May 1, 2017
The 鶹ý (ACS) Health Policy and Advocacy Group updated the 2009 鶹ýStatement on Health Care Reform and has developed the following 2017 Statement on Health Care Reform. The 鶹ýBoard of Regents reviewed and approved the statement at its February meeting in Chicago, IL.
The 鶹ý is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.
—鶹ýMission Statement
The 鶹ýis the largest surgical organization in the U.S., representing more than 80,000 members from all states and surgical specialties. The 鶹ýwas founded in 1913 and is dedicated to high-quality, safe surgical care delivered in a compassionate, ethical manner. Surgeons perform approximately 30 million operations annually in the U.S. Although the 鶹ýappreciates the challenges facing the U.S. health care system, the organization also emphasizes that many aspects of surgical health care in the U.S., including surgical education and training, are the best in the world.
The 鶹ýstrongly supports efforts to ensure that individuals have universal access to patient-centered, timely, affordable, and appropriate health care, while maintaining that surgeons are an integral and irreplaceable component of quality health care.
To this end, in any health care reform bill, the 鶹ýstrongly supports four core principles:
Achieving these goals and building a better health care delivery system will require all stakeholders to work together.
The 鶹ýhas a multifaceted approach to enhancing quality and safety in health care worldwide. The cornerstone of this effort focuses on our clinical registries and our educational efforts to drive quality improvement and safety. Scientific evidence shows that providing safe and effective quality surgical care will help to reduce the cost of health care delivery. Cost reductions must be linked to quality improvement efforts.
The 鶹ýregistries are built with scientific rigor, using standards and critical audit functions to ensure that surgeons and patients have valid, reliable information upon which to base health care decisions and drive improvement. College registries include the 鶹ýNational Surgical Quality Improvement Program (鶹ýNSQIP®) and clinical databases focused on pediatrics, bariatrics, breast disease, cancer, trauma, as well as the Surgeon Specific Registry™. The 鶹ýeducation, improvement, and verification programs are broadly applied using the registries for their supporting infrastructure.
鶹ýNSQIP, for example, represents a nationwide effort to use risk-adjusted tools to improve surgical care and cut costs. This program helps to prevent thousands of surgical complications each year, which, in turn, reduces costs. These achievements have been recognized by the National Academy of Medicine, the National Quality Forum, and The Joint Commission.
The Centers for Medicare & Medicaid Services (CMS) quality programs have evolved under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) into two major programs: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The 鶹ýmaintains that performance measurement is important in establishing value-based care for patients in both payment programs. Performance measurement should focus more on patient safety than on surgeons adequately attaining participation thresholds in CMS payment programs. The 鶹ýsupports CMS and all payors in their efforts to align their quality programs with individual patient needs and goals of care. The 鶹ýsent a cautionary message to CMS with regard to the use of outcome measures. Outcome measures are an invaluable tool in driving improvement, but they lack the statistical capabilities for discerning differences among individual surgeons for the purposes of payment differentiation or public reporting. Outcome measures, when used, should be risk adjusted and stratified and used to assist in developing quality improvement initiatives.
The 鶹ýsupports defining performance measurement within episodes of care using phases of care to define the foci for measurement. For example, the surgical phases of care are as follows: surgical preoperative evaluation and preparation, immediate preoperative readiness, perioperative, intraoperative, postoperative, and postdischarge. The 鶹ýrecommends use of high-value process measures and directed patient-reported outcome measures that are consistent with the goals of surgeons and their patients for each specific episode of care.
The 鶹ýsupports quality, safety, and related performance measurements that meet the following standards:
Furthermore, the 鶹ýbelieves that Congress should:
The 鶹ýhas a longstanding policy of supporting universal access to affordable, high-quality, safe surgical care delivered in a timely and appropriate manner. Achieving universal access to such care requires that our nation maintain a well-trained and available surgical workforce to meet the needs of all surgical patients. The shortage of surgeons in several surgical specialties in many areas of the country jeopardizes patient access to timely, high-quality surgical care.
Provision of appropriate, high-quality, safe, and cost-effective patient care should begin with defining unwarranted, unnecessary, high-cost care. Surgeons should reduce unwarranted variation in order to preserve quality while optimizing resource use. Efforts to promote value-based risk models linking quality and optimal cost should encourage rewards and limit penalties. Further, optimal care should encourage patient engagement in shared decision making. Patients require education and support in fulfilling their individual role in the maintenance of health and well-being. These efforts should promote access to appropriate and compassionate care for all.
The 鶹ýsupports the repeal of the Independent Payment Advisory Board. The 鶹ýmaintains that Medicare payment policy should remain the primary purview of Congress rather than delegated to an unelected, unaccountable governmental body that may minimize input from stakeholders and citizens. Any binding mandates promulgated from such a body that affect reimbursement should be fairly constructed, spread across the spectrum of all health care interests, and not directed at any one sector, such as surgery.
In accordance with the “Statement on medical liability reform” developed by the 鶹ýLegislative Committee and approved by the Board of Regents in October 2014,
Meaningful medical liability reform would reduce health care costs and improve patient access to care, as demonstrated by the following examples:
The 鶹ýmaintains that our nation’s medical liability system is broken and that it fails both patients and physicians. Less than 3 percent of patients who sustain medical injury sue for monetary compensation. Furthermore, in 37 percent of all closed liability claims, no error was discovered. In addition, the present liability system costs an estimated $100 billion annually. The system is costly, inefficient, and the process of compensating injuries related to medical errors is inaccurate.
The mission of the 鶹ýis to improve the care of the surgical patient, safeguard standards of care, and create an ethical practice environment. The College is a proven leader in patient safety through initiatives such as 鶹ýNSQIP. The failing medical liability process jeopardizes the public’s trust in the health care system and threatens to undermine the successes that the 鶹ýhas achieved. Therefore, the 鶹ýwill continue to lead the way by advancing practical reforms that improve patient safety and provide quality health care.
Beyond traditional legislative remedies, the medical liability system is in need of transformative change that focuses less on monetary reparations and more on patient safety, quality care, and provider accountability. Adverse events should be approached with open communication and recognition that an unfortunate outcome is not synonymous with negligence. Compensation for injured patients, monetary or otherwise, should be fair and timely without the unnecessary delay commonly associated with the current tort process. Hospitals should pursue system-level changes that assure patients of quality care and that prevent event recurrences. Ultimately, negligent providers should be held accountable.
Alternative, patient-centered solutions to liability reform have received varying degrees of attention. Health courts, enterprise liability, and alternative dispute resolution can be crafted around patient-centered principles and also provide excellent opportunities for reform. However, on balance, disclosure and offer programs, otherwise known as CRPs, show great promise for promoting a culture of safety, quality, and accountability; restoring financial stability to the liability system; and requiring the least political capital for implementation. Whereas any of these alternatives would represent an improvement over the status quo for both patients and providers, they should be explored through additional research and advocacy. In addition, structural barriers to implementation, such as obsolete reporting requirements to the National Practitioner Data Bank and inconsistent apology protections, must be addressed.
Thus, the 鶹ýbelieves that incorporating medical liability reform is essential in any comprehensive health care reform effort and supports the following:
*鶹ý. 鶹ýPolicy and Position Paper on GME Reform. January 2017. Available at: /~/media/files/advocacy/workforce/2017_ahp_gmepaperappendixprimer.ashx. Accessed April 4, 2017.