To access the Web portal, you will needyoureight-digitFellowshipIDnumber(whichcanbefoundonyourFellowshipcardoronthemail-inglabelonyourmonthlypackagecontainingtheBulletinandtheJournal of the American College of Surgeons).

After opening the Web browser of your choice(forexample,InternetExplorer,Firefox,orAOL),enterwww.efacs.org inthe“openfile”areaofyourbrowser. The first page you will see is the loginpage.

Before logging in to the portal, click on the“QuickStartGuide”underthe loginareaof thepage.Thisguidewillprovideyouwithinstructionsonhowto log in,aswellasa succinct reviewofwhatyouwillfindinvariousareasoftheCollege’sWebportal.

Whenyouarereadytogetstarted,enteryoureight-digitFellowshipIDnumberasyourusername.Yourpasswordisyourlastname.Example:

Username:12345678 Password:smith


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• Integration—Inaportal,relevanttoolsandinformationcomefrommanysourcesandaredisplayedjustfortheuser.

• Content management—Whereas contentfor a Web site is usually published by sub-mittingittoaWebmasteroraWebteamforposting, a portal provides content-authoringsystemsthatallownontechnicalstafftocreatecontent.Thiscontentisroutedtothemanagingeditorforapproval;afterelectronicapproval,the content is immediately published on theportal (no coding required). As a result, theinformationauserneedsandwantsgetstohimorherfaster.

Web portal Editorial Board The Web portal Editorial Board is made up

of at-large members, community editors, andassociatecommunityeditors(seebox);LazarJ.Greenfield, MD, FACS, Associate Editor; JerrySchwartz,ManagingEditor;LinnMeyer,Direc-torofCommunications,andHowardTanzman,DirectorofInformationTechnology(IT);andtheauthorofthepresentarticle(Editor-in-Chief).

• At-large members—At-largemembersoftheACS Web portal Editorial Board focus on “bigpicture”issues.Responsibilitiesincluderecom-mendingtopicsofinteresttoportalusers;gener-atingcontent,thesolecriterionbeingrelevance

MembersRobertW.Anderson,MD,FACS CommunityEditor,BiomedicalEngineeringRichardG.Azizkhan,MD,FACS Co-CommunityEditor,PediatricSurgeryClydeF.Barker,MD,FACS CommunityEditor,TransplantationSurgeryKevinE.Behrns,MD,FACS CommunityEditor,GastrointestinalSurgeryRichardP.Billingham,MD,FACS CommunityEditor,Colon&RectalSurgeryF.WilliamBlaisdell,MD,FACS CommunityEditor,SeniorSurgeonsKirbyI.Bland,MD,FACS At-LargeMemberMurrayF.Brennan,MD,FACS CommunityEditor,InternationalSurgeryDavidG.Burris,MD,FACS CommunityEditor,UniformedServicesJohnL.Cameron,MD,FACS SeniorConsultant,GastrointestinalSurgeryWilliamG.Cance,MD,FACS CommunityEditor,TranslationalOncologyRobertR.Cima,MD,FACS At-LargeMemberOrloH.Clark,MD,FACS CommunityEditor,EndocrineSurgeryMarionE.Couch,MD,FACS Co-CommunityEditor,Otolaryngology–Head&NeckSurgeryMyriamJ.Curet,MD,FACS At-LargeMemberDonE.Detmer,MD,MA,FACS At-LargeMember

ACS Web portalEditorial Board

LeeR.Duffner,MD,FACS CommunityEditor,OphthalmicSurgeryTimothyJ.Eberlein,MD,FACS At-LargeMemberRichardJ.Finley,MD,FACS CommunityEditor,CanadianFellowsJulieA.Freischlag,MD,FACS CommunityEditor,CareerMentoringDavidM.Gershenson,MD,FACS Co-CommunityEditor,Gynecology&ObstetricsJohnGlaser,PhD At-LargeMemberPeterS.Greene,MD,FACS At-LargeMemberRobertS.D.Higgins,MD,FACS CommunityEditor,CardiothoracicSurgeryJulianT.Hoff,MD,FACS CommunityEditor,NeurologicalSurgeryMaryA.Hooks,MD,FACS CommunityEditor,CareerMentoringKarenD.Horvath,MD,FACS At-LargeMemberJohnG.Hunter,MD,FACS CommunityEditor,SurgicalJournalEditorsDannyO.Jacobs,MD,FACS CommunityEditor,CareerMentoringDanielleA.Katz,MD CommunityEditor,OrthopaedicSurgeryBlairA.Keagy,MD,FACS CommunityEditor,VascularSurgeryM.MargaretKemeny,MD,FACS CommunityEditor,SurgicalOncology

Editor-in-Chief: GeorgeF.Sheldon,MD,FACSAssociate Editor: LazarJ.Greenfield,MD,FACSManaging Editor: JerrySchwartz


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DouglasA.Levine,MD Co-CommunityEditor,Gynecology&ObstetricsStephenJ.Mathes,MD,FACS Co-CommunityEditor,PlasticSurgeryMaryH.McGrath,MD,FACS Co-CommunityEditor,PlasticSurgeryRobinS.McLeod,MD,FACS At-LargeMemberJ.WayneMeredith,MD,FACS CommunityEditor,TraumaSurgeryLouisM.Messina,MD,FACS At-LargeMemberAnthonyA.Meyer,MD,PhD,FACS CommunityEditor,CareerMentoringLinnMeyer DirectorofCommunicationsLenaM.Napolitano,MD,FACS CommunityEditor,SurgicalCriticalCareSherwinB.Nuland,MD,FACS CommunityEditor,History&PhilosophyJuanC.Paramo,MD CommunityEditor,ResidentsJohnH.Pemberton,MD,FACS At-LargeMemberWalterJ.Pories,MD,FACS CommunityEditor,BariatricSurgeryJoeB.Putnam,Jr.,MD,FACS CommunityEditor,CardiothoracicSurgeryCharlesF.RinkerII,MD,FACS CommunityEditor,RuralSurgeonsDavidW.Roberson,MD,FACS Co-CommunityEditor,Otolaryngology–Head&NeckSurgery

RonnieA.Rosenthal,MD,FACS CommunityEditor,GeriatricSurgeryGraceS.Rozycki,MD,FACS At-LargeMemberAjitK.Sachdeva,MD,FACS At-LargeMemberMarshallZ.Schwartz,MD,FACS Co-CommunityEditor,PediatricSurgeryM.MichaelShabot,MD,FACS CommunityEditor,InformaticsRobertL.Sheridan,MD,FACS CommunityEditor,BurnMedicine&SurgeryS.EvaSingletary,MD,FACS CommunityEditor,BreastCancerSurgeryNathanielJ.Soper,MD,FACS CommunityEditor,MinimallyInvasiveSurgeryWileyW.Souba,MD,ScD,FACS At-LargeMemberHowardTanzman DirectorofInformationTechnologyJamesC.Thompson,MD,FACS SeniorConsultant,GeriatricSurgeryGaryL.Timmerman,MD,FACS CommunityEditor,YoungSurgeonsCourtneyM.Townsend,Jr.,MD,FACS At-LargeMemberDonaldD.Trunkey,MD,FACS CommunityEditor,TerrorismRichardD.Williams,MD,FACS CommunityEditor,UrologicSurgery

andusefulness;servingaspeerreviewerswhencalledupontodoso;andmaintainingcommuni-cationwithregardtoqualityofportalcontent.

• Community and associate community edi-tors—Althoughtheseeditorsandat-largemem-bersoftheboardareequallyimportantintermsofhierarchy,communityeditorshaveamoredetailedfocus.Theseeditorsidentifycontentforcommu-nity areas, assuming responsibility for overallquality of intellectual content, and maintainactivity on discussion boards. Each communityeditorselectsasmallgroupofexperts—associatecommunityeditors—toassistinidentifyingandcreatingcontentforhisorhercommunity.

Currently,thereare17at-largemembers,44community editors, and 138 associate commu-nityeditors.AtleastonecommunityeditorhasbeenassignedthetaskofactingasaliaisontotherespectiveAdvisoryCouncilforeachofthesurgicalspecialties.

The communities There are two types of communities in the

portal:specialtycommunitiesandspecialinter-estcommunities.

• Specialty communities mirror the ACSAdvisory Councils for the Surgical Specialties,with10subspecialtieslistedundergeneralsur-


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gery: bariatric surgery, breast cancer surgery,burn medicine and surgery, endocrine surgery,gastrointestinal surgery, minimally invasivesurgery,surgicalcriticalcare,surgicaloncology,transplantationsurgery,andtraumasurgery.

• Special interest communitiesarecomposedof(1)clinicalareasthatarenotsubspecialtiesundergeneralsurgery,and(2)nonclinicalareasofspecialinterest.Currently,therearecommu-nities designated for biomedical engineering,Canadian Fellows, career mentoring, geriatricsurgery, history and philosophy, informatics,internationalsurgery,residents,ruralsurgeons,seniorsurgeons,surgicaljournaleditors,terror-ism,translationaloncology,uniformedservices,andyoungsurgeons.

Portal communities offer core content, edi-torials, reports,algorithms,discussion forums,automated news feeds, links to related Websites/portals, important meeting dates, videos,recommendedreading,accreditation/certificationinformation,andmore.Portalusersareabletojoinasmanycommunitiesastheywish.

In addition to these robust content areas, e-FACS.org offers members useful tools that in-cludetheabilitytocalculateandlogcontinuingmedicaleducationcredits,trackresidenthours,andenterinformationintocaselogs.

How it all came aboutEarly last year, key players from the Com-

municationsandITstaffandIparticipatedinadesignworkshopwithoutsideportalconsultantstoensurethattheorganizationalandusergoalsfore-FACS.orgwouldbereflectedonthehomepage and secondary page designs. Workshopparticipants defined user profiles that werethenusedasthebasisfordecisionmakingwithregard to content organization, nomenclature,andnavigation.Aftergroupinginformationintocategories based on fundamental organizationprinciples,contentgroupswererankedbyorderofimportancetoportalusers.

The final designs for the portal’s home pageand secondary pages were then developed bythe vendor and approved by College staff lastApril. The design features easy-to-use naviga-tionwith linkstoCollegehighlights,advocacy,memberservices,education,qualityandsafety,and specialties and communities, as well as a

Dr. Sheldon is Editor-in-Chief of e-FACS.org,

the College’s Web portal. He is professor of sur-gery and social medi-cine and former chair

of surgery, University of North Carolina-Chapel Hill. He is a former Re-gent and Past-President

of the College.

placeforrotatingadvertisementsfromapprovedcommercialsponsors.Fromthehomepage,us-erscanalsoperformbasicanddetailedcontentsearches,searchforacolleague,lookforupcom-ingevents,andprovidefeedbackregardingthefeaturesandnavigationoftheportal,aswellascustomizetheirownhomepagetoincludeitemsthatinteresttheminadditiontocontentthatwillbeprovidedforthembytheCollege.

Weareverypleasedtonowbeabletoannouncethe formal launchofe-FACS.org. Obviously, itwilltakeseveralyearstobringtheportaltofrui-tion(nottomentionthefactthattheportalwillalwaysbeevolvingtomeettheincreasingneedsofitsusers),butthedevelopmentphaseandbetatesting stages have provided us with excellentfeedbackthathashelpedusmaketheCollege’sWebportalasusefulanduserfriendlyaspossibleforourmembersatthispointintime.

ThisisaveryexcitingprojectfortheAmericanCollegeofSurgeons,andwegreatlyappreciatetheResidentandAssociateSocietyandtheCom-mitteeonYoungSurgeonsforrecommendingitonbehalfoftheentiremembership.Wehopethatyouwillvisite-FACS.orgnowandonaregularbasis—ifnotdaily—inthefuture.WebelievetheWebportalwillmake it easier formembers tokeepcurrentonthewealthofinformationthatisavailableonadvancesinsurgeryandrelatedissues,andweareconvincedthatregularuseofe-FACS.organdtheinformationandfeaturesitoffers will make all of our professional lives alittleeasier.


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CPTThisarticlecontainsasummaryofchanges

inthe2006Current Procedural Terminol-ogy (CPT)* that are relevant to general

surgeryandcloselyrelatedspecialties.Remem-berthatthisarticlemaybeusefultoothersinthe office who perform coding functions. Thechangesarediscussedincodesequence.

Necrotizing soft tissue infectionAnotehasbeenaddedaftercode+11008,Re-

moval of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection,statingthatcode49568istobeusedwhenmeshisin-sertedforclosurefollowingdebridementofnec-rotizingsofttissueinfection.However,nochangehasbeenmadetothedescriptorofcode49568,Implantation of mesh or other prosthesis for in-cisional or other ventral hernia repair.Considermakinganotationinyourbookbycode49568thatitistobeusedforsuchaclosureandcross-reference that wording to the note after code+11008.Thatway,youwillrememberwhereyoufoundthelanguageintheeventofanaudit.

Skin replacement surgeryThesectionthatwasheaded“FreeSkinGrafts”

inearliereditionsoftheCPTisnowheaded“SkinReplacement Surgery and Skin Substitutes”;itcontainsnewnotesonusingthecodesandasubstantial number of new codes. Codes wereaddedforautografts/tissue-culturedautografts,acellulardermalreplacements,allograft/tissue-culturedallogeneicskinsubstitutes,andxeno-grafts.Codesforapplicationofbilaminateskinsubstitutesandallograftshavebeendeleted.

Amongotherthings,thenotestellthereader

Current Procedural Terminology:

by Albert Bothe, Jr., MD, FACS,Chicago, IL,

toseparatelyreportthesurgicalpreparationandtypeofskingraftorskinsubstitute.Theinitialwound site preparation is reported either bycode(s)15000-15001or theprimaryprocedure(forexample,radicalmastectomy).Code15000isSurgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture; first 100 sq cm or one percent of body area of infants and children,andcode+15001isforeach additional 100 sq cm or one percent of body area of infants or children. Notethatlanguage“orincisionalreleaseofscarcontracture”wasaddedtobothcodes.

Thelastparagraphofthenewnotesaysthecodesinthissectionarenottobereportedunlesstheskingraftorsubstituteissurgicallyanchoredin place. Sutures and staples have tradition-ally been used and, as time went on, surgicaltechniquesincludedsuchthingsasfibringluesandsteri-strips.Morerecently,skinsubstituteshavecometomarketthatrequirenowrappingorasimplegauzewrap.Itisinthosesituations,where no surgical anchoring is done, that thecodesinthissectionarenottobeused.

Thelasttwosentencesoftheparagraphofthenotesshouldread,“Whenanygraftingservicesareperformed in the office, the supply of skinsubstitute/graft should be reported separately.Routinedressingsuppliesarenotreportedsepa-rately.”Thenotethatappearsinthebookomitsthephrase,“anygrafting.”

Vascular proceduresThesevenCategoryIIIcodes(0033T-0049T)for

reportingplacementofanendovasculargraftfortherepairofthedescendingthoracicaortahavebeenmovedtoCategoryIcodes(33880-33891).However,thecodeshaveadditionallanguagein

and Jean A. Harris, Associate Director,Division of Advocacy and Health Policy, Washington, DC

Changes for 2006

*All specific references to CPT (Current ProceduralTerminology) terminology and phraseology are © 2005AmericanMedicalAssociation.Allrightsreserved.


17

thedescriptorandextensiveintroductorylanguagehasbeenadded,explainingwhatthecodesincludeandwhatmaybeseparatelyreported.Codes34833and34834,foropeniliacandbrachialarteryexpo-sure,havebeenmodifiedtoallowthemtobeusedforendovascularrepairofthethoracicaorta.

A new code, 36598, Contrast injection(s) for radiologic evaluation of existing central venous ac-cess device including fluoroscopy, image documen-tation and report, hasbeenestablishedtoreporttheevaluationofthepositionandfunctionofanexistingcatheter.Theprocedureincludesremovalof anyobstructivematerial, sonotesdirect theusernottoreportcode36598withcodes36595or36596,removalofpericatheterorintracatheterobstructivematerial.

Codes37184-37188wereaddedformechanicalarterialandvenousthrombectomyinperipheralvessels.Thenewmaterialalsoincludesextensivenotesexplainingwhatisincludedinthecodesandwhatmaybereportedseparately.Thenewcodeshaveabull’seyesymbolinfrontofthem,meaningthecodeincludesmoderate,orconscious,sedation.Code37209hasbeenmodifiedtopermititsuseforbothvenousandarterialcatheterexchangeduringthrombolytictherapy.Itpreviouslywaslimitedtoarterialcatheterexchange.

Finally, code 37718, Ligation, division, and stripping, short saphenous vein, and code37722,Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below,wereadded.Therearenotessayingdonotreportcodes37718or37722witheachotherorwiththeexistingcode37700,Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions. Thereisasimilarnoteun-derexistingcode37735,Ligation and division and complete stripping of long or short saphenous veins of lower leg, with radical excision of ulcer and skin graft and/or interruption of communication veins of lower leg, with excision of deep fascia.Thatnotesaysnottoreportcode37735withcodes37700,37718,37722,and37780.Thedescriptor for code37780isLigation and division of short saphenous vein at saphenopopliteal junction (separate procedure).

Bariatric surgeryCode43770wasaddedfor laparoscopicplace-

mentofanadjustablegastricbandandsubcutane-ousport.Codeswerealsoaddedforlaparoscopic

revision(code43771),removal(code43772),andremoval and replacement (code 43773) of theadjustablegastricbandcomponentonly.Laparo-scopicremovalofboththeadjustablegastricbandandsubcutaneousportiscoveredbycode43774.There are notes that say to report code 43770witha –52modifier,meaninga reduced servicewasperformed,whenonlyonecomponentisre-placedandreporttheunlistedgastriclaparoscopiccode (43659)whenremovalandreplacementofboth components isperformed.Anoteexplainsthatcode43770includesanybandadjustmentsthroughoutthepostoperativeperiod.

Arevisionwasmadetocode43848,foranopenrevisionofagastricrestrictiveprocedure,tolimitits application to gastric restrictive proceduresotherthanadjustablegastricbanding.Threenewcodeswereaddedforopenrevision,removal,andremoval and replacement of subcutaneous portonly(codes43886-43888).

Intestine, rectum, and anus proceduresAgroupoffournewlaparoscopiccodes(44180-

44188) were added for enterolysis, jejunostomyfordecompressionorfeeding,non-tubeileostomyor jejunostomy, and colostomy or skin level ce-costomy.Note that the code for enterolysishasthe phrase “separate procedure” as part of thedescriptor.Theproperwaytoreportextensiveen-terolysiswhenperformedwithanotherprocedureistoreporttheprimaryprocedurewithmodifier–22,whichindicatesanunusualproceduralservicewasdone.Yourpayorwillprobablywantacopyoftheoperativenoteandperhapsaletterexplaininghowmuchmoreworkwasinvolved.

A laparoscopic add-on code (44213) was es-tablishedformobilizationof thesplenicflexureperformedinconjunctionwithapartialcolectomy.Alaparoscopicrepaircode(44227)wasaddedforclosure of an enterostomy, with resection andanastomosis, in either the large or small intes-tine.

Thephrase“separateprocedure”wasremovedfromcode44310,Ileostomy or jejunostomy, non-tube,and44320,Colostomy or skin level cecostomy,andreplacedwithnotestellingCPTusersnottoreport 44310 and 44320 with certain specifiedcodes.

Code45395wasaddedforacompleteabdomi-noperinealproctectomywithcolostomyperformed


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laparoscopically.Code45397wasaddedforlaparo-scopicproctectomywithacolo-analanastomosisandcreationofacolonicreservoir.Thecodealsoincludesadivertingenterostomyifperformed.Acodewasaddedforalaparoscopicproctopexy(code45400)andanotherwasaddedforalaparoscopicproctopexywithsigmoidresection(code45402).There is a new unlisted laparoscopy procedurecodefortherectum(code45499).Finally,acodewasaddedforadiagnosticanorectalexaminationrequiringgeneral,spinal,orepiduralanesthesia(code45990).ThereisanoteinformingCPTus-ersnottoreportcode45990withcertainotherprocedures.

Code46505wascreatedtoreportchemodener-vationoftheinternalanalsphincter.Twocodeswereaddedtoreportthepouchadvancementofanileoanalpouchfistulaorsinus.Theyarecode46710,whichusesatransperinealapproach,andcode46712,whichusesacombinedtransperinealandtransabdominalapproach.

Category II codesCategory II codes, which were introduced in

2004,providedawayforreportingandtrackingperformance through a payor’s claims-process-ingsystem.Thesearenottraditionalprocedurecodes—theyarecodesthatgiveclinicaldataandarereportedinadditiontotheprocedurethatwasperformed.Thecodesdonothaverelativevaluesattachedtothem,theiruseisoptional,andtheymay not be used in place of Category I codes.Theyare in the formof fourdigits followedbytheletter“F.”Examplesare1000F,Tobacco use, smoking, assessed;1002F,Anginal symptoms and level of activity, assessed;and2000F,Blood pres-sure measured.

Inthe2006CPT,theCategoryIIsectionismuchmorerobustthanithasbeenpreviously,havinggonefromtwodiseaseswith14measurestosixdiseaseswiththreedozenmeasures.Equallyim-portantistheadditionoftwomodifiersthatsaythemeasurewasconsideredbut,becauseofmedi-calorpatientcircumstancesthataredocumentedinthemedicalrecord,wasnotprovided.

ThecodesarelistedinfullbytypeofserviceinthesectionoftheCPTlabeledCategoryIIcodes.In Appendix H, the measures are grouped bydiseaseandmoreinformationisgivenabouthowthey will be used. Each measure has a defined

numeratoranddenominatorthat,whenthedivi-sionisdone,representthepercentageofpatientsforwhomtheservicewasprovided.

Itisimportantthatcategorycodesbewellun-derstoodbyallphysicians,includingsurgeons,ifapayorinyourareabeginsapayforperformanceplan. Itwouldnotbesurprising if somepayorsbeginusingthecoronaryarterydiseasemeasure-mentsforpatientswhoreceivesurgicaltreatmentofthedisease.Likewise,payorscouldrequestanorthopaedicsurgeontreatingosteoarthritis,eithersurgicallyormedically,tousetheosteoarthritismeasures.

TheCentersforMedicare&MedicaidServiceshas established a series of “G” codes that it isusing ina similarvoluntary reportingprogrambeginningJanuary3,2006.AfutureBulletinar-ticlewillprovidemoredetailedinformationaboutthisprogram.

Category III codesCode0120T,Ablation, cryosurgical, of fibroad-

enoma, including ultrasound guidance, each fibro-adenomaandCode0133T,Upper gastrointestinal endoscopy, including esophagus, stomach, and ei-ther the duodenum and/or jejunum as appropriate, with injection of implant material into and along the muscle of the lower esophageal sphincter (eg, for treatment of gastroesophageal reflux disease) havebeenadded.Remember that ifaCategoryIIIcodeexistsforaprocedure,itmustbeusedinsteadofaCategoryIunlistedcode.

Dr. Bothe is associ-ate dean and executive director, University of

Chicago practice plan, Chicago, IL.


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of the 91st annualCLINICALCONGRESS

HIGHLIGHTS


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The91stAnnualClinicalCongressoftheAmerican College of Surgeons in SanFrancisco,CA,featuredadiverseassort-mentofgeneralsessionsonavarietyof

issuesofinteresttosurgeons—includingclinicalprocedures, practice-related topics, and issuesrelatedtopolicyandliability—and39postgradu-atecoursesthatpresentedlearningopportuni-tiesonthemostadvancedprocedures.

A total of 14,986 individuals attended themeeting. Among attendees, 8,986 were physi-cians; the rest included exhibitors, guests,spouses,andconventionpersonnel.

HighlightsAt the American Urological Association lec-

ture,whichimmediatelyfollowedtheOpeningCeremony, Michael D. Maves, MD, FACS,executivevice-presidentoftheAmericanMedi-cal Association (AMA), presented BrandingMedicine.Inhislecture,usingtheexperiencesoftheAMAincreatingabrandasanexample,Dr.Mavesexplainedthatabrandiswhatdefinesanorganization’splaceintheworld,andthatitcanhelpto“elevate,celebrate,andmakestronger”thefieldofmedicine.

NewlyinstalledPresidentDr.AndersonpresidedovertheConvocationSundaynight.

ACS Secretary John O. Gage, MD, FACS, bearing the Great Mace, led the processional of ACS Regents andOfficersduringtheConvocation.SeatedoneithersideoftheaislewerethesurgeonswhowerebeinginitiatedintoFellowshipthatevening.

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AlsoonMonday,James L. Cox, MD, FACS, delivered the John H. Gibbon, Jr., Lecture,SurgeryforAtrialFibrillation,andJ. Patrick O’Leary, MD, FACS,presentedSurgery’sEn-try into Its Modern Era: Depicted by the Artof the Times as the Charles G. Drake Historyof Surgery Lecture. On Tuesday, the ScudderOration on Trauma, Trauma in Transition: AFantasticVoyage,waspresentedbyC. Thomas Thompson, MD, FACS.MedicalProgressandHealthCareAccess:CanTheyBeReconciled?,the Ethics and Philosophy Lecture, was pre-sentedWednesdaybyDaniel J. Callahan, PhD.AlsoWednesday,William C. Wood, MD, FACS,presentedEvidence-BasedCancerTreatmentforPopulationsorIndividuals?,theCommissiononCancer Oncology Lecture;Timothy G. Buch-man, MD, PhD, FACS, FCCM,presentedtheI.S. Ravdin Lecture, The Times of Our Lives:Physiologic Variability during Critical IllnessandRecovery;andJonathan L. Meakins, MD, FACS,presentedtheDistinguishedLectureoftheInternationalSocietyofSurgery,Evidence-BasedSurgery:TheFuture?!AndonThursday,fortheMartinMemorialLecture,Donald Ken-nedy, PhD,presentedScienceandPolitics:HowRichaMixtureDoWeWant?

In celebration of the 100th anniversary oftheJournal of the American College of Surgeons (JACS) (originally called Surgery, Gynecology & Obstetrics), JACS hosted Centennial Sympo-sium: Cherishing the Past, Shaping the Future,whichfeaturedguestspeakersfromothermedi-caljournalsandwasmoderatedbySeymour I. Schwartz, MD, FACS,JACSEmeritusEditor.JACS andElsevier,itspublisher,hostedareceptionforattendeesimmediatelyafterthesymposium.

In conjunction with the College’s AdvancedTraumaLifeSupport®(ATLS®)program’smeet-ing, in which members from 29 countries dis-cussedpertinentissuesrelatedtotheprogram,theATLScelebratedits25thanniversary.

The College, in conjunction with the PfizerMedicalHumanitiesInitiative,presentedSurgi-calVolunteerismAwardstotwoFellowsinrec-ognitionoftheireffortsinhelpingthemedicallyunderserved.George F. Ellis III, MD, FACS, aurologistfromLongwood,FL,andfounderandchairofPrimaryCareAccessNetwork,receivedthedomesticvolunteeraward,andDomingo T.

Alvear, MD, FACS, a pediatric surgeon fromHarrisburg,PA,andfounderofWorldSurgicalFoundation,receivedtheinternationalvolunteeraward.TheawardswerepresentedbyCourtney

Dr. Alvear (left) recipient of the 2005 SurgicalVolunteerismAwardforinternationalvolunteerservice,withDr.Perea-HenzeandDr.Townsend.

Dr. Ellis (center), recipient of the 2005 SurgicalVolunteerismAwardfordomesticvolunteerservice,withDr.Townsend(left)andDr.Perea-Henze.

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M. Townsend, Jr., MD, FACS, Chair of theBoardofRegentsatthattime,andRaul Perea-Henze, MD,ofPfizer(seephotos,page22).

Another award, the 2005 Distinguished Phi-lanthropist Award, was presented in absentiato Dr. and Mrs. Robert Wayne Hobson II, FACS, by the Fellows Leadership Society. Dr.Hobsonisprofessorofsurgery,chiefofthedivi-sionofvascularsurgery,directorofthevascularfellowshipsprogram,professorofphysiology,andassociatedirectoroftheprograminvascularbiol-ogyinthedepartmentsofsurgeryandphysiologyattheUniversityofMedicineandDentistryofNewJersey.Dr. andMrs.Hobson received theaward in recognition of their establishment ofthe Robert W. Hobson II and Joan P. HobsonRemainderUnitrustandtheirmajorgifttotheCollege, as well as Dr. Hobson’s extraordinarycontributionstohiscommunity,thecountry,andtheprofessionofsurgery.

Thenewestchapter,Iran,receiveditscharter.Heshmatollah Kalbasi, MD, FACS,thefirstPresident of the Iran Chapter, accepted thecharterfromtheBoardofGovernors(seephoto,thispage).

AmemorialserviceforClaude H. Organ, Jr., MD, FACS,whopassedawayinJune2005,washeld.ThememoryofDr.Organ,the84thPresi-dentoftheAmericanCollegeofSurgeons,washonoredbyFellowsandcolleaguesintheservice,whichwasfollowedbyareception.

TheACSWebportalandcaselogsystemwerepresented forbeta testing forFellows.Attend-ees were able to see and experience first-handthesetwonewmembers-onlyonlineinformationservices.

AglanceatsurgeryofthepastwasprovidedattheMovieClassicsofthePastVideoSession,whichfeaturedvideosofsurgeriesperformedin1953,1956,and1959.

SomehighlightsoftheClinicalCongresswerereportedpreviouslyintheNovember2005issueoftheBulletin.ThepresentationoftheDistin-guished Service Award, the College’s highesthonor,toDonald D. Trunkey, MD, FACS,ofPortland,OR,isfeaturedinthatissue,aswellas the announcement of the Honorary Fellow-shipsbestowedonBruce Benjamin, MB, DLO, FRACS, FAAP; Prof. Sir Alfred Cuschieri, FRS (Edin), MD, MD(Hon), ChM, FRCS (Edin, Engl), FRCPS (Glas)(Hon), FRCSI (Hon); and Prof. Sergio Pecorelli.

Officers installedDuring the Convocation ceremony, Kathryn

D. Anderson, MD, FACS, FRCS,wasinstalledasthe86thPresidentoftheAmericanCollegeofSurgeons (see photo, page 21). Dr. Anderson isprofessor emeritus at the Keck School of Medi-cine, University of Southern California (USC),LosAngeles.

AFellowoftheCollegesince1975,Dr.AndersonisthefirstwomantobeelectedPresidentoftheAmericanCollegeofSurgeons.ShehasservedasanactiveparticipantinandleaderofnumerousCollegeactivities,includingserviceasamemberoftheBoardofGovernors(1986-1992),amember(1986-1992)andChair(1990-1991)oftheAdvisoryCouncil for Pediatric Surgery, a member of theFinanceCommittee(1992-1995),amemberoftheHonorsCommittee(1992-2002),amember(1995-2002)andChair(1998-2002)oftheOrganizationCommittee, a member of the CommunicationsCommittee(1995-2002),anex-officiomemberoftheBoardofRegents(1992-2002),ACSSecretary

Dr.Kalbasi(left),representingtheCollege’snewIranChapter,withDr.Townsend.

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(1992-2001), ACS First Vice-President(2001-2002),andACSPresident-Elect(2004-2005).

InherPresidentialAddress,which was published in theDecember 2005 Bulletin, Dr.Andersonspokeoftheneedforhumanityindeliveryofhealthcare,providinghistoricalexam-plesofcrisesinhumanityanddiscussing what she perceivesasthepresent-daycrises.

Other newly installed Offi-cers areJ. Patrick O’Leary, MD, FACS,asFirstVice-Presi-dent,andWilliam F. Sasser, MD, FACS, as Second Vice-President.

Dr.O’Learyischair,depart-ment of surgery, LouisianaStateUniversityHealthScienc-esCenter,NewOrleans,LA.AFellowsince1975,Dr.O’Learyserved as Chair (2001-2003)andVice-Chair(1999-2001)oftheExecutiveCommitteeoftheBoardofGovernors.Heservedon the Governors’ Committeeon Chapter Activities (1997-1998), liaison member: 1998-2002), the Board of Regents’Communications Committee(1999-2002), and was Presi-dentoftheLouisianaChapterof the ACS (2000-2001). Dr.O’Leary currently serves ontheAdvisoryCouncilforGen-eralSurgeryandasamemberoftheAdvisoryCommitteeonSurgicalEducationandSelf-As-sessmentProgram.

Dr.Sasser isassociate clini-cal professor of surgery, St.Louis University, St. Louis,MO. A Fellow since 1971, Dr.Sasser served as Secretary ofthe Executive Committee oftheBoardofGovernors(1998-2001), as Chair of the Gover-nors’ Committee to Study the

Dr.Jacobs(secondfromright),recipientofthe2005NationalSafetyCouncilSurgeons’AwardforSafety,withDr.Shackford(left),Dr.Ulczycki,andDr.Meredith.

Dr.Cooley(right),washonoredwiththefirstOutstandingPatientServiceAward.HeispicturedwithDr.Russell(left)andDr.Copeland.

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FiscalAffairsoftheCollege(1998-2001),andasaliaisonmemberoftheGovernors’CommitteeonSocioeconomicIssues(1997-1998)andGovernors’CommitteeonChapterActivities(1996-1998).HeservedasamemberoftheFinanceCommitteeoftheBoardofRegentsfrom1998to2001.

New Officers-ElectEdward M. Copeland III, MD, FACS, of

Gainesville,FL,wasnamedPresident-Electdur-ingtheAnnualMeetingofFellows.Dr.CopelandistheEdwardR.WoodwardProfessorofSurgeryattheUniversityofFloridaCollegeofMedicine(UFCM),Gainesville.

AFellowsince1974,Dr.Copelandhasbeenac-tivewithintheCollegeandhasheldmanyimpor-tantposts.ImmediatePast-ChairoftheBoardofRegents,Dr.Copelandhasbeenamemberofthe

Boardsince1999;hehasservedasChairoftheBoard’sFinanceCommitteeandmemberoftheHonorsCommitteesince2003.HewasSecretaryof the Board of Governors from 1994 to 1995,hasservedasVice-Chair(2001)andChair(2002-2003)oftheProgramCommittee,andwasChairof theGovernors’CommitteeonSocioeconomicIssues(1995-1996),theExecutiveCommitteeoftheBoardofGovernors(1995-1996),theMedicalMotionPicturesCommittee(1990-1993),andtheCommitteeonYoungSurgeons(1982-1983).Dr.CopelandhasalsobeenactiveontheAmericanBoard of Surgery, serving as chair (1990), vice-chair(1989),andamemberofvariouscommitteesfrom1984to1988.

AfterreceivinghisbachelorofartsinchemistryatDukeUniversity(1959),Dr.Copelandearnedhismedicaldegree(1963)atCornellUniversityMedicalSchool.Dr.Copelandthencompletedhisinternship(1963-1964)andresidency(1964-1969)attheHospitaloftheUniversityofPennsylva-nia,whereDr.Copelandalsocompletedseveralfellowships—includingaresearchfellowshipintheHarrisonDepartmentofSurgicalResearch(1966-1967)andaclinicalfellowshipthroughtheAmericanCancerSociety(1968-1969)—andwasthechiefresidentofgeneralsurgeryfrom1968to1969.Healsoservedastheadvancedseniorfellow incancersurgeryat theM.D.AndersonHospitalandTumorInstituteattheUniversityofTexasCancerCenterinHouston,from1971to1972.

Dr.CopelandwasalsoactiveasamajorintheU.S.Army,asareservecommissionedofficerin1964, then on active duty from 1969 to 1971.HeworkedintheThirdFieldHospital,Saigon,Vietnam,forwhichheearnedabronzestar,andlaterservedasassistantsurgicalconsultanttotheOfficeoftheSurgeonGeneral.

Dr.CopelandhasbeenattheUFCMsince1982.Before his current post, he was professor andchairofthedepartmentofsurgeryfrom1982to2003 and interim dean from 1996 to 1997. HehasalsoservedasthedirectoroftheUniversityof Florida Shands Cancer Center (1994-1999).Beforehis tenureatUFCM,Dr.CopelandwaswiththeUniversityofTexasMedicalSchoolinHouston, as assistant professor (1972-1973),associate professor (1973-1976), and professor(1976-1982)ofsurgery.Duringthissametime,

Dr. Debas (right), to whom the 2005 Surgical Forum volumewasdedicated,picturedwithDr.Ashley.

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ThePast-PresidentsoftheCollegemetfortheirannualluncheon.Lefttoright,frontrow:JamesC.Thompson,EdwardR.Laws,C.RollinsHanlon,OliverH.Beahrs,andFrankC.Spencer.Backrow:LaSalleD.Leffall,Jr.,R.ScottJones,M.J.Jurkiewicz,GeorgeF.Sheldon,andRichardR.Sabo.

PastrecipientsoftheCollege’smostprestigioushonor,theDistinguishedServiceAward,gatheredduringtheCongress.Lefttoright,frontrow:JohnO.Gage,JamesC.Thompson,RobertE.Hermann,LaMarS.McGinnis,Jr.,JosefE.Fischer,andC.BarberMueller.Backrow:RichardB.Reiling,FrankPadberg,J.RolandFolse,andF.WilliamBlaisdell.

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hewasassistantprofessor,professor,andclini-calprofessorattheM.D.AndersonHospitalandTumorInstitute.

Dr.Copelandhaspublishedmorethan580ar-ticlesintheliteratureandhasservedonseveraleditorial boards, including The Journal of the American College of Surgeons, The American Surgeon,The Journal of Parenteral and Enteral Nutrition,Surgical Oncology,andCurrent Opin-ion in General Surgery.

InotheractionsduringtheAnnualMeetingoftheFellows,David L. Nahrwold, MD, FACS,Chicago,IL,wasnamedFirstVice-President-Elect,andRobert E. Berry, MD, FACS,Roanoke,VA,wasnamedSecondVice-PresidentElect.

Dr. Nahrwold, a retired surgeon, has been aFellow since 1971. He has been a member oftheBoardofRegents since1995andhasbeenan active member of the Board of Governors,including member (1994-1995) and later Vice-

Chair (1995-1996) then Chair (1996-1998) oftheExecutiveCommittee.HewasalsotheChairof the Nominating Committee of the Fellows(1991-1992)andhasservedontheDevelopmentCommittee. Dr. Nahrwold has also served asSecretary and President of the PennsylvaniaChapteroftheACS.

Dr.BerryhasbeenaFellowsince1966.HewasamemberoftheBoardofGovernorsfrom1991to1997andisaPast-ChairoftheCommitteeonDevelopment.HehasalsoservedasPresidentoftheVirginiaChapteroftheACS.

The new slate of ACS Officers and RegentsoftheCollegeispicturedonpages36-39ofthisissue.

Board of GovernorsMark A. Malangoni, MD, FACS,waselected

toaninitialone-yeartermasChairoftheBoardofGovernors.M. Margaret Kemeny, MD, FACS,

Dr.Ashley(frontrow,left)withthisyear’sSurgicalForumExcellenceinResearchAwardrecipients.Frontrow,lefttoright:Dr.Ashley,Dr.Sung,Dr.Chang,Dr.Jackson,andDr.Leaphart.Backrow:Dr.Yopp,Dr.Tsung,Dr.Wang,Dr.Ghali,andDr.Stroehlein.Notpictured:Drs.TendulkarandFinan.

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was elected to an additional one-year term asVice-Chair. Julie A. Freischlag, MD, FACS,wasre-electedtoanadditionalone-yeartermasSecretary.

Karen E. Deveney, MD, FACS, waselectedto theBoardofGovernorsExecutiveCommit-tee.Re-electedtotheExecutiveCommitteewasValerie W. Rusch, MD, FACS.

Board of RegentsTheFellowsoftheCollegeelectedGerald B.

Healy, MD, FACS,tobeChairoftheBoardofRegents.Dr.Healy is otolaryngologist-in-chief,Children’sHospital,Boston,MA,andisthefirstotolaryngologist in the College’s history to beselectedtoserveasChairoftheBoard.

Dr.HealyhasbeenamemberoftheBoardofRegentssince1997andamemberoftheExecu-

tive Committee of the Board of Regents since2000(Chair,2003).HewaselectedVice-ChairoftheBoardofRegentsin2003.AsaRegent,hehasservedontheAdvisoryCouncilforOtolar-yngology–HeadandNeckSurgery(1997-2000),theMemberServicesLiaisonCommitteeoftheBoardofRegents(Chair,2003-2005),theNomi-natingCommittee(2000-2001),andtheCentralJudiciary Committee (1998-2003; Chair, 2001-2003).Inaddition,Dr.Healyservesasamemberof the Board of Regent’s Honors and FinanceCommittees(Chair,2005).

BeforehebecameaRegent,Dr.Healyservedon the Board of Governors (1990-1996) andchaired the Advisory Council for Otolaryngol-ogy–HeadandNeckSurgery(1995to1997).

ReplacingDr.HealyasVice-ChairoftheBoardofRegentsisMary H. McGrath, MD, FACS.

InternationalGuestScholars,ExchangeTravelers,andInternationalRelationsCommittee(IRC)membersmetduringtheconvention.Frontrow,lefttoright:Dr.Maffei;Dr.Schneider;Dr.Stoyanova;FumiakiTanaka,MD,PhD,Beppu,Japan,JapanExchangeFellow;andDr.Hsieh.Middlerow:Dr.Mertens;Dr.Lan;andDr.Defechereux.Thirdrow:Dr.Agarwal;Dr.Kaperonis;HaukeLang,MD,PhD,EssenGermany,GermanExchangeFellow;HugoV.Villar,MD,FACS,newVice-ChairoftheIRC;andDr.Teras.Backrow:JohnR.Benfield,MD,FACS,thenewChairoftheIRC.

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Dr.McGrathisprofessorofsurgery,divisionofplastic surgery, University of California, SanFrancisco.ShehasbeenamemberoftheBoardof Regents since 1997. College committees onwhich Dr. McGrath has been active includetheCommunicationsCommittee (Chair, 2005),CommitteeonEthics(Chair,2003),NominatingCommittee(Chair,2002),theAdvisoryCouncilonPlasticandMaxillofacialSurgery,theCommitteeonEmergingSurgicalTechnologyandEducation,theCommitteeonDevelopment,theCommitteeonPre-andPostoperativeCare,theCommitteeonEducation,and theAdvisoryCommitteeonSurgicalEducationandSelf-AssessmentProgram(SESAP).Dr.McGrathalsoservedontheBoardofGovernors(ExecutiveCommittee,1996)andonitsCommitteeonAmbulatorySurgicalCareandCommitteeonSocioeconomicIssues.

The following individuals were re-elected toadditional three-year terms on the Board ofRegents (all MD, FACS): Alden H. Harken, Charles D. Mabry, Robin S. McLeod, andCarlos A. Pellegrini.

Awards and honorsInadditiontotheawardsdescribedpreviously

inthisarticle,severalotherawardswerepre-sentedduringlastyear’sClinicalCongress.

The Commission on Cancer’s (CoC) CancerFighter Award was presented to Donald L. Morton, MD, FACS,chiefexecutiveofficeroftheJohnWayneCancerInstitute,SantaMonica,CA,andprofessoremeritusofsurgicaloncologyattheUniversityofCalifornia–LosAngeles,attheCoC’sannualmeeting.

Thefirst-everACSOutstandingPatientSer-

Dr.Feezor(center),recipientoftheResidentAwardforExemplaryTeaching,with(fromleft)Dr.Russell,Dr.Copeland,Dr.Anderson,andAjitK.Sachdeva,MD,FACS,FRCSC,DirectoroftheDivisionofEducation.

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viceAwardwaspresentedtoDenton A. Cooley, MD, FACS,arenownedcardiovascularsurgeonfromHouston,TX.TheawardwasgivenatthePresident’s Dinner by Thomas R. Russell, MD, FACS, ACS Executive Director, and Dr.Copeland(seephoto,page24).

Lenworth M. Jacobs, Jr., MD, FACS, re-ceived the National Safety Council Surgeons’AwardforServicetoSafety.Theaward,whichrecognizedDr.Jacobs’“continuouscommitmentto patient care through prevention programs,surgical excellence, and education,” was pre-sentedbySteven R. Shackford, MD, FACS, immediatepast-presidentof theAmericanAs-sociationfortheSurgeryofTrauma;John Ulc-zycki, directoroftheNationalSafetyCouncil’sTransportation Safety Group; and J. Wayne Meredith, MD, FACS,ChairoftheACSCom-mitteeonTrauma(seephoto,page24).

The 2005 Surgical Forum volume was dedi-catedtoHaile T. Debas, MD, FACS.Dr.Debas,executivedirectoroftheUniversityofCalifor-nia–SanFranciscoGlobalHealthServices,washonored with this dedication because of hisextraordinarycontributionstothefieldofsurgi-calscienceandbecauseheisanexemplaryrolemodelforyoungacademicsurgeons(seephoto,page25).

RecipientsofthethirdannualSurgicalForumExcellenceinResearchAwards—whichrecogniz-esoutstandingSurgicalForumpapers—includedthe following: Jimmy C. Sung, MD, JD, H.LeeMoffittCancer,Tampa,FL; Eric I. Chang, MD, NewYorkUniversitySchoolofMedicine,NewYork,NY; Lindsey N. Jackson, MD, TheUniversityofTexasMedicalBranch,Galveston,TX; Cynthia L. Leaphart, MD, Children’sHospitalofPittsburgh,Pittsburgh,PA; Adam Yopp, MD, TheMountSinaiSchoolofMedicine,NewYork,NY; Allan Tsung, MD, UniversityofPittsburgh,Pittsburgh,PA; Grace J. Wang, MD, Brigham and Women’s Hospital, Boston,MA; Shadi Ghali, MD, New York UniversityMedical Center, New York, NY; Michael A. Stroehlein, MD, KlinikumCologne-Merheim,Cologne, Germany; Amod Tendulkar, MD, SanFranciscoVeteransAffairsMedicalCenter,SanFrancisco,CA; andKelly R. Finan, MD, UniversityofAlabama,Birmingham,AL. TheseawardswerepresentedbyStanley W. Ashley,

MD, FACS, Chair of the Committee for theForumonFundamentalSurgicalProblems(seephoto,page27).

The International Guest Scholars for 2005were honored by the International RelationsCommittee. These scholars included the fol-lowing:Daniel M. Maffei, MD,BuenosAires,Argentina;Thierry Defechereux, MD,Liege,Belgium;Airton Schneider, MD,PortoAlegre,Brazil;Diana V. Stoyanova, MD,Sofia,Bulgar-ia,Ching-Hua Hsieh, MD,KaohsiungHsien,Taiwan;Renato A. Mertens, MD, FACS,San-tiago,Chile;Ping Lan, MD,Guangzhou,China;Gaurav Agarwal, MS,Lucknow,India;Elias Kaperonis, MD,Zografou,Athens,Greece;andJuri Teras, MD, Tallinn,Estonia (seephoto,page28).

The third annual ACS Resident Award forExemplaryTeachingwaspresentedtoRobert Feezor, MD,aPGY-7andadministrativechiefresident in the University of Florida generalsurgeryprogram(seephoto,page29). Theawardis sponsored by the Division of Education torecognize excellence in teaching by a residentandtohighlighttheimportanceofteachinginresidents’dailylives.Dr.FeezorwasselectedbyanindependentreviewpaneloftheSubcommit-teeonResidentEducationbasedonevidenceofteachingexcellence.


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V olunteerism, patient safety, commu-nicationwith themembership,andagreater influence inWashington,DC,wereonlyafewoftheCollege’sgoals

andhighlightsof2005.

New Orleans and Operation Giving BackEveryoneintheCollegewantstothankallthe

volunteersfromacrossthecountryandabroadforthesupportgivenduringthehumandisasterinNewOrleansandtheGulfCoast.Thescenesontelevisionwereheart-wrenching,especiallythehumansufferingwitnessedattheNewOrleansconvention center, where the College met forthe2004ClinicalCongress.Iamsureallofyousharedmyfrustrationandhopelessnessfornotbeingabletorespondimmediatelytotheneedsofthecitizensofthedevastatedregions.Thestoriesofheroismandsacrificethatarenowemergingattesttothekindnessandstrengthofthehumanspiritshownbysomany,includingseveraloftheFellowswhoattendedthe2005ClinicalCongressinSanFrancisco,CA.

AsofOctober,however,thejobhadjustbegun.People needed to be relocated, new physiciansfound, lives mended both physically and men-tally,studentsandresidentsallowedtocontinuetheirtraining,andtheabilityofthiscountrytorespondtoatragedywithinitsbordersstrength-enedtoensurethateverycitizenhastherightsandprotectionsprovidedbytheConstitutionoftheUnitedStatesandbytheHippocraticOatheachofushastaken.TherolethattheAmeri-canCollegeofSurgeonsshouldtakeindisastersituationswillbethoroughlyevaluatedtohaveinplaceamethodofquickresponsethroughourvolunteerprogram,OperationGivingBack,un-dertheleadershipofKathleenCasey,MD,FACS,and Paul Collicott, MD, FACS. At the ClinicalCongress, we expressed our gratitude to thesetwo individuals and their teams for providinginformationtovolunteersthroughtheOperation

GivingBackWebsiteandforcoordinatingwiththeAmericanAssociationofMedicalCollegestherelocation of surgical residents. The AmericanCollegeofSurgeonsshouldandwillbepartofthenationalresponseteamtothesedisastersinthefuture.

ACS Web portalTheCollege’snewWebportalisasecure,single

pointofentryWebsitethathasthefunctional-ityandflexibilitytocatertothedemandsofitsusers.(Seerelatedarticle,page12.)Thesinglesign-onserviceallowsuserstopersonalizeandmanagetheinformationavailabletothem.Thismembers-onlyservice isunderthedirectionofGeorgeSheldon,MD,FACS,asEditor-inChief,andLazarGreenfield,MD,FACS, asAssociateEditor.Theeditorialboard ismadeupof indi-vidualswhorepresentallthesurgicalspecialtiesandspecial interestssuchassurgicaloncology,youngsurgeons,andhistoryandphilosophy,tonameafew.TheWebportalwasintroducedatthe2005ClinicalCongress,andIhopeallattendeeshadtheopportunitytovisitthedemonstrationbooth.Someofthehelpfultoolswillbeelectroniccaselogs,onlinesystemsfortrackingcontinuingmedical education credits, scientific discussionforums,andclinicalvideos.

TimothyEberlein,MD,FACS,hasdoneafan-tasticjobasthenewEditor-in-ChiefoftheJour-nal of the American College of Surgeons (JACS),andIamsurehewouldappreciateanyandallinputfromthemembers.YounowreceiveJACSalongwiththeBulletininonepackage.Inthelastyear,therehasbeena30percentincreaseinsub-missionstoJACS,andtimeforfirstdecisiontopublishhasbeendroppedinsomecasestoaslittleastwoweeks.JACSisnowoneofthetimeliestpublicationsinexistence.Ameasureofitsimpactisthe12percentincreaseinnumberofarticlespublishedanda20percentincreaseincitations.BecauseJACSistheofficialscientificjournalof

by Edward M. Copeland III, MD, FACS, Gainesville, FL

R eport of the Chairof the Board of Regents


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theAmericanCollegeofSurgeons, thosehigh-impactarticlesthatneedrapiddisseminationtothelaypresscanberelayedthroughtheCommu-nicationssectionoftheCollege,auniquefeatureonlyavailabletoJACS.

NSQIPUnder the direction of R. Scott Jones, MD,

FACS, the ACS National Surgical Quality Im-provementProgram(NSQIP)continuestogrowasexpected.Approximately80hospitalsare inthe enrollment stage and the volume of casesneededforenrollmenthasbeenloweredsothatsmallerhospitalscannowparticipate.Amulti-specialtymodelhasbeendevelopedthatallowsthesehospitalstocollectdataonurology;neu-rosurgery; orthopaedics; ear, nose, and throat;plasticsurgery;thoracicsurgery;andgynecologicsurgery.Thegoalistoreducesurgicalmorbidityandmortalitybyinstitutingbestpracticemeth-odsnationwide.Datacurrentlybeingreviewedshow that surgical morbidity was significantlyreducedinthepopulationstudied.TheCentersfor Medicare & Medicaid Services (CMS) Im-provementProgramisexpectedtobefunctionalthismonth.TheACSNSQIPwillberecognizedby CMS, thus providing further incentive forhealthcaresystemstoenrollintheNSQIP.

ACOSOGThe American College of Surgeons Oncology

Group (ACOSOG) received continued fundingfromtheNationalInstitutesofHealth.SpecialthanksweregiventoSamuelWells,MD,FACS,whoinitiallyorganizedthegroupandcompletedthesuccessfulfundingrenewalprocess.HehasnowsteppeddownastheChairandHeidiNel-son,MD,FACS,Rochester,MN,andDavidOta,MD,FACS,Durham,NC,arethenewCo-Chairs.Collaborative resource management amongACOSOG, Duke University, and the NationalCancer Data Bank of the American College ofSurgeonshasbeenstrengthened.

Meetings and conventionsIn the College’s role as a surgical umbrella

organization,andwiththehelpofallCollegesup-portservices,ourMeetingsandConventionstaffcontinuestoprovidemeetingand/orassociationmanagement quite successfully for the South-

easternSurgicalCongress,PacificCoastSurgicalAssociation,andthecombinedOtolaryngologicalSpringMeetingandtheAmericanLaryngologicalAssociation.AtCollegeheadquartersinChicago,rentalspaceandsupportservicesareprovidedfortheSocietyforVascularSurgeryandrentalspacefortheSocietyofThoracicSurgeonsandtheAmericanBoardofThoracicSurgery.

Practice managementAcommitmenttopracticemanagementcontin-

uestobeahighpriority.ThePracticeManage-ment Course for surgeons was taught to ravereviews at both the Clinical Congress and theSpringMeeting.TheDivisionofEducationhaspublishedatwo-volumesetofCD-ROMsaimedatresidentsandyoungsurgeons.

ACS-SurgeonsPACThe American College of Surgeons Profes-

sionalAssociationandPoliticalActionCommit-tee(ACS-SurgeonsPAC),underthedirectionofAndrewWarshaw,MD,FACS,hashadsuccessininfluencinglegislatorsandtheirstaffmembersonissuessuchasMedicarereimbursement,tortreform(especiallyatthestatelevel),andresidentworkhours.ThePAC is completing its secondyear in existence and anyone who doubts itsvalueshouldinviteDr.Warshaworamemberofhiscommitteetopresentthedatatoyourstatechapter.Ashasbeennoted,ifeverymemberofthe College donated just $250 to the PAC, thesumtotalofmoneyavailableforusewouldmore

continued on page 63

Dr. Copeland is Edward R. Woodward Professor, department of surgery, University of Florida College of

Medicine, Gainesville, FL, and President-Elect

of the College.


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TheprimaryresponsibilityoftheBoardofGovernorsistoserveasthecommu-nications link between the Fellows oftheCollegeandtheCollege’sleadership.

MembersoftheBoardofGovernorsareallocatedbystate,province,orcountrytorepresenttheFellows within. The Governors are surveyedannuallyinorderforACSleadershiptobettergaugetheclimateofthesurgicalenvironmentin which ACS Fellows practice. At its annualbusinessmeetingatthe2005ClinicalCongressinSanFrancisco,CA, theBoardreviewedtheresultsof thisyear’s survey.Theresults indi-catedthatthehighest-rankingissuesofconcerntoourFellowsareasfollows:

• Professionalliability/tortreform• Physicianreimbursement• Healthcarereform• Graduatemedicaleducation• PhysiciancompetencymeasurementTheBoardofGovernorsalsoreviewedtheCol-

lege’sactivitiesinresponsetothe2004survey.Overall,theFellowsarepleasedwiththeworkthattheCollegeisdoingontheirbehalf.

TheBoardalsoheardreportsfromitssixcom-mittees:Blood-BorneInfectionandEnvironmentalRiskcontinuestosubmitmanuscriptsforpublica-tionintheJournal of the American College of Sur-geons,ChapterActivitiescompleteditsrecruitmentofStARs for itsStateAdvocacyRepresentativesprogram,FiscalAffairsfinalizedalong-termduesstrategy, Physician Competency and Health willdevelop a statement on economic credentialing,Socioeconomic Issues nominated two recipientsthisyeartoreceivesurgicalvolunteerismawards,and Surgical Practice in Hospitals and Ambula-tory Settings continues to work on revisions totheGuidelines for Optimal Ambulatory Surgical Care and Office-Based Surgery. Inadditiontotheongoingprojects,thecommitteesalsocontinuetosubmit educational programs for the upcomingClinicalCongressandSpringMeeting.

Operation Giving BackOperation Giving Back—another spin-off of

the Board of Governors—was officially intro-duced at the 2004 Clinical Congress, and hashad a busy and exciting year. Relationshipshave been established on the domestic andinternationalfronts,volunteerresourceshavebeenresearchedandcompiled,theonlineWebresource has been revised and expanded, andworkhasbeeninitiatedwiththeACSCommit-teeonResidentEducationtowardthecreationofvolunteeropportunitiesforresidents.

InresponsetotheravagesofMotherNature,theprogramwasextendedwellbeyond itspri-mary mission when it mobilized surgeons inresponsetotwomajornaturaldisastersin2004and2005.TheWebsitequicklyadaptedtoserveas a means of conveying timely and pertinentinformationoneverythingfrompointsofcontactforrespondingtocontinuityofcareforaffectedpatients.Theimmediateandoverwhelmingre-sponseofACSmembersisclearandcompellingevidenceoftheneedforinformationonhowtoassistinsuchsituations.

Equally compelling was the difficulty expe-

R eport of the Chairof the Board of Governors

by Courtney M. Townsend, Jr., MD, FACS, Galveston, TX

Dr. Townsend is professor and chair-man, department of

surgery, University of Texas Medical Branch,

Galveston, TX.

continued on page 63


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ItremainsatruepleasureformetocontinueasyourExecutiveDirectoroftheCollege.Ihave now nearly completed my sixth yearinthisposition.Ihavefoundtheplanning

sessionsandthereorganizationoftheCollegetobe critically important as we attempt to createchangesthatwillimprovetheenvironmentforoursurgicalpatients.Itisquiteremarkabletodaytoobservethepaceoftransformationinhealthcare,whether that change concerns political issues,education, or, ultimately, quality improvementandsafety.IdobelievethatwearebeginningtoseesometangibleresultsfromtheeffortsthattheCollegehasputforthoverthelastseveralyears,particularlyintheareaofquality,sothatwecanbettermeetthechallengesthatfaceus.

The late Claude H. Organ, Jr., MD, FACS,became President of the College in October2003,andheoftensaidhewantedhistermtoberememberedasthe“YearoftheResident.”IdobelievethattheCollegeistrulyaddressingtheneedsofyoungsurgeonsthroughourResidentandAssociateSociety,andwearealsoreachingout to medical students. Many of those youngpeoplewere inattendanceatthe2005ClinicalCongressinSanFrancisco,CA,andspecificses-sionshadbeenorganizedforthem.WecontinuetoaddtruevaluetobecomingamemberoftheAmericanCollegeofSurgeonssothatresidentscanappreciatetheimportanceofjoiningearlyintheirtraining.Educationalproducts,freeatten-danceatmeetings,subscriptionstoourvariouspublications,andonlineaccesstoACS Surgery: Principles & PracticeareonlysomebenefitsofResident membership. I am pleased to reportthatin2005wehadasignificantincreaseinthenumberofresidentsapplyingformembership.

Workingwiththevarioussurgicalboards,weareattemptingtoinformourFellowsaboutthechangesinmaintenanceofcertificationandmain-tenanceoflicensure.Themorefrequentneedtodocument continued professional development

and linking it to one’s practice will certainlybecomeastandardforthefuture.Themeansofmeetingtherequirementsinthesixcoreareasof competencyhave led tovariouscoursesandprogramstheCollegehasdeveloped.HopefullytheywillbeofvalueasFellowsinalldisciplinesmeettheneedsofthefuturebymaintainingtheircertificationandcompetency.Itwillbeamuchmorevigorousprocessthatwillrequireappropri-atedocumentation,asituationthatIbelievewillbesomewhatexpeditedbytheuseofelectronictoolssuchastheCollege’sWebportal.

Another major thrust of the College todayis the ideaofaccrediting institutionsbasedondiscipline-specific care of surgical patients. Wehave a long history of doing such work. TheCommissiononCancerhaslongverifiedcancercentersthroughouttheU.S.,andtherearenowmorethan1,400centersaccreditedthroughourprograms.Wehavealsobeensuccessfulinveri-fyingwithtraumacentersandvariouslevelsofcarethatcanbedeliveredatinstitutions.Cur-rently, there isvery real interest in lookingatotherareastheCollegemightaccredit,suchasbariatricprogramsandbreastcenters—thelistcouldpotentiallygoonandon.Wearetryingtoimplementthiseffortinacollaborativefashionbydealingwiththevariousstakeholdersinthesenew areas where there may be some disparitywithrespecttothequalityofcare.Thereseemstobeaveryrealneedforaprofessionalgrouptobeginaccreditinginstitutionsaroundsystemsofcareforsurgicalpatients.

A major movement in Washington revolvesaroundthecurrentpaymentstructureforMedi-careandhowtheprogramexpectstopayphysi-ciansfortheirservicesinthefuture.Payingforperformance—or,consumer-driven,value-basedpurchasing—linkshigh-qualitycaretopayments.Acorrectionorfixinthecurrentsystemseemsinextricablyassociatedwiththisconcept.Clearly,as a College, we need to look seriously at this

by Thomas R. Russell, MD, FACS, Chicago, IL

R eport of theExecutive Director


34

conceptwithrespecttosurgicalproceduresandtoattempttodevelop(forinpatientsaswellasoutpatients)themeanstoevaluatesurgicalout-comesorprocessesofcareleadingtohighquality.Wemustbeattheforefrontofdevelopingthesestandards to assist our surgeons—an outcomethatultimatelywillbenefitthesurgicalpatient.ProgramssuchastheNationalSurgicalQualityImprovementProgramandtheCaseLogSystem,whichwasshowcasedattheClinicalCongress,aresignificanteffortsonourpart.

Intheareaofeducation,itisbecomingincreas-ingly evident as we listen to Fellows and ourGovernors that Web- and video-based learningwillbecomeevermoreimportantasthehealthcaredollarsshrinkandsurgeonshavelessdiscre-tionaryfundsfortraveltodistantmeetings.Wewillattempttocontinuetodevelopthesetypesof educational products and are in the forma-tivestagesofdevelopingtheAmericanCollegeofSurgeons’AccreditedEducationalInstitutes,whichwillbeestablishedacrossthecountryfordidactic and hands-on training. These will beplaceswheresurgeonscanaccesseducationalma-terialclosetowheretheyliveinacost-effectivewayandparticipateintheeducationalactivitiestheyneedinordertoadvanceandimprovetheirpractices.

Wearecontinuingtotrytoincreasethevisibil-ityoftheAmericanCollegeofSurgeonsthroughcommunicationsvehiclessuchasSurgery News,the Bulletin, ACS NewsScope, and, of course,theJournal of the American College of Surgeons.Electronictoolsalsofurtherourabilitytoreachout to our Fellowship. We are attempting tomarkettheCollegeandletthepublicknowmoreaboutwhatwearedoingthroughpressreleasesandbyrespondingtoinquiriesfromthepublic.

Finally,inthespiritofthe“YearofUnity”asoutlinedbyourImmediatePast-President,Ed-wardR.Laws,MD,FACS,theCollegeisworkingdiligentlywithmanyoftheotherstakeholdersinhealthcareinordertoreallycollaborateandcooperatewiththeirefforts.WehaveacompletecomplementofdelegatestotheAmericanMedi-cal Association’s House of Delegates, and thisyear we have taken over the administrativeactivitiesofrunningtheSurgicalCaucus,whichmeetsduring theHouseofDelegates sessions.Wecontinuetohavestrongrelationswithmany

otherhealthandmedicalsocieties,includingtheJointCommissiononAccreditationofHealthcareOrganizations, as well as with industry. It isclearthattheproblemsinhealthcaretodayaresosignificantandcomplexthatnoorganizationcanpossiblydealwith resolving someof theseimportantproblemsalone.

Again, it is a true privilege to serve as yourExecutiveDirectorasweattempt to representthesurgicalcommunityandforgeabetterhealthcaresystemthatultimatelywillbenefitpatientswhorequiresurgicalcareandtreatmentinourhospitalsandoutpatientsettings.

Dr. Russell is Executive Director of

the College.


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Officers/Officers-Elect

ACS Officers and Regents

John L. CameronTreasurerGeneral surgeryProfessorandchair,departmentofsurgery,TheJohnsHopkinsUniversitySchoolofMedicineBaltimore, MD

John O. GageSecretary

General surgeryPrivatepractice

Pensacola, FL

William F. SasserSecond Vice-PresidentThoracic surgeryAssociateclinicalprofessorofsurgery,St.LouisUniversitySt. Louis, MO

Kathryn D. AndersonPresidentPediatric surgeryProfessor emeritus, department of surgery,University of Southern California Los Angeles, CA

J. Patrick O’LearyFirst Vice-President

General surgeryChair,departmentofsurgery,

LouisianaStateUniversityHealthSciencesCenter

New Orleans, LA

David L. NahrwoldFirst Vice-President-ElectGeneral surgeryEmeritusprofessorofsurgery,FeinbergSchoolofMedicine,NorthwesternUniversityChicago, IL

Edward M. Copeland IIIPresident-Elect

General surgeryEdwardR.Woodward

Professor,departmentofsurgery,UniversityofFlorida

CollegeofMedicineGainesville, FL

Robert E. BerrySecond Vice-President-

ElectThoracic surgery

Professoremeritusofsurgery,UniversityofVirginiaSchool

ofMedicineRoanoke, VA


36

A. Brent EastmanGeneral surgery

Chiefmedicalofficer,ScrippsHealth,andN.PaulWhittier

ChairofTrauma,ScrippsMemorialHospital,

La Jolla, CA, andclinicalprofessorofsurgery,

UniversityofCalifornia,SanDiego

San Diego, CA

Board of Regents

L. D. BrittGeneral surgery BrickhouseProfessorandchair,departmentofsurgery,EasternVirginiaMedicalSchoolNorfolk, VA

Barbara L. BassGeneral surgery

Chair,departmentofsurgery,MethodistHospital

Houston, TX

Gerald B. HealyChairOtolaryngology–head and neck Otolarynogologist-in-chief,Children’sHospitalBoston, MA

H. Randolph BaileyColon and rectal surgeryClinicalprofessorandchief,divisionofcolonandrectalsurgery,UniversityofTexasHealthScienceCenterHouston, TX

Bruce Douglas BrownerOrthopaedic surgery

Gray-GosslingProfessorandchairman,departmentof

orthopaedicsurgery,UniversityofConnecticut

HealthCenter,Farmington, CT,

anddirectoroforthopaedics,HartfordHospital,

Hartford, CT

Martin B. CaminsNeurological surgeryClinicalprofessorofneurologicalsurgery,MountSinaiHospitalandMedicalSchoolNew York, NY

Mary H. McGrathVice-Chair

Plastic surgery Professorofsurgery,

divisionofplasticsurgery,UniversityofCalifornia–San

FranciscoSan Francisco, CA


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Board of Regents

Jack W. McAninchUrology

Professorofurology,UniversityofCalifornia–

SanFrancisco,andchiefofurology,

SanFranciscoGeneralHospital

San Francisco, CA

Alden H. HarkenCardiothoracic surgery

Professorandchairman,departmentofsurgery,

UniversityofCalifornia–SanFrancisco,EastBay

Oakland, CA

Josef E. FischerGeneral surgery

Professorofsurgery,HarvardMedicalSchool,andchairmanofsurgery,

BethIsraelDeaconessMedi-calCenter

Boston, MA

Charles D. MabryGeneral surgeryPrivatepracticePine Bluff, AR,andassistantprofessorofsurgery,practicemanagementadvisortothechairman,departmentofsurgery,UniversityofArkansasforMedicalSciencesLittle Rock, AR

Richard J. FinleyGeneral surgery Professorandhead,divisionofthoracicsurgery,UniversityofBritishColum-biaFacultyofMedicineVancouver, BC

Barrett G. HaikOphthalmic surgeryChair,departmentofophthal-mology,UniversityofTennesseeHealthScienceCenter,Col-legeofMedicineMemphis, TN


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Board of Regents

John T. PreskittGeneral surgery

Attendingsurgeon,BaylorUniversity

MedicalCenterDallas, TX

Carlos A. PellegriniGeneral surgery

HenryN.HarkinsProfessorandchairman,

departmentofsurgery,UniversityofWashington

Seattle, WA

Karl C. PodratzGynecology (oncology)JosephI.andBarbaraAsh-kinsProfessorofSurgery,andprofessorofobstetricsandgynecology,MayoClinicRochester, MN

J. David RichardsonVascular surgeryProfessorofsurgeryandvice-chairman,departmentofsurgery,Uni-versityofLouisvilleSchoolofMedicineLouisville, KY

Thomas V. WhalenPediatric surgery

Professorofsurgeryandpediatrics,andchiefof

pediatricsurgery,RobertWoodJohnsonSchool

ofMedicineNew Brunswick, NJ

Robin S. McLeodColon and rectal surgeryProfessorofsurgeryandhealthpolicy,managementandevaluation,UniversityofToronto,andhead,divisionofgeneralsurgery,Mt.SinaiHospitalToronto, ON


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Collegenews

Duringthelastseveralmonths,the citizens of Louisiana haveexperiencedandlearnedmuch.Intimesofpersonalorsocietaldisaster,thereoccursapreciousopportunityforthoseindividualswhoareadverselyaffected.Itisperhapsonlythenthattheyareabletoidentifyandfullyappreci-atethosefriendswhowilluncon-ditionallystandbythem.

ItisimportantfortheFellowsoftheCollegetoknowthattensofthousandsoftheircolleaguesindividually came, sent, or of-feredtocometotheaidofLoui-sianansduringtheaftermathofHurricaneKatrina.Louisiana’scaresbecame their concern. Inthe first 48 hours alone, morethan50,000hitswere receivedon the College Web site fromFellowswhounderstoodthene-cessityofconfrontingthefierce

urgencyofnow,whounderstoodthatintheunfoldingoflivesandopportunity,thereissuchathingasbeingtoolate.ThomasR.Rus-sell,MD,FACS,ACSExecutiveDirector, andPaulE.Collicott,MD,FACS,Director,DivisionofMemberServices,havealsomadethemselvesavailabletorepresen-tativesofboththeLouisianaandMississippiChaptersinordertoexplore still other avenues inwhichtheCollegemaybeofhelp.These discussions have beenfruitfulandarecontinuing.

Members of the Administra-tion of the State of LouisianahaveaskedthatIcastaboutandfindwordstoexpressourthank-fulnessanddepthofaffectionforthose surgeons who have beenfriendstousduringourordeal.IsupposethatnobetterwordsmaybefoundthanthoseShake-

spearechoseforPoloniustoof-ferinadvicetohissonLaertes,concerning the value of a trueandlastingfriendship:

Thosefriendsyouhave,andtheirfriendshiptested,Thengrapplethemtoyoursoul,withhoopsofsteel. —Hamlet,ActI,SceneIII

ThecitizensofLouisianawillnot forget their friends amongthe American College of Sur-geons.Pleaseknowthatshouldthe necessity ever arise, weLouisianansmaybecountedontoupholdourpart of a specialfriendship’sbargain.

Dr. Johnson is professor of surgery, Louisiana State University Health Sciences Center, Monroe, LA, and Pres-ident of the ACS Louisiana Chapter.

A “thank you” from Louisianaby Lester W. Johnson, MD, FACS, Rayville, LA

WelcometothefirstinaseriesofmonthlyarticlesontheJointCommission on Accreditationof Healthcare Organizations(JCAHO).Eachmonth,adiffer-entarticlewillfocusonJCAHOactivities that are relevant tosurgeons.Formoreinformationortosignupfore-mailnewslet-tersandinformationonJCAHO,visitwww.jcaho.org.

JCAHOtracesitsrootsback

A look at JCAHO

The Joint Commission and the ACSnearlyacenturytothefound-ingoftheAmericanCollegeofSurgeons.Theworkofvisionarysurgeon Ernest Amory Cod-man,MD,FACS,ofBoston,MA,promptedtheACStolaunchahospital standardization pro-gramin1917.Inthe1950s,theACS transferred the programto the newly formed JCAHO,where three members of theboard of commissioners are

stillnominatedbytheACS.For2006, the three ACS commis-sionersforJCAHOareLaMarS.McGinnis,Jr.,MD,FACS,DavidL. Nahrwold, MD, FACS, andKurtNewman,MD,FACS.

In the more than 50 yearssinceitwasestablished,JCAHOhas changed names, expandeditsscope,andearnedareputa-tionasaninternationalleaderinpatientsafetyandquality.


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April23–26

34th Spring Meeting to be held in Dallas, TX

TheAmericanCollegeofSurgeonsinvitesyoutoattendits34thAnnualSpringMeeting,whichwillbeheldApril23–26,2006,attheWyndhamAnatoleinDallas,TX.

To emphasize its strong support of generalsurgery, the American College of Surgeons de-votesitsannualSpringMeetingtotheinterestsandneedsofthepracticinggeneralsurgeon.Theobjectiveofthismeetingistoprovidethreedaysofcomprehensivelearningonthelatestclinicalandpracticemanagementtopicsvitaltoprovid-ingoptimal surgical care.At the conclusionoftheSpringMeeting,participantswillpossessanenhancedunderstandingofthemultiplefacetsofsurgicalcarethatcanbeusedbothtoraisethestandardsofsurgicalpracticeand improvethecareofthesurgicalpatient.

The College and the Society of AmericanGastrointestinalEndoscopicSurgeons(SAGES)willco-sponsorjointsessions,ACS/SAGES2006Assembly:InflammatoryBowelDiseaseandTheChangingFaceofSurgicalEducation:WhatDoesItMeantoSurgeonsinPractice?onWednesday,April26.ACSandSAGESareholdingtheirre-spectivemeetingsinaback-to-backformatatthesamelocation.Respondingtotheneedsofgeneralsurgeons, this format provides an opportunityforparticipantstoattendtwoexceptionalsurgi-calmeetingsandviewmorediversecommercialexhibits cost-effectively within one trip. TheACS Spring Meeting will be held April 23–26andtheSAGESmeetingdatesareApril26–29.Participantscanregisterforeachmeetingateachorganization’srespectiveWebsite.

The Advisory Council for General SurgeryhasplannedaprogramfortheSpringMeetingthatwill beof interest toall general surgeonsand residents. Beginning on Sunday, April 23,the Resident Programs will be held, includingACS Resident Members’ presentation of hy-pothesis-testing research at Clinical AbstractPresentations by Residents and unusual cases

atSpectacularCasesbyResidents.AtSurgicalJeopardy,teamsofsurgicalresidentsfromacrossthecountrywillcompetewithoneanothertotesttheirsurgicalknowledge.

OnMonday,April24,theACSwillpresenttheExcelsior Surgical Society/Edward D. ChurchillLecture, featuring Jay L. Grosfeld, MD, FACS,andACSHighlightsfromthe2005ClinicalCon-gress Video-Based Education Sessions in SanFrancisco,CA.

OnSundaythroughWednesday,GeneralSes-sion highlights include the following: CurrentEvaluationoftheAcuteAbdomen;ManagementoftheGeriatricSurgicalPatient;PayforPerfor-


41

Preliminary ProgramProgramissubjecttochange.

General Sessions

Sunday, April 23

8:00–9:00amThe Operating Room of the Future (GS01)moderator: RichardM.Satava,Jr.,MD,FACS,Seattle, WA

Theoperating roomof the future takesadvantageofadvances in robotic technologies.Thenewroboticscrubnurse(Penelope)fromColumbiaUniversityandColumbiaPresbyterianMedicalCenterdemonstratestheefficiencyofsuchrobots.Currentresearchisunderway indevelopinganoperatingroomwithnopeoplepresent (except the patient), in which the surgeoncontrolsnotonlytheintuitivesurgicalrobotbuthasautomatictoolchangersandautomaticsupplydispens-ersthatarevoicecontrolled.Thisfreesthescrubandcirculatingnursesformoreintellectuallychallengingduties than simply passing instruments or supplies.Implicationsforprehospitalandmilitaryapplicationsareconceptualized.

9:00–10:30amClinical Abstract Presentations by Residents (GS02)co-moderators: StevenD.Wexner,MD,FACS,Weston, FL BarryJ.Jenkins,MD,Augusta, GA

Theauthorsofabstracts(surgicalinvestigatorsin-training)willpresentsummariesofhypothesis-testingresearch, completed or in progress, not previouslypresentedorpublished.

9:00–10:30amCurrent Evaluation of the Acute Abdomen (GS03)moderator: DavidV.Feliciano,MD,FACS,Atlanta, GA

This session will provide an overview of the threecommoncausesofacuteabdomenandtheinfluenceofnewerdiagnosticmodalitiesonthetimingofdiagnosisandinitiationoftherapy.

10:45am–12:15pmSpectacular Cases from Residents (GS04)

mance:WhatYouShouldKnow;UsingBestEvi-dencetoImprovetheOutcomesofYourGeneralSurgeryPatients;UpgradingYourGeneralSur-geryPractice;andIntroductionoftheACSWebPortalforthePracticingGeneralSurgeon.

Also,forthefirsttime,coffeewillbeavailableto attendees at various times throughout themeeting.

ThemeetingwillbeheldattheWyndhamAna-tole,located20minutesawayfromtheDallas-FortWorth Airport. In addition to being a premiermeetingfacility,thehotelfeaturestenniscourts,an 80,000 square-foot spa and fitness center,boutiques,aprivateseven-acreparkwithjoggingtrack,andseveraldiningoptions.

Makeplansnowtoattendthisimportantmeet-ing.InformationregardingtheGeneralSessionsandregistrationisincludedinthisbooklet.Onlineregistrationopensthismonthatwww.facs.org.

ACS Advisory Council for General Surgery

chair:MarkA.Malangoni,MD,FACS,Cleveland, OHvice-chair:DavidV.Feliciano,MD,FACS, Atlanta, GADeborahL.Aaron,MD,FACS,Kelchikan, AKLindaM.Barney,MD,FACS,Dayton, OHKennethE.Chandler,MD,FACS,Decatur, ALJosephB.Cofer,MD,FACS,Chattanooga, TNThomasH.Cogbill,MD,FACS,La Crosse, WIC.SuzanneCutter,MD,Long Island City, NYJamesA.Edney,MD,FACS,Omaha, NERichardJ.Finley,MD,FACS,Vancouver, BCMichaelJ.Hart,MD,FACS,Seattle, WAA.LetchKline,MD,FACS,Biloxi, MSJohnK.MacFarlane,MD,FACS,Vancouver, BCAnthonyA.Meyer,MD,FACS,Chapel Hill, NCFabrizioMichelassi,MD,FACS,New York, NYStephenE.Olson,MD,FACS,Burns, ORVictorE.Pricolo,MD,FACS,Providence, RIA.FrederickSchild,MD,FACS,Miami, FLJoseL.Sorrentino,MD,FACS,San Juan, PRMarcK.Wallack,MD,FACS,New York, NY

staff:PaulE.Collicott,MD,FACS,Chicago, ILMarkPeterson,Chicago, IL


42

co-moderators: A.FrederickSchild,MD,FACS,Miami, FL JuanC.Paramo,MD,FACS,Miami Beach, FL

Extraordinarycaseswillbepresentedbyresidentstoagroupofexpertpanelistsforaninteractivediscussion.

10:45am–12:15pmEverything You Wanted to Know about the Spleen (GS05)moderator:H.LeonPachter,MD,FACS,New York, NY

Fordecades,thespleenhascapturedtheimaginationof poets, physicians, and surgeons. Among its manyfunctions,thespleenfiltersoutagedbloodcellsandisconsideredanintegralorgancloselyassociatedwiththeabilitytofightinfection.Alternatively,thespleenmaybecomeinvolvedbyavarietyofhematologicconditions.Manyoftheseconditionsareeithercompletelyorpar-tially relieved by removal of the spleen (autoimmunethrombocytopenicpurpura). In other pathologic conditions such as myelofibro-sis,and insomeof the leukemias, splenectomy,whilenot curative, allows for patient comfort, reduces theneedfortransfusionrequirements,andfacilitatestheadministrationofchemotherapeuticagents.Theobjec-tiveofthecourse isto: (1)reviewcurrent indicationsforsplenectomy;(2)delineateadvancesinlaparoscopicsplenectomyanditspitfalls;(3)detailmethodsofsplenicpreservationinthetraumaticandnontraumaticsetting;and(4)explorevariousmethodsinthemanagementofspleniccyststhatincludecystectomywithoutsplenec-tomy, decapsulation, and guidelines for laparoscopicapproaches.

1:30–3:00pmEndoscopic Approaches to Upper Gastrointes-tinal Bleeding (GS06)moderator:GregoryV.Steigmann,MD,FACS,Denver, CO

Theobjectiveofthissessionistounderstandcur-rentendoscopicmethodsandtechniquesfordiagnosisandtreatmentofuppergastrointestinalbleeding,aswellasmanagementofrecurrentbleedingafterinitialendoscopictreatment.

1:30–3:00pmPalliative Care (GS07)moderator:AnneC.Mosenthal,MD,FACS,Newark, NJ

Thissessionwillfocusonthecommonandessentialskillsinend-of-lifecareforthepracticingsurgeon.At-

tendeeswilllearneffectivecommunicationskillsandbasicstepsnecessarytoconductthe“donotresusci-tate”discussion,howandwhentowithholdandwith-drawlifesupport,andhowtocarefortheimminentlydyingpatientinthelastdaysoflife.

1:30–4:00pmSurgical Jeopardy (GS08)moderator: MarkW.Bowyer,MD,FACS,Burke, VA

Sessionattendeeswillpittheirsurgicalknowledgeagainst the best and brightest resident teams fromaroundthecountrywhowillbecompetingwitheachotherina“Jeopardy”-styleformat.AlargenumberofquestionswillbedrawnfromtheSurgicalEducationand Self-Assessment Program so attendance at thissessionwillbeofvaluetosurgeonspreparingfortheirboardexaminations.

3:30–5:00pmManagement of the Geriatric Surgical Patient (GS09)moderator: Ronnie A. Rosenthal, MD, FACS, New Haven, CT

Attendees will learn what special factors must beconsideredinpreoperativedecisionmaking,intraop-erativemanagement,andpostoperativecareofelderlysurgicalpatients.

3:30–5:00pmOutcomes for Bariatric Surgery (GS10)moderator: Edward H. Livingston, MD, FACS, Dal-las, TX

TheAmericanCollegeofSurgeonsandtheAmericanSocietyforBariatricSurgeryhavedevelopedbariatricsurgerycentercertificationprograms.Representativesfrombothorganizationswilldiscussthedifferencesandcommon ground between the two programs. Recentpublishedstudieshavedemonstratedrelativelyhighmortalityratesforhigh-riskbariatricsurgerypatients.Lackingfromthesestudieshasbeenguidanceregard-ingriskstratificationforprospectivebariatricsurgerypatients. Proposed risk indices for these patients,allowing for prospective risk assessment of patientsundergoingtheseoperations,willbediscussed.

Monday, April 24

8:00–9:30amCurrent Management of Sigmoid Diverticulitis


43

(GS11)moderator:DeborahA.Nagle,MD,FACS,Philadel-phia, PA

This session will address the standard of careevaluation and treatment of sigmoid diverticulitisandevolvingareasofmanagement.

8:00–9:30amPay for Performance: What You Should Know (GS12)moderator: William A. Rough, MD, FACS, Mount Holly, NJ

Payforperformance(P4P)willbethemostradicalchangeinphysicianreimbursementsincetherelativevalue-basedsystemwasintroduced.Thispanelpre-sentationwillprovideup-to-the-minuteinformationtopracticingsurgeonsthatwillallowthemtounder-standthedetailsofP4Pandconsideradjustmentsintheirofficetobesuccessfulunderthisnewsystem.Qualityindicators,measurement,andreportingwillbe discussed, including ACS programs such as theNationalSurgicalQualityImprovementProgram.TheinteractiverolesoftheCentersforMedicare&Med-icaidServices,privateinsurers,surgeons,hospitals,andpatientsinP4Pwillalsobeexploredwithampletimefortheaudiencetodirectspecificquestionstothepanel.

8:00–9:30amVenous Disease (GS13)moderator:AnthonyJ.Comerota,MD,FACS,Toledo, OH

Considerableadvanceshavebeenmadeinevaluationandtreatmentinpatientswithacuteandchronicvenousdisease.Thissessionreviewscurrentriskfactorassess-ment,prophylaxis,pharmacotherapy,andinterventiondesignedtoappropriatelyreducetheonsetofacutedeepvenousthrombosis(DVT),managethosediagnosedwithacuteDVT,andreducethemorbidityofchronicvenousdisease.Theparticipantshouldbeabletoidentifythepatient at high risk for venous thromboembolism,prescribeappropriateprophylaxis,understandcurrentpharmacotherapyforacuteDVT,integrateastrategyforthrombusremovalforpatientswithacuteDVTtoreducepost-thromboticmorbidity,andrecognizetreatmentop-tionsforacutevenousdisease.

9:45–11:15amCurrent Management of Soft Tissue Infections (GS14)

moderator:DonaldE.Fry,MD,FACS,Chicago, IL

Thissessionwilldiscusscurrentinformationaboutthemanagementofseveresofttissueinfectionsthatmaybecausedbydifferentbacterialorganisms.

9:45–11:15amAngioaccess (GS15)moderator: R. James Valentine, MD, FACS, Dallas, TX

Attendeeswilllearncurrentrecommendationsforpatientsrequiringpermanentaccessforhemodialysis,includingDialysisOutcomesQualityInitiativecrite-ria,preoperativeevaluation,patencyratesofstandardaccessgrafts,complexoptionsforhemodialysisaccess,accessgraftsurveillance,andendovascularandsurgi-caloptionsforfailingaccessgrafts.

11:15am–12:15pmExcelsior Surgical Society/Edward D. Churchill Lecture (GS16)introducer:ThomasR.Russell,MD,FACS,Chicago, ILintroducer: Mark A. Malangoni, MD, FACS, Cleve-land, OHintroducer: Kathryn D. Anderson, MD, FACS, San Marino, CAlecturer:JayL.Grosfeld,MD,FACS,Indianapolis, IN

This lecture is named for the Excelsior SurgicalSociety,agroupof80medicalofficerswhometforthefirsttimein1945attheExcelsiorHotel,Rome,Italy.ThislecturealsohonorsColonelEdwardD.Churchill,afamoussurgeonandconsultanttotheU.S.ArmyintheWorldWarIIItalianTheater,whopresentedthefirstkeynoteaddressatthismeeting.

1:30–3:00pmAccelerated Partial Breast Irradiation (APBI) (GS17)moderator:JamesA.Edney,MD,FACS,Omaha, NE

APBI is a potentially important new modality todeliver radiotherapy in conjunction with breast-conservingsurgerywithinanabbreviatedtimeperiodascomparedwithtraditionalexternalbeamradiation,which takes6.5weeks. In this session, the relativemeritsofthevariousapproachesavailabletodeliverAPBIwillbeexamined.Thesewillincludecatheter-based partial breast brachytherapy, intracavitary


44

brachytherapy(mammosite),3-Dconformal/externalbeamradiotherapy,andintraoperativeradiotherapy(intrabeam).

1:30–3:00pmDiagnosis, Surveillance, and Treatment of Dys-plasia in the Gastrointestinal Tract (GS18)moderator: Fabrizio Michelassi, MD, FACS, New York, NY

Attendeeswillbeabletoreviewthemodalitiesfordiagnosisandsurveillanceofdysplasiaofpreneoplas-ticconditionsinthegastrointestinaltract.Presenta-tionswillfocusondysplasiainBarrett’sesophagus,intraductalpapillarymucinousneoplasms,ulcerativecolitis, and anal intraepithelial neoplasia. Modernstrategiesofoperativetreatmentwillbereviewedforeachoftheaboveconditionswithspecialemphasisonfunctionaloutcomes.

1:30–3:00pmUsing Best Evidence to Improve the Outcomes of Your General Surgery Patients (GS19)moderator:ThomasH.Cogbill,MD,FACS,La Crosse, WI

Thistimelytopicwillbeexploredfromfourdiffer-ent vantage points: rural general surgery practice,university teaching program, multispecialty grouppracticeexperiencewithanewprocedure,andmul-tispecialtygrouppracticeexperiencewithanestab-lished procedure. Speakers will draw on their ownunique perspectives to highlight the methods withwhich current best evidence has been incorporatedintotheirpracticetoimprovepatientoutcomesandwillillustratethesemethodswithspecificexamplesfromtheirrecentexperience.

3:30–5:00pmCurrent Role of Sentinel Lymph Node Biopsy in Cancer (GS20)moderator:MarcK.Wallack,MD,FACS,New York, NY

Thissurgicalforumwillreviewthelistofsentinellymphnodebiopsyandthenaddressitsuseintreat-ingcancerofthebreastandmelanoma.Furthermore,therewillbementionofnewhorizonswiththistech-nique.

3:30–5:00pmDiagnosis and Management of Rectal Cancer (GS21)

moderator:VictorE.Pricolo,MD,FACS,Providence, RI

Theobjective of this session is toprovide anun-derstanding of the current diagnostic and stagingmodalitiesforcanceroftherectum.Participantswillbeinformedoftreatmentoptionsincludingsurgery,chemotherapy, and radiation therapy for variousstagesofcurablerectalcancer.

3:30–5:00pmFundamentals of Hepatic Surgery for the Gen-eral Surgeon (GS22)moderator:JosephB.Cofer,MD,FACS,Chattanooga, TN

Thissessionwillcovertheworkupofthesolidlivermassanddescribe the identificationand treatmentof benign liver lesions together with primary andmetastaticliverlesions.Inaddition,thissessionwilldescribehowtodiagnoseand treat commonbiliarytract injury,howtodiagnoseandtreatprimaryhe-patocellularcancer,whenresectionisindicated,andwhentoreferfortransplantation.Finally,thissessionwilldiscussnovelmeansoftherapy.

Tuesday, April 25

8:00–9:30amThe Role of Laparoscopic Colectomy in General Surgery (GS23)moderator:EugeneF.Foley,MD,FACS,Charlottes-ville, VA

Thissessionwilldiscussthepresentroleandindi-cationsforlaparoscopiccolonresections.Inaddition,itwilldebatethecontroversyaboutwhattrainingisnecessary for surgeons to be competent to performtheseprocedures.

8:00–9:30amFollow-Up Regimens for Resected Gastrointes-tinal Malignancies (GS24)moderator: E. Christopher Ellison, MD, FACS, Co-lumbus, OH

Attendeeswilllearnthebestandmostcost-effectivemethodsofmonitoringpatientswhohaveresectionofcolorectal cancer,pancreaticendocrine tumors,pri-maryhepatomas,pancreaticandbiliarycancers,andgastriccancer.Thespeakerswillfocusonendoscopicsurveillance; imaging, including positron emission


45

tomography;andserumtests.Thesessionwillclosewithapaneldiscussiononmonitoringpatientswithresectedgastrointestinalmalignancies.

10:00–11:30amTricks of the Trade in Laparoscopic Resection of Solid Organs (GS25)moderator:LeenaKhaitan,MD,FACS,Atlanta, GA

Duringthissession,minimallyinvasiveapproachesto surgery on the liver, spleen, adrenal gland, andpancreas will be discussed. By the end of this ses-sion,attendeeswillbewellawareofwhichpathologicconditions may be amenable to minimally invasivesolidorgansurgery.Theywilllearnthe“tricksofthetrade”andleavewithasurgicalarmamentariumforsolidorgansurgery.

10:00–11:30amAdvanced Operative Techniques in Trauma for the Community General Surgeon (GS26)moderator: Andrew B. Peitzman, MD, FACS, Pitts-burgh, PA

Thissessionwillfocusonchallengesforthecom-munity general surgeon in trauma care. Operativeapproachestoabdominalinjuries,thoracic,neck,andextremityvascularinjurieswillbediscussed.Manage-mentbasedonavailableresourcesandexpertise,de-finitiveoperativerepair,anddamagecontrolconceptswillbereviewed.

1:30–3:00pmUpdate on Parenteral Nutrition (GS27)moderator:DannyO.Jacobs,MD,FACS,Durham, NC

This session, targeted toward the practicing sur-geon, will review the latest information availableregarding nutritional support of surgical patients.Presenterswillreviewindicationsforuseofparen-teral therapies including decision making and thelatestdataonefficacies.Insightsandsummariesofimportantresearchadvancesthatmayaffectpatientcareinthenearfuturewillalsobepresented.

1:30–3:00pmCrisis in Cancer Care: The Role of the American College of Surgeons in Evaluating and Improv-ing the Quality of Cancer Care (GS28)moderator:StevenB.Edge,MD,FACS,Buffalo, NY

Variationsanddisparitiesinthequalityofcancer

carethataffectoutcomesarewidelydocumented.Sur-geryremainsacornerstoneofcancercare,andalargebodyofevidenceshowsthatvariationinthequalityofsurgicalcareisamajorissue.TheimprovementofthequalityofcancercareforallAmericanshasbecomeanationalpriority.TheACSCommissiononCancer(CoC)haslong-definedstandardsforhospitalcancercareprograms,includingstandardsformaintainingand using registries to monitor cancer care. TheCoC has recently undertaken a major reorganiza-tiontoenhanceitsprogramstoimprovethequalityof cancer care. New programs leverage the cancerregistrynetworkandtheNationalCancerDatabaseforquality improvement.Thissessionwillexaminethescopeoftheprobleminqualityimprovement;therolethesurgeonplaysincontributingtoandsolvingtheproblem;andthequalityimprovementactivitiesoftheCoC,includingpresentingtheresultsofthreemajorqualityinitiatives.

3:30–5:00pmUpgrading Your General Surgery Practice (GS29)moderator: Nathalie M. Johnson, MD, FACS, Port-land, OR

Thisforumisdesignedtohelpattendeesgainsomeinsightintothewaystoobjectivelyevaluatepracticeperformance.Itwillreviewevaluationofoverheadandhowtotakestepstocontrol it.Therewillbe infor-mationonforecastingandplanningforthefutureofone’spracticeandguidanceonhowtoaccessresourcestohelpaccomplishthis.Inaddition,thesessionwillreview technologic upgrades like electronic medi-cal records and transcription technologies that canstreamlinecostintheseareasanddecreaseworkload.Theobjectivesofthissessionareto:(1)learnobjectiveassessmenttoolsforpracticeperformancemeasures;(2)understandstaffingratiosandoverheadcontrol;(3)learnwaystoplanforfuturepracticedevelopment;(4)learntoevaluatetheneedsofpracticeelectronicmedical records; and (5) learn affordable ways toincorporatenewtechnology.

3:30–5:00pmIntroduction of the ACS Web Portal for the Practicing General Surgeon (GS30)moderator:RichardJ.Finley,MD,FACS,Vancouver, BC

AttendeeswilllearnhowtousethenewACSWebportaltogainaccesstoACSresourcesthatarespecifictotheirneedsandthoseoftheirpatients.


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Wednesday, April 26

8:00–10:00amACS/SAGES 2006 Assembly: Inflammatory Bowel Disease (GS31)co-moderators: SteveEubanks,MD,FACS,Columbia, MO FabrizioMichelassi,MD,FACS,New York, NY

Current theories on etiology of inflammatoryboweldiseasewill be reviewed.Attendeeswill gainan understanding of modern medical treatment ofCrohn’sdiseaseandulcerativecolitis.Newadvancesinsurgicaltreatmentofinflammatoryboweldiseasewillhighlightbowel-savingandrestorativesurgicalprocedureswithspecialemphasisonfunctionalout-comes.

10:15am–12:15pmThe Changing Face of Surgical Education: What Does It Mean to Surgeons in Practice? (GS32)co-moderators: MarkA.Malangoni,MD,FACS,Cleveland, OH JeffreyL.Ponsky,MD,FACS,Cleveland, OH

Thissessionwilldetailthedevelopmentsinsurgicaltraining,skillstraining,andmaintenanceofcertifica-tion and outline the role of the College in this pro-cess.

Video-Based Education

Monday, April 24

Highlights from the 2005 Clinical Congress Video Education Session (VE01)7:00–9:30pmmoderator:DanielB.Jones,MD,FACS,Boston, MA

Videotaped surgical proceduresperformedandnar-ratedbygeneralsurgeonswillbepresentedduringthisevening session. An interactive panel discussion willencourageparticipantstopresentquestionsorchallengestothecoordinatorandguestpanelists.Thesevideoswerepreviouslyshownatthe2005ClinicalCongress.


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Key:GS = General SessionVE = Video-Based Education Session

Sunday

GS01The Operating Room of the Future8:00–9:00am

GS02Clinical Abstract Presentations by Residents9:00–10:30am

GS03Current Evaluation of the Acute Abdomen9:00–10:30am

GS04Spectacular Cases from Residents10:45am–12:15pm

GS05Everything You Wanted to Know about the Spleen10:45am–12:15pm

GS06Endoscopic Approaches to Upper Gastrointestinal Bleeding1:30–3:00pm

GS07Palliative Care1:30–3:00pm

GS08Surgical Jeopardy1:30–3:00pm

GS09Management of the Geriatric Surgical Patient3:30–5:00pm

GS10Outcomes for Bariatric Surgery3:30–5:00pm

Monday

GS11Current Management of Sigmoid Diverticulitis8:00–9:30am

GS12Pay for Performance: What You Should Know8:00–9:30am

GS13Venous Disease8:00–9:00am

GS14Current Management of Soft Tissue Infections9:45–11:15am

GS15Angioaccess9:45–11:15am

GS17Partial Breast Irradiation1:30–3:00pm

GS18Diagnosis, Surveillance, and Treatment of Dys-plasia in the Gastrointestinal Tract1:30–3:00pm

GS19Using Best Evidence to Improve the Outcomes of Your General Surgery Patients1:30–3:00pm

GS20Current Role of Sentinel Lymph Node Biopsy in Cancer3:30–5:00pm

GS21Diagnosis and Management of Rectal Cancer3:30–5:00pm

Spring Meeting Program at a glance


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GS22Fundamentals of Hepatic Surgery for the General Surgeon3:30–5:00pm

VE01Highlights from the 2005 Clinical Congress Video Education Sessions7:00–9:30pm

Tuesday

GS23The Role of Laparoscopic Colectomy in General Surgery8:00–9:30am

GS24Follow-Up Regimens for Resected Gastrointesti-nal Malignancies8:00–9:30am

GS25Tricks of the Trade in Laparoscopic Resection of Solid Organs10:00–11:30am

GS26Advanced Operative Techniques in Trauma for the Community General Surgeon10:00–11:30am

GS27Update on Parenteral Nutrition1:30–3:00pm

GS28Crisis in Cancer Care: The Role of the American College of Surgeons in Evaluating and Improving the Quality of Cancer Care1:30–3:00pm

GS29Upgrading Your General Surgery Practice3:30–5:00pm

GS30Introduction of the ACS Web Portal for the Prac-ticing General Surgeon3:30–5:00pm

Wednesday

GS31ACS/SAGES 2006 Assembly: Inflammatory Bowel Disease8:00–10:00am

GS32The Changing Face of Surgical Education: What Does It Mean to Surgeons in Practice?10:15am–12:15pm


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Registrationforthe2006SpringMeetingwillopeninJanuary.Pleasevisitwww.facs.orgformoreinforma-tionasitbecomesavailable.

Registration location and hours RegistrationwillbeheldattheWyndhamAnatole.

Sunday,April23.................7:00am–5:00pm Monday,April24.................7:30am–5:00pm Tuesday,April25................7:30am–5:00pm Wednesday,April26............7:30am–11:00am

Registration fees Registrationfeesforthe2006SpringMeetingwillbeavailableinJanuary.Pleasevisitwww.facs.orgformoreinformationasitbecomesavailable.

International attendees InternationalFellows,guestphysicians,andmeet-ing attendees: Please be aware that the process ofobtainingavisatoattendmeetingsintheU.S.takesmuchlongerthaninthepast.Youarestronglyurgedtoapplyforavisaasearlyaspossible,preferablyatleast60daysbeforethestartofthemeeting.YoumayrequestaletterwelcomingyoutothemeetingfromtheCollegebycontactingtheInternationalLiaisonSectionatpostmaster@facs.orgorbyfaxat312/202-5001.

Technical exhibits To enhance the educational value of the meeting,morethan50companieswilldisplayproductsorser-vicesrelatedtothepracticeofsurgery.Yourregistra-tion includes coffee breaks Sunday, 10:30–10:45 am,3:00–3:30 pm, and Monday, 9:30–9:45 am, 3:00–3:30pm,intheexhibithall. Technical exhibits will be open on the followingdates/times:

Sunday,April23...................10:00am–3:30pm Monday,April24..................9:00am–3:30pm

Children TheACSpolicyregardingchildrenisasfollows: •Youngerthan12:notpermittedonSocialProgramtours •Youngerthan16:notpermittedonexhibitfloororinscientificsessions •16andolder:musthaveabadgetoenterexhibitareaormeetingrooms.

Thispolicyincludesinfantsinstrollersandarms.

Accreditation The American College of Surgeons is accreditedby theAccreditationCouncil forContinuingMedicalEducationtoprovidecontinuingmedicaleducationforphysicians.

CME credit The American College of Surgeons designates thiseducational activity for a maximum of 27 Category1 credits toward the American Medical AssociationPhysician’sRecognitionAward.Eachphysicianshouldclaimonlythosecreditsthathe/sheactuallyspentintheeducationalactivity.

Compact discs Selectedgeneralsessionswillberecordedliveandwillbeavailableforpurchaseoncompactdisc.AdditionalinformationwillbeavailableonsiteinDallas,TX,attheNationalAudioVideoboothneartheregistrationarea.

Postgraduate course syllabi on CD-ROM ACD-ROMcontaining14selectpostgraduatecoursesyllabifromthe2005ClinicalCongresswillbeavailableforpurchaseattheSpringMeetingregistrationdesk.

Social Program ASocialProgramwillbeofferedduringtheSpringMeetinginDallas,TX.A$50nonrefundableadvanceregistrationfeeisrequiredforparticipationintheSocialProgram. The registration fee entitles you to attendscientific sessions and coffee breaks and to view thetechnicalexhibits.RegisteredSocialProgramattendeeswillalsoreceiveatotebag. Thisyearwewillbeofferingthefollowingtour:Pri-vateWineandCheesePairingClass. The tour has a required minimum and maximumnumberofparticipants.Advanceregistrationisstronglyrecommended.Thetourwillbecancelediftheminimumnumberisnotreached,andticketswillbeavailableforon-sitepurchaseonlyifspaceallows.Thetouroperatorreservestherighttochangetouritinerariesandmakepropersubstitutionswhennecessary.

Meeting location and accommodations The34thAnnualSpringMeetingwillbeheldinDal-las,TX,whereyoucanvisittheDallasMuseumofArtor

Registration information


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thenewNasherSculptureCenter,shopattheNorthParkCenterortheGalleria,orenjoythemusicandvibrantnightlifeoftheWestEndorDeepEllum. ThemeetingvenueistheWyndhamAnatoleHotel,convenientlylocatedclosetodowntownandaquicktriptotheshopping,dining,andotherareaattractions.Allnewlyrenovatedguestroomshavevoicemail,computerdataports,hairdryers,irons/ironingboards,coffeemak-ers, and weekly newspaper delivery. Hotel amenitiesincludeahostof11restaurantsandbars,24-hourroomservice, conciergeservice,aworld-classfitnesscenter,aprivateseven-acrepark,andoneofthenation’smostextensiveprivateartcollections. Reservationscanbemadebycallingthehoteldirectlyatthenumberslistedbelow.PleaseindicatethatyouwillbeattendingtheACSSpringMeetinginordertoobtainthespecialgrouprates.Reservationscanalsobemadeonline throughahousing linkon theSpringMeetingsectionoftheACSWebsiteatwww.facs.org.

WyndhamAnatoleHotel 2201StemmonsFreeway Dallas,TX75207 Hotelmainphone:214/748-1200 Hotelreservations:214/761-7500 Wyndhamcentralreservations:800/WYNDHAM Hotelguestfax:214/761-7520 ACSgrouprate:$195single/doubleplustax

ReservationsmadeafterthehousingdeadlineofApril1,2006,oraftertheroomblockfills,aresubjecttospaceandrateavailability.Adepositofonenight’sstayisre-quiredwhenmakingyourreservation,payableviacheckorcreditcard.Thedepositisrefundableifthereservationiscancelledatleast48hoursbeforeyourscheduledar-rivaldate.Pleasealsonotethataftercheck-in,anearlydeparturefeeofonenight’sstaywillapplyifyouchoosetocheckoutbeforeyourscheduleddeparturedate.

Transportation SpecialmeetingsaverairfaresareavailableonUnitedAirlines.Choosefromthefollowingsavingsoptions: • Receivea5percentdiscountoffthelowestapplicabledomesticdiscountfare,includingfirstclass. • Receivea10percentdiscountoffmidweek coachfares,purchasedsevendaysinadvance. • Obtaina5percentadditionaldiscountontheprevi-ouslymentionedfaresifticketsarepurchasedatleast30daysinadvanceofyourtraveldate. Area/zonefaresbasedongeographiclocationarealsoavailablewithno Saturday night stay required.Minimumstay(twonights)variesbyairline;seven-dayadvance

purchaserequired.(Zonefaresarenotavailablethroughonlineticketpurchase;pleasecallUnitedAirlinesatthenumberslistedbelow.) These special discountsareavailableby calling theairlinedirectly(independentlyorthroughatravelagent).BesuretoindicatethenameofthemeetingtowhichyouwillbetravelingandrefertotheACSfilenumberstoobtainthespecialfares.

UnitedAirlines 800/521-4041 8:00am–10:00pm(ET) ACSFile501CR

Car rental Avisisdesignatedastheofficialcarrentalcompanyforthe2006SpringMeeting.SpecialmeetingratesanddiscountsareavailableonawideselectionofGMandotherfinecars.Toreceivethesespecialrates,besuretomentionyourAvisWorldwideDiscount(AWD)numberwhenyoucall.

AvisReservations 800/331-1600 Website:www.avis.com AWDnumber:B169699


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A M E R I C A N C O L L E G E O F S U R G E O N S • D I V I S I O N O F E D U C AT I O N

ObjectivesAt the end of the course, the participants will be able to

describe:

• Theessentialsofpersonalfinancialmanagementasthey

relatetoyoungsurgeonsinpracticeandresidentsandtheir

families.

• The impact of interest rates and time upon loans,

compound interest, and the implications for debt

management.

• Thebuildingblocksnecessaryforthesurgeonstoinvest

successfully.

• Theimportanceoftimeinreducingtheriskofinvesting.

• Thebasicsofmutual funds, stocks, bonds, andother

investmentvehicles.

• Howtoevaluateandchooseafinancialadvisor.

Intended audience:• Surgicalresidentsandsurgeonsrecentlyinpractice.

TheAmericanCollegeofSurgeonsDivisionof

Education presents the Personal Financial

Planning and Management Course for

Residents and Young Surgeons, which uses an

interactive/lectureformattoarmsurgeonswith

basicfinancialmanagementskills.Thecourseis

designedtoeducateandequipyoungsurgeonswith

theknowledgetomanagetheirpersonalfinancial

future,includingdebtmanagement,preparationfor

significantlifeevents(suchasretirementorcollege

educationoftheirchildren)andproperplanningfor

financialstressesrelatedtotheirsurgicalpractice.

OrdersmaybeplacedthroughACSCustomerServiceat312/202-5474orviatheCollege’sWebsiteat:

www.acs-resource.orgFormoreinformationcontactLindaStewart [email protected],ortel.312/202-5354

FellowsoftheAmericanCollegeofSurgeons: $120Non-Fellow: $215RASmember: $75SurgicalResident,notaRASmember*: $95

*Non-RASresidentsmustsupplyaletterconfirmingstatusasaresidentfromaprogramdirectororadministrator,andarelimitedtooneCD-ROM.(Additional$16forshippingandhandlingofinternationalorders.)

Eachyear,theAssociationofWomenSurgeons (AWS) spon-sorsaneducationalconference,awards dinner, and network-ing breakfast in conjunctionwith the American College ofSurgeonsannualClinicalCon-gress. Kathryn D. Anderson,MD, FACS, the new Presidentof the College, attended theannual networking breakfast,whichwasheldonOctober19,and spent time talking withstudents, residents, and otherAWSmembers.

This year, the educationalprogram,whichdrewa record138 participants, featured apanelofthreewomensurgeons:BarbPettitt,MD,FACS;Rose-maryDuda,MD,MPH,FACS;and Carla Pugh, MD, PhD,FACS.Theydiscussedhowtheyachieved success on their ownterms and provided attendeeswith an understanding of thecareerchoicesthatareavailabletosurgeonsandtheinspirationtodaretobedifferent.

Followingtheopeningsessionof the program, the keynotepresenter—best-selling authorandassociateprofessorofedu-cation and organizational be-havioratStanfordUniversity—DebraMeyerson,PhD,present-ed Leading Changes throughTempered Radicalism. Thecourse provided participantswith a deeper understandingof thenatureof contemporarygender discrimination and anapproach to change that willenableparticipantstoimprove

conditions for women withoutjeopardizingtheircareers.

On October 17, the AWSrecognizedoutstandingwomensurgeonsat its annual awardsdinner. The AWSawards pro-gramrecognizes individualswho have contributed excep-tional service to women insurgery and the association,honorsthosewhodemonstrategreat potential as future lead-ers insurgery,andencouragesand supports female medicalstudents pursuing a career insurgery. This year’s recipientsof the following awards wererecognized:

• TheNinaStarrBraunwaldAward: Karin Muraszko, MD,FACS

• The Honorary MemberAward: Morris Kerstein, MD,FACS

• The Distinguished Mem-ber Award: Patricia Lowery,MD,FACS

• The Outstanding WomanResidentAward:LeoraBalsam,MD

• The Patricia Numann,MD, Medical Student Award:ErikaManning

In addition, the 2006 AWSFoundation/Ethicon Endo-Surgery, Inc. fellowship waspresented to Anjali Kumar,MD,andhermentor,LauraEs-serman, MD, FACS, from theUniversityofCaliforniaatSanFrancisco.

In 2006, the AWS will cel-ebrate25yearsofinspiring,en-couraging,andenablingwomensurgeons to realize their pro-fessional and personal goals.Pleasemarkyourcalendarandjoin us for the AWS 25th An-niversaryGalaandConference,October6–7,2006,inChicago,IL. For more information, call630/655-0392, e-mail [email protected], or visitwww.WomenSurgeons.org.

Association of Women Surgeons meets in San Francisco

Left toright:HilarySanfey,MD,AWSPresident;Dr.Anderson;andSueStuart,MD,AWSImmediatePast-President.


53

The 2006 Nominating Com-mitteeoftheFellows(NCF)hasthetaskofselectingnomineesforthethreeOfficer-Electposi-tions—President-Elect, FirstVice-President-Elect, and Sec-ond Vice-President-Elect—ofthe American College of Sur-geons.TheNCFusesthefollow-ingguidelineswhenreviewingthenamesofpotentialOfficer-Electnominees:$ LoyalmembersoftheCol-

lege who have demonstratedoutstandingintegrityandmedi-calstatesmanshipalongwithanunquestioned devotion to thehighest principles of surgicalpractice.$ Demonstrated leadership

qualitiesthatmightbereflectedbyserviceandactiveparticipa-tion on ACS committees or inother components of the Col-lege.$ Recognitionoftheimpor-

tance of representing all whopracticesurgery.$ Consideration of women

andmembersofotherunderrep-resented populations encour-aged.

The 2006 Nominating Com-mittee of the Board of Gover-nors (NCBG) has the task ofselectingnomineesforseatsontheBoardofRegentstobefilledduring the 2006 Clinical Con-gress. The guidelines used bytheNCBGwhenreviewingthenamesofpotentialnomineesforelectiontotheBoardofRegentsare the same as for Officers-Elect,plusthefollowing:$ Geography, surgical spe-

cialtybalance,andacademicorcommunity practice are takenintoconsideration.$ Individualsnolongerinac-

tive,surgicalpracticeshouldnotbenominated forelectionorre-electiontotheBoardofRegents.

The surgical specialties thatshouldbegivenpriorityconsid-eration for nomination to theBoard of Regents include thefollowing:$ Generalsurgery$ Otolaryngology–head and

necksurgery$ PlasticsurgeryNominations for candidates

for ACS Officers-Elect or theBoard of Regents should becomposed of one or two para-graphs about the potentialcontributions each candidatecan offer in terms of what heorshecandoforthemembersof the College. Please submitnominations to [email protected].

The deadline for submittingnominationsisTuesday, Feb-ruary 28, 2006. Ifyouhaveanyquestions,pleasecontactPatri-ciaSpreckselat312/[email protected].

ACS seeking nominations for Officers-Elect and the Board of Regents

Trauma and Critical Care 2006 scheduled for March

Trauma and Critical Care2006 will present TechniquesandTechnology:BasicstoCut-tingEdge,March20–22,atCae-sarsPalace,LasVegas,NV.

Kenneth L. Mattox, MD,FACS,isprogramdirector.Theprogram committee includesDavidB.Hoyt,MD,FACS;Jay

A.Johannigman,MD,FACS;M.MargaretKnudson,MD,FACS;David W. Tuggle, MD, FACS;andprogramcoordinator,MaryK.Allen.

Theprogramobjectivesaretoachievethefollowing:

• describe innovative andappropriate techniques and

technology for optimal care oftheinjuredpatientinurbanandruralsettings

• describe operative tech-niquesfortheapproachtoandrepair of traumatic injuries toabdominal organs and vesselsandextremityvessels

• discuss techniques and


54

technology for optimal care inthecriticalcaresetting,includ-ing ventilator-associated com-plications,multiorgandysfunc-tion, coagulopathy, iatrogeniclesions,andsepsis

• applyconceptsfromtrau-macasestudiestothepracticesetting

• describe the evolution oftraumaepidemiologyandman-agement

• discusspracticalexposuretechniques and guidelines formanagement of difficult trau-maticinjuriesofcarotid,verte-bral,anddistalsubclavianves-sels; lumbar vein; esophagus;distal profundi femoris; andgroin

• identify challenges andsolutions indisasterprepared-nessandresponse,drawingonlessonslearnedfromHurricaneKatrinaandtherecentLondonbombings

• discussappropriatesurgi-cal response to uniquely chal-lenging injuries with addedcomplicating circumstances,includingobesity,coagulopathy,andageofpatient

• describeappropriateuseoftechniqueandtechnologyinap-proachingthetornbronchusatthetracheaanddiaphragmaticrupture with bleeding in thechest

• discussmanagementofre-nalinjuryinachildintheruralsetting

• contrast craniectomy fol-lowingbraininjuryinthemili-taryversusciviliansettingsandinadultsversuschildren

• discuss management ,technology, and techniquesfor optimal care of diversetrauma-related issues, includ-ing complicated fractures for

the nonorthopaedic surgeon,necrotizing fasciitis, interos-seous devices prehospital andER, burns, spinal cord injury,interventionalradiologyinchil-dren,prehospitaladjuncts,andurologicinjuries

• debate the value of moreliberaluseofvenacavalfiltersintraumapatients

• discusssocioeconomicandethical trauma-related issues,includingtheEmergencyMedi-calTreatmentandActiveLaborAct, videotaping as a learningtool, futility, and transfers totraumacenters

• evaluate the benefit ofknowledge gained and lessonslearned in providing qualitytraumacareinthepracticeset-ting

Facultymembersincludethefollowing: Karim Brohi, MD,London, UK; Henry C. Cleve-land, MD, FACS, Denver, CO;Michael Coburn, MD, FACS,Houston, TX; Raul Coimbra,MD, FACS, San Diego, CA;Demetrios Demetriades, MD,PhD, FACS, Los Angeles, CA;Eric R. Frykberg, MD, FACS,Jacksonville,FL;DavidB.Hoyt,MD,FACS,SanDiego,CA;JayA. Johannigman, MD, FACS,Cincinnati, OH; M. MargaretKnudson,MD,FACS,SanFran-cisco,CA;FredA.Luchette,MD,FACS, Maywood, IL; RobertC. Mackersie, MD, FACS, SanFrancisco, CA; Kenneth L.Mattox, MD, FACS, Houston,TX; Norman E. McSwain, Jr.,MD, FACS, New Orleans, LA;J.WayneMeredith,MD,FACS,Winston-Salem, NC; MichaelH. Metzler, MD, FACS, LasVegas, NV; Scott H. Norwood,MD, FACS, Baton Rouge, LA;Patrick J. Offner, MD, FACS,

Denver, CO; Peter Rhee, MD,FACS, Los Angeles, CA; AliSalim,MD,FACS,LosAngeles,CA;LynetteScherer,MD,FACS,Los Angeles, CA; C. WilliamSchwab, MD, FACS, Philadel-phia,PA;MichaelJ.Sise,MD,FACS,SanDiego,CA;DavidW.Tuggle, MD, FACS, OklahomaCity,OK;AlexB.Valadka,MD,FACS,Houston,TX;andDavidH. Wisner, MD, FACS, Sacra-mento,CA.

CompletecourseinformationcanbeviewedontheAmericanCollege of Surgeons Web site(www.facs.org/trauma/cme/traumtgs.html).Forfurtherin-formation,contacttheTraumaOfficeat312/202-5342.

The following continuingmedicaleducationcoursesintrauma are cosponsored bytheAmericanCollegeofSur-geonsCommitteeonTraumaandRegionalCommittees:

• Trauma and Critical Care 2006,March20–22,LasVegas,NV.

• Trauma and Critical Care 2006—Point/Coun-terpoint XXV, June 5–7,Williamsburg,VA.

Completecourse informa-tion can be viewed online(as it becomes available)through the American Col-legeofSurgeonsWebsiteat:http://www.facs.org/trauma/cme/traumtgs.html, or con-tact the Trauma Office at312/202-5342.

Trauma meetings calendar


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TheAmericanCollegeofSurgeonsisofferinghealth policy scholarships to subsidize atten-danceandparticipationinLeadershipPrograminHealthPolicyandManagement,attheHellerSchool for Social Policy and Management atBrandeisUniversity(http://www.heller.brandeis.edu/welcome/leadership_program.asp).The2006coursetakesplacefromMay29toJune3.Theaward is in the amount of $8,000, to be usedtowardthecostoftuition,travel,housing,andsubsistenceduringtheperiodofthecourse.

Oneofthescholarshipsisreservedforgeneralsurgeons,andisfullyfundedbytheCollege.TheCollegeisverypleasedthatanumberofthesur-gicalspecialtysocietieshavepartneredwiththeACStoco-sponsora scholarship foramemberingoodstandingofboth theCollegeand theirsocietytoattendthishealthpolicyintensive.Theparticipating societies supporting scholarshipsare the American Academy of Ophthalmology,theAmericanAcademyofOtolaryngology–Head&NeckSurgeryFoundation,theAmericanAs-sociationofNeurologicalSurgeons,theAmericanSocietyofColonandRectalSurgeons,theAmeri-can Society of Plastic Surgeons, the AmericanUrogynecologicSociety,TheSocietyofThoracicSurgeons,andtheSocietyforVascularSurgery.

Generalpoliciescoveringthegrantingofthehealthpolicyscholarshipsare:

• The award is open to surgeons who aregeneralsurgeonsormembersingoodstandingoftheoneoftheabovesocieties,aswellasoftheAmericanCollegeofSurgeons.Applicantsmustbeatleast30yearsold,butyoungerthan55,onthedatethatthecompletedapplicationisfiled.

• The award is to be used to support therecipientduringtheperiodofthecourse.Indi-rectcostsarenotpaidtotherecipientortotherecipient’sinstitution.

• Applicationsforthisscholarshipconsistofthefollowingitems:

—Onecopyoftheapplicant’scurrentcurricu-lumvitae

—Onecopyofaone-pageessay,discussingwhy

theapplicantwishestoreceivetheHealthPolicyScholarship

• Applicationforthisawardmaybesubmittedevenifcomparableapplicationtootherorganiza-tionshasbeenmade.Iftherecipientacceptsasimilarscholarshipfromanotheragencyoror-ganization,theHealthPolicyScholarshipwillbewithdrawn.Itistheresponsibilityoftherecipientto notify the Scholarships Section of the ACS,which administers this program, of competingawards.

• TheHealthPolicyScholarshipmustbeusedintheyearforwhichitisdesignated.Itcannotbepostponed.

• The scholar is required to serve one yearasapro temmemberofthehealthpolicysteer-ing committeeofboth theACSandhis orherspecialty society following completion of thecourse.Thisobligationincludesparticipationinoccasionalmeetingsandasarevieweroradvisorasrequested.

• Abriefreportofthescholar’sexperiencesand activities is due at the conclusion of thescholarshipperiod.Asimpleaccountingisalsorequired.

TheclosingdateforreceiptofapplicationsisFebruary1,2006.AllapplicantswillbenotifiedoftheoutcomeoftheselectionprocessbyMarch 31, 2006.

QuestionsmaybedirectedtotheACSScholar-ships Administrator at 312/202-5281. Require-ments for the Health Policy Scholarships arepostedontheACSWebsiteat www.facs.org.

Please send applications for this scholarshipto: Scholarships Section, American College ofSurgeons, 633 N. Saint Clair St., Chicago, IL60611-3211.

Health policy scholarships available for 2006


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57

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– CompleteCPT, HCPCSLevelII, andICD-9codes.

– CurrentMedicare CorrectCoding Initiativebundling edits,nationaland localfeeschedules, andMedicare policyinformation.

– Medicareinforma- tiononglobalfee daysandmodifier usage.

– Automaticcalcu- lationoffeesby geographiclocality.

– FulltextLocal MedicalReview Policies,fall2003.

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TheAmericanCollegeofSur-geonsBoardofGovernorsCom-mitteeonSocioeconomicIssues,in association with the PfizerMedical Humanities Initiative(PMHI), is seeking nomina-tionsforthe2006SurgicalVol-unteerism Award. Committeemembers are looking for ACSFellowswhoaremakingasig-nificantcontributiontosurgicalcarethroughvolunteeractions.Candidatesforthisawardmaypractice their surgical volun-teerism either in a domestic,international, or military set-ting.Allsurgicalsubspecialtiesareeligibleforconsideration.

An application form and abrief narrative are required.The narrative should be sub-mitted inEnglish,and limitedto500words,brieflydescribingwhyyoubelieveyournomineedeservesthisaward.

All nominations will be as-sessed on the following sevencriteria:

• Community impact: Themedicalbenefitonthelocalcom-munity/medicalfacilityovertheprevious12months(20points)

• Humanitarianism: Thedegree to which the volunteerdisplays true, selflessaltruism(20points)

• Long-term effect: Thepo-tential impact on the com-munity/medical facility in thefuture—that is, training andfacilities that have continuedimpact(15points)

• Number of people served: Thenumberofpeoplehelpedas

adirectresultoftheprojectoractofvolunteerism(15points)

• Length of service: Thenumber of years participatingintheseactivities(10points)

• Organizational leadership: The organizational leadershipandpersonalfinancialsupportand/orfundsraisedonthepartofthecandidate(10points)

• Frequency of service: Thefrequencyofserviceintermsofpersonaltimevolunteeredoverthelastyear(10points)

A survey by the committee,conducted by the Institutefor Health Policy of the Mas-sachusetts General Hospital,determinedthatapproximately30percentofU.S.andCanadiansurgeonsactivelyparticipateinmorethan250differentvolun-teerdomesticandinternationalorganizations. The College isseekingtoidentifyandformallyrecognizethoseindividualsur-geonsandvolunteerprograms.

Atthe91stClinicalCongressinSanFrancisco,CA, lastOc-tober,theCollegeawardedtheACS/PMHISurgicalVolunteer-ismAwards toDomingoT.Al-vear,MD,FACS,ofHarrisburg,PA, and George F. Ellis III,MD, FACS, of Longwood, FL.Dr. Alvear received his award

ACS seeking nominations for ACS/PMHI volunteerism award

for his humanitarian effortsin the internationalarena.Heis the founder and presidentof World Surgical Foundation,Inc.Dr.Ellisreceivedhisawardforhishumanitarianeffortsinthe domestic arena. He is thefoundingchairofPrimaryCareAccess Network. Courtney M.TownsendJr.,MD,FACS,Chairof the Board of Governors atthattime,presentedtheawardsinassociationwithPMHI.Theirplaques read: “In recognitionof those surgeons committedto giving something of them-selvesback to societybymak-ingsignificantcontributionstosurgicalcarethroughorganizedvolunteeractivities.”

Thenominationformispost-edontheACSBoardofGover-nors’Website,http://www.facs.org/about/governors/boardgv.html.Thedeadlineforsubmit-ting nominations is Tuesday, February 28, 2006.

Please send your form andnarrativetoPatriciaA.Spreck-sel, Administrator, Board ofGovernors, American CollegeofSurgeons,633N.SaintClairSt.,Chicago,IL60611.E-mail:psprecksel@facs .org , fax:312/202-5021.


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The American College of Surgeons (ACS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ACS designates this educational activity for a maximum of 4 Category 1 credits toward the AMA Physician’s Recognition Award (PRA). Each physician should claim only those credits that he/she actually spent in the activity. The American Medical Association has determined that physicians not licensed in the U.S. who participate in this CME activity are also eligible for AMA PRA Category 1 credit.

^ Replaces the basic course offered by the American College of Surgeons.

^ A printable CME certificate is available upon success-ful completion.

^ CD will install the necessary software (PC or Mac).

^ The learner is offered two attempts to pass a multiple-choice exam with a minimum score of 80% at the completion of the program.

^ Residents must submit a letter from their director/chair to document residency status.

^ Only one user per CD is allowed. Online access is needed to register the CD and to take the exam.

^ $300 for nonmembers^ $225 for Fellows of the College^ $125 for residents with letter proving status*^ $90 for Resident and Associate Society (RAS) members (Additional $16 for shipping and handling of international orders) *Non-RAS residents must supply a letter confirming status as a resident

from a program director or administrator and are limited to one CD-ROM.

The American College of Surgeons and the National Ultrasound Faculty have developed “Ultrasound for Surgeons: The Basic Course” for surgeons and surgical residents on CD-ROM.

The objective of the course is to provide the practicing surgeon and surgical resident with a basic core of education and training in ultrasound imaging as a foundation for specific clinical applications.

The CD can be purchased online at http://www.acs-resource.orgor by calling Customer Service at 312/202-5474.For additional information, contact Linda Stewart, tel. 312/202-5354, e-mail [email protected]

The following comments were received in the mail or via e-mail regarding recent articles published in the Bulletin and the “From my perspective” columns written by Executive Director Thomas R. Rus-sell, MD, FACS.

Challenges in rural surgery IreadwithinterestDr.Russell’s

“Frommyperspective” (Bull Am Coll Surg. 2005;90(8):4-5)andDr.Rinker’sarticle(Meetingtheneedsofruralgeneralsurgeons.Bull Am Coll Surg.2005;90(8):13-18)intheAugustissue.

WhenIfirststartedpracticein1984, I was recruited to go to asmall hospital that was approxi-mately50milesfromalargerur-banhospital.

Atthattime,thisruralhospitalwasservicedbyitinerantspecial-ists, such as an orthopaedic sur-geon who held a morning cliniconceeverytwoweeks,aurologistwho came in approximately oneday every two weeks, and a gas-troenterologist who performedendoscopyonceortwiceamonth.OneofthereasonsIwasrecruitedwasthatIhadexperienceintheseareas and was able to augmentservicesinthehospital.

Once I began to perform theseprocedures in the hospital withexcellent results, I found myselfthesubjectofcontinuedcriticismfromtheseitinerantsubspecialistswho resented my involvement inwhattheyconsideredtheir“turf.”Some of these specialists rotatedthroughasmanyasfivehospitalsaweek.

Ultimately, a complaint wasmade to the statemedical board,eventhoughthequalityofmyworkwasexcellentandIneverhadbeenthedefendantinanylawsuits.Atthe time, one of the problems instating my case before the statemedicalboardwasthatthegeneralsurgerycommunityandexpertsIapproachedtodefendmewerenotcertain about the defensibility of

thewhole“ruralsurgerymodel.”IndividualsurgeonsIapproachedwould generally find the indi-vidualworkIhadperformedtobesatisfactory. However, they wereuncomfortable with the conceptofageneralsurgeonworkinginaruralsurgeryfield.

I believe it is essential for theCollege to assist surgeons in set-tinghighstandardsandinmeetingthem.TheCollegeshouldprovidemethods whereby surgeons canevaluate their own work objec-tivelyandgainassistanceinsuchanevaluation.Thiswillhelpthemtocorrectproblemsintheirworkandtodefendthemselvesagainstunreasonablecriticism.

Particularly in view of pay forperformance,orvalue-basedpur-chasingforphysicians,Ibelieveitisimportantforsurgeonstohaveasystemthattheyunderstandandthat they can use to counter un-warrantedcriticismandthatwillallow themto improve theirownworkandbeabletomarketthem-selvesiftheirworksomerits.

The policy of the federal gov-ernmenttowardsmallerhospitalsgenerally has been to reduce re-imbursement to the point wheresmaller operating rooms can nolonger function. I thinkthat thisis a simplistic approach becausepatientswhogotolargerhospitalsmayincuradditionalcostsresult-ingfromadditionalconsultationsand so forth. The College shouldcreate a system that will allowthesethingstobemeasuredtode-terminewhichisthebestarea.F. Andrew Morfesis, MD, FACS

Fayetteville, NC

Addressing ER shortagesI readwithgreat interest your

article in the Bulletin about thecrisisinouremergencyrooms(Bull Am Coll Surg.2005;90(6):4-5).Weare facing the same problems atourinstitution.Assecretaryofthemedicalstaff,Ihavebeenaskedtoaddress this issue and find long-

termsolutionsforthisproblem.Wedecidedtohiregroupsofphysiciansto cover our emergency room forobstetrics-gynecology.Thisiswork-ingwellandwenowplantodothesametoaddresstheshortageinourneurosurgery and cardiothoraciccoverage.

Wehavefoundthatthis isavi-ablealternativeandprovidesanim-mediate,quickfixfortheproblem.I am sure that others around thecountrywillhaveideasthatmightalso be appropriate, and it wouldbe appreciated if you could sharethesewithus.Thisisatruecrisisaffectingourpatientsandwemustallworktogethertoresolveit.

Rafael Espada, MDHouston, TX

TheOctober“Frommyperspec-tive”column(Bull Am Coll Surg.2005;90(10):4-5) was right on themoney.Itwasalsoonetotwoyearslate.

Thecombinationofskyrocketingprofessionalliabilitycostsandde-creasingreimbursementsismakingit impossible for the average sur-geoninprivatepracticetocontinueto run faster to accomplish all ofthe care tasksof theday.The sadrealityofthesituationisthatpay-mentfromthein-networkinsuredpatients don’t even justify beingonemergencydepartmentcall.Thereimbursements only make sensefrom a business/financial perspec-tive if the treating surgeon is outof the insurance network. Onlyunderthosecircumstancescanthereimbursement be possible at anadequate level.Thishas createdaquandary: leave thenetworks andbecomepartofagreaterissueofac-cesstocareforevenelectiveorsemi-urgentsurgery,orstayinnetworkand try to get off the emergencydepartmentcoverageroster.Whichbetterservesthegreatergood?Wehaveclearlycometothepointwherebotharenolongerpossible.

It’s amazing to consider thatmillions of people out there pay


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for medical coverage to be underthecareofanetwork,onlytofindonadailybasis that therearenoservicesavailable to themdespitepaying high premiums and thattheyhavetopayoutofpocketforcare.Itiswrongtolayanyrespon-sibilityforthisonthebacksofthealready-beleagueredsurgeons,mostofwhomjusttrytogetthrougheachdaydoingtherightthingandhop-ingforsomerelief.Somethinghastochange.Theemergencydepart-mentisnolongeranissuerelatedtoprovidingcharitycareinthetra-ditionalsense.Itisnowall charitycare,insuredornotinsured,ifthesurgeonisstillwithintheinsurancenetworks.Allsurgeonsworkhard,andallhavetofeedtheirfamilies,leavingtheemergencydepartmentcall as more of a mandate than aconsideredchoice.

Thisneedstochange.The out-of-network fee system

works financially but becomes avery unwelcome surprise to thepatientandoftensetsupasystemwhere the patient and treatingphysician are at odds regardingfinances. This system should beaboutthecareandmedicalrelation-shipratherthananeconomicone.Thenumberofuninsuredpersonsnationally will swell enormouslysoonbecausepeoplearebeginningto realize that the coverage theypaysuchlargedollaramountsforprovidesverylittlebenefit.

N. A. Bertha, DO, FACSFlorham Park, NJ

Thank you for your commentsintheOctoberissue(Bull Am Coll Surg. 2005;90(10):4-5) regardingtheincreasingdifficultiesinsecur-ingemergencysurgicalservicesincommunity hospitals. You notedthat one solution being discussedwasanewcategoryofhealthcareprofessionals known as “surgicalhospitalist.”

Ithoughtyoumightbeinterestedtoknow thathere inSantaRosa,CA, one hospital delivery system

has been operating under such asystempracticallysince1997,andformally,undercontractwithSut-terHealth,since2000.Itseemstoserveourprimarycareandemer-gencyroomdoctorswell,aswellasmaking a positive contribution tothehospital’sbottomline.

Chris Kosakowski MD, FACSSanta Rosa, CA

Iamrefreshedtoseeothersrais-ingtheissueoffatigueandsurgicalperformance (Bull Am Coll Surg.2005;90(10):4-5).Asaformercom-mercialpilotandgeneral surgeonwholeftclinicalpracticeatage50,Ibelieveitwillonlybeamatteroftimebeforethepublicdemandsas-surancesthatpeopleperformingop-erativeproceduresarenotimpairedasaresultofsleepdeprivation.

Thedegradationinperformancecaused by fatigue is well docu-mented in the trucking and avia-tionindustries.Mostsurgeonsareunwillingtoacceptfallibility.Oftenthereareprofoundpressuresforasurgeontocompleteelectivecasesafterworkingallnightoncall.Theissue may be an unstated factorin early retirement. The medicaleconomics are such that we can-not work at a reduced pace (40hours/week) and earn more than$30,000/year.

My family and my health weremoreimportantthanworkinginanenvironmentthatplacedmeatriskfor creating preventable medicalerrors. I enjoyed the opportunitytocareforpatientsafterhours,butIcouldnottoleratethementalfogthatpersistedforseveraldaysafterworking 24 to 36 hours withouta break. I am of the opinion thatthereshouldnotbeanyresidencyworkhourrestrictions.Residencyisthebestenvironmenttoinwhichtodetermineone’scapacityforper-formingwork.Inprivatepractice,thereislittleifanysupportsystemtofallbackon.

IbelievetheCollegeshouldtakea leadership role in bringing the

issueoffatiguetothepublic.Itismorethan justbeingoncall—themedical economics today is moreabout throughput than qualityof output. The ripple effect of asurgeoncancelingfiveorsixelec-tive cases after an all-nighter issignificant. The hospital and an-esthesiologist would be the mostupset;IhavebeenfiredbypatientsafterIcanceledtheircasesbecauseofmypersonalfatigueandconcernaboutperformingsurgery.Itiswellknown that sleep deprivation hassimilareffectstoalcoholingestion.We expect airline pilots to not bedrunkwhenflying,sowhyshouldwe have surgeons operating in asimilarlyimpairedstatecausedbysleepdeprivation?Daniel P. Congreve, MD, FACS

Bettendorf, IA

Pay for performance (P4P)We in the Philippines launched

thequalitymovementin2003,andwehavepeerreviewscomposedofthepresidentsofallmajormedicalsocieties in the country. We meeteverymonthtodiscusswiththemtheerrorscommittedbycolleaguesbasedonclaimsreimbursement.Iguessthereisanimmediatecallforaction here. Unfortunately, manyphysicians still do not see this asanurgentcallandstillbelievethattheir autonomy as a physician isbeingsteppedonandviolated.Theresponse of physicians in devel-oped countries and in developingcountries seems to be the same.PhilHealth, the national HealthInsurance of the Philippines (forwhich I am a vice-president forqualityassurance)iswillingtopayforgoodqualityservice,asstudiesshow that monetary incentiveswork.However,howmuchof thisincentivecanreallymakeourcol-leaguesacceptthattoerrishuman,buttocorrectitisdivine!

Good luck with your qualityperformanceendeavorsandIcon-gratulate you. Hopefully we canworktogethertowardthecommon


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goal of bringing quality care toeverypatient.

Madeleine de Rosas-Valera, MD, MScCHHMCambridge, MA

I am in disagreement with theconceptofP4P.Ibelievethiswillmake more income for the largegroupswithhighlyadvancedcom-puter systems, to the detrimentofthesurgeoninsolopractice.Ittroublesme that theCollegeandtheAmericanMedicalAssociationhaveboughtintotheconcept.

Perhaps my most meaningfulsurgery was done with the FirstMarine Division Danang RVNwhen I was paid a paltry sumcomparedwithwhatmycolleaguesweremakingbackintheStates.Inprivatepractice,manyofmymostchallenging and satisfying casesendedupwithrecompenseoflittleornone.

I don’t think this concept willhelpthehave-nots(that is,thosewithout insurance, the poor, andthe undocumented). Mark medown as being against the wholeP4Pproject.

Richard R. O’Reilly, MD, FACS, FCCP

Bakersfield, CA

I read with great interest Dr.Russell’sarticleregardingP4PintheAugustBulletin(2005;90(8):4-5).Iagreethatphysiciansshouldbeheldtocertainstandardsandberewardedforperformance.Thein-surancecompaniesarepartoftheequationinthehealthcaredeliv-erysystem.Theyhavecreatedanunbearableburdenofbureaucracyon the patients and providers atacostof25percentto31percentofeveryhealthcaredollarspent.Congress,thebusinessindustries,andpayorsandprovidersofhealthcareshouldholdinsurancecompa-nies to the same standard. TheirpremiumsandprofitmarginshavetobesubjectedtoP4Paswell.Wehope that the American College

of Surgeons will take the lead toaccomplishthis.

K. J. Lee, MD, FACSPast-President, American

Academy of Otolaryngology–Head & Neck Surgery

New Haven, CT

Addressing needs of surgical specialties

I appreciate the article entitled“ACStakesonspecialtyissues”(Bull Am Coll Surg. 2005;90(10):17-21).AsanotolaryngologistwhohasbeenamemberoftheCollegeforalmost20 years, I have long avoided theACS meetings because I felt thattheneedsofnon-general surgeonswerenotbeingaddressed.Thisisarefreshingpiecethatshowsthatthe

Collegerepresentstheinterestofallsurgeons.Thankyou.

Earl H. Harley, MD, FACSWashington, DC

Tribute to Dr. OrganItwaswithdeepappreciationand

pleasurethatIreadtheSeptemberBulletin. The superb tribute toClaudeH.Organ,Jr.,waswellde-servedforClaudeforallthereasonsmentionedinthearticle,plusotheractivitiesandcontributions.

I had the privilege of knowingClaudeandIamgratefulindeedfortheBulletin’sportrayalofClaude’slifeinsuchanexcellentway.

Asa G. Yancey, Sr., MD, FACSAtlanta, GA


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thantriplethatavailabletolobbyistswhoopposeourpositions.

Thank you Once again, Thomas Russell, MD, FACS,

ExecutiveDirector,andhis staffhavedoneanexcellentjob.Wehavemanyironsinthefire.AsChairoftheBoardofRegentsandonbehalfof

rienced by those willing to volunteer and thebarrierstheyencountered,whichhadanegativeimpactonthedeliveryofcare.Itishopedthatissuessuchastheportabilityofmedicallicensesoverstatelines,credentialingofvolunteers,andtheprovisionoftortliabilitycoveragetomedi-calvolunteerswillbeexaminedinanewlight

themembers of theBoardofRegents and theOfficersoftheCollege,IwouldliketothankDr.Russellandhisstaffandalsoextendthehearti-est thanks to the hundreds of volunteers whomaketheAmericanCollegeofSurgeonsagreatorganizationwithdiversegoalsandaccomplish-mentsthatallcometogethertoprovidethebestandsafesthealthcareforourpatients.

andwithrenewedimportanceintheaftermathofthesedisasters.

There remains much to be done. OperationGivingBackwillcontinuetoadheretoitsmis-sion of facilitating volunteerism on both thedomesticandinternationalfronts.

REPORT OF THE CHAIR OF THE BOARD OF REGENTS, from page 32

REPORT OF THE CHAIR OF THE BOARD OF GOVERNORS, from page 33

procedures will be reimbursed at 50 percent.This policy change will be phased in, however,withsubsequentproceduresreducedbyonly25percentin2006,andby50percentin2007.

Savingsfromthispaymentpolicychangewereredistributed to other fee schedule servicesthroughanacross-the-boardadjustmentinprac-ticeexpenseRVUs.

Thecombinedimpactoftheconversionfactorreductionandthechangesmadetowork,practiceexpense,andliabilityRVUsforkeyhigh-volumesurgicalservicesisshowninTable3,page10.

In 2005, CMS implemented a demonstration project that allowed higher reimbursement for certain chemotherapy services. Will that project continue in 2006?

Yes, the demonstration project will continue,althoughithasbeenmodifiedsignificantly.

For 2005, CMS conducted a one-year demon-stration for office-based oncology services, inwhicha$130paymentwasmadewhenpatients

undergoingchemotherapywereaskedquestionsabout theirpain,nausea, and fatigue.CMSde-cidedtocontinuethedemonstrationproject foran additional year but changed the reportingrequirements “in order to take a further steptowardencouragingqualitycareandpromotingbestclinicalpractices….”

For 2006, reporting will no longer be specifictochemotherapyadministrationbutinsteadwillbeassociatedwithphysicianE/Mvisitsforestab-lished patients with cancer. The demonstrationis available only to office-based hematologists/oncologistswhoprovideanE/Mservice(atlevels2through5)toanestablishedpatientwhohasoneof13typesofcancer.Toqualifyfortheadditional$23pervisit,thephysicianmustsubmitaG-codepertainingtoeachofthefollowingthreeissues:(1)theprimaryfocusofthevisit,(2)thecurrentdiseasestate,and (3)whethercurrentmanage-mentadherestoclinicalguidelines.

CMSestimatesthatthereviseddemonstrationprojectwillincreasepaymentstooncologistsbyapproximately$150millionin2006.

WHAT SURGEONS SHOULD KNOW ABOUT, from page 11


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NTDBTMdatapoints

Annual report 2005, dataset version 5.0by Richard J. Fantus, MD, FACS, Chicago, IL, and John Fildes, MD, FACS, Las Vegas, NV

issuesthatcharacterizethecur-rent state of care for injuredpersonsintheU.S.Thereporthas implications in many ar-eas, including epidemiology,injurycontrol,research,educa-tion, acute care, and resourceallocation. This effort is inkeeping with the mission ofthe College’s Committee onTraumatodevelopandimple-mentmeaningfulprogramsfortraumacare.

This reportmarksourcom-plete transition to the use ofthemechanismsof injuryandthe external cause of injury

The National Trauma DataBankTM (NTDB) Version 5.0is an updated analysis of thelargestaggregationof traumaregistry data that has everbeen assembled. The NTDBcurrentlycontainsadecadeofdata,almost1.5millionrecordsfrom565traumacentersin45states, Puerto Rico, and theDistrictofColumbia.Thistotalrepresentsanincreaseofmorethan370,000recordsfromthe2004report.

The Annual Report Version 5.0 isbasedon917,265recordsfrom2000to2004.NTDBhasbeguntousearolling-yeartimeframe for theannual analysisin order to focus on the mostrecent quality data. Prior toanalysis, NTDB data are sub-jected to a quality screeningfor consistency and validityonsuchfieldsasage,sex,andlengthofstay.

The NTDB is committed tobeing the nonproprietary na-tional repository for traumacenterregistrydata.Itisesti-matedthat70percentofLevelI and 53 percent of Level IIcenters in theU.S. contributedatatotheNTDB.OurgoalistoreceivedataoneverypatienttreatedineverytraumacenterintheU.S.

The purpose of this reportis to inform the medical com-munity,thepublic,anddecisionmakersaboutawidevarietyof

code groupings that were de-veloped by the internationalinjury prevention communityandpublishedby theCentersfor Disease Control and Pre-vention (CDC) in Morbidity and Mortality Weekly Report(1997;46(RR14):1-30). TheCDC and international part-nersdevelopedthisframeworkto createauniformreportinglanguage for injury mortalityandmorbidity.

TheNTDBisanexcitingpro-gramthathasthepotentialtosignificantly improve the careofinjuredpatientsintheU.S.The NTDB committee wouldlike to thank all the traumacenters that contributed dataandhopethatthisreportwillattractnewparticipants.

Throughout the year, wewillbehighlightingthesedatathroughbriefmonthlyreportsintheBulletin.ThefullNTDBAnnual Report Version 5.0 isavailableontheACSWebsiteasaPDFfileandaPowerPointpresentation at http://www.ntdb.org.

Ifyouareinterestedinsub-mitting your trauma center’sdata,contactMelanieL.Neal,Manager, NTDB, at [email protected].


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FEATURES - f ACS

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