The Board of Regents of the American College of Surgeons met in Chicago, February 6 and 7, 1998. Overall, College finances remain in satisfactory condition and the fellowship is growing at a steady rate. Neurosurgical participation in the fellowship remains significant and neurosurgical participation in the various committees has been outstanding.
Report Card Project and Outcomes
The Report Card Project originally began within the Board of Governors as a response to managed care. The desire, similar to the one in neurosurgery, was to provide Fellows with a means of measuring their own clinical outcomes in comparison to their peers. One of the procedures chosen for the Report Card Project is lumbar laminectomy, and we have been actively involved, along with orthopedic spine surgeons, in reviewing the instrument designed to collect the data for the outcome studies and for the report card itself. This is moving along quite well and will be supported by the American College of Surgeons.
Clinical Trials
The ACS has put on effective courses on Clinical Trials Methods. These are expensive to produce, but the response from the participants that have included neurosurgeons has been encouraging.
The National Cancer Institute has approved a proposal from the ACS to set up a nationwide Clinical Trials program. The statistical arm will be located in Philadelphia and 15 institutions will be involved in the initial phase. The National Cancer Database, maintained by the College of Surgeons, is the base for selection of the initial trials. There will be 11 Clinical Trials supported for the first two to three years, including four in thoracic oncology, two in colorectal cancer, one in retinoblastom and one in breast cancer.
The opportunity for a Neurosurgical Clinical Trial will be forthcoming. Educational opportunities will be built into the framework of the Clinical Trials program and it is recognized that maintaining excellent accrual to the various trials will be essential for their success.
New Technology Educational Courses
At the recommendation of the Committee on Emerging Surgical Technology, the College will undertake a validation process for fellows undergoing educational courses designed to enhance their practice with new technology . This will include such procedures as stereotactic breast biopsy and the use of intraoperataive ultrasound for general surgical techniques. Undoubtedly, there will be other College programs designed to teach new technologies. The concerns, of course, are the same as those faced by neurosurgery, in that one must be aware of malpractice exposure, the maintenance of the tax exempt status of the organization providing the instruction, and the antitrust aspects of a verification procedure that might extend to credentials issues.
Subspecialty Advisory Councils
The Advisory Councils for the various subspecialties have been quite active. They have been reviewing together the prerequisites for PGY-1 experience before going into surgical specialties. They have been considering the possibility of including representatives from the candidate group on the various Advisory Councils and have been interacting with The Board of Governors and its Report Card Project. They also will provide material for the recently redesigned Journal of the American College of Surgeons, which will periodically highlight specialty areas of surgery, including neurosurgery.
Reimbursement Issues
A position paper on the role of residents in managed care systems was debated and is being matured. It will probably be broadened to include more than just the role of residents. This will be brought before the Regents at the June meeting. The American College of Surgeons participates in the activities of the ICAHO and the Council of Medical Specialty Societies and both of these organizations are conntinuing to assert their respective influence over important areas in surgical care. The professional liability area has been marked by tort reform initiatives in the various states, some of which have been successful and some of which have been declared unconstitutional. A surgeon has been appointed to The Board of the American Tort Reform Association (ATRA) to replace Ben Blackett, MD, who has served so well for surgery and for neurosurgery.
The regulatory update and physician reimbursement areas are under constant analysis by the College staff . Executive Director Paul Ebert, MD, has been very active in testimony in Washington, with an attempt to deal with both the issue of practice expense and with regard to the conversion factor, both of which areas are of major concern to surgeons. The College’s coding activities have expanded significantly and they now have a coding hotline, which handles significant numbers of inquiries every day.
Edward D. Laws, Jr., MD
Regent for Neurosurgery, American College of Surgeons