Payment reform tops College of Surgeons' priorities

The American College of Surgeons’ strength in advocacy and its wide-ranging educational programs are two of the primary benefits of membership for urologists, according to Robert R. Bahnson, MD, chair of the board of directors of the College’s political action committee and a leader of the College’s Health Policy Advisory Group. In this interview, Dr. Bahnson outlines the College’s work on payment reform, the broad appeal of the College’s clinical congress, and other services available to fellows. Dr. Bahnson is the Dave Longaberger Chair in Urology and professor and chair of urology at The Ohio State University Wexner Medical Center, Columbus. He was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, professor and chairman of urology at the University of Wisconsin, Madison.

What are the current priorities of the American College of Surgeons?

Payment reform is our current top priority. The sustainable growth rate has been a thorn in all of our sides for a long time, and it appears that there’s a movement to eliminate it. Doing so requires some alternative payment method, and the American College of Surgeons (ACS) has invested tremendous amounts of time and energy in coming up with one. It’s called the value-based update, and over a transition period of somewhere between 5 and 10 years, surgeons will continue to be reimbursed for episodes of care under the traditional fee-for-service method. However, in order to obtain payment and qualify for bonuses, there will be quality reporting incentives and EHR meaningful use requirements that providers will have to meet.

The ACS is also heavily invested in the development of programs to improve the quality and safety of surgery. Specific examples include NSQIP (the National Surgical Quality Improvement Program) and two committees: the Commission on Cancer and Committee on Trauma.

How do you feel these efforts have progressed?

I’m pleased with the way the College has acted proactively. I was somewhat surprised to hear several high-ranking senators describe the Affordable Care Act as a “train wreck.” I’m hoping we can, through work and through thoughtful processes, actually make it better.

How did you become involved with the College as both a member and now an officer?

As a resident, I enjoyed going to the American College of Surgeons clinical congress. In particular, the surgical forum was an opportunity for residents to present some of their more interesting data. I then became a fellow and was asked to be on the advisory council as the young urology representative.

I continued to work through the advisory council on the program committee, became a member of the program committee, and ultimately was elected as an officer of the College. I’m currently chair of the board of directors of the College’s political action committee, and I’m also one of the four leaders of the Health Policy Advisory Group.

It’s been a very long time of service. I’ve enjoyed it and as I’ve gotten to this point in my career, I find it fascinating to study some of these global issues that affect surgeons. It’s great to be a student again.

How does the clinical congress attract urologists?

We’ve worked very hard to offer content at the clinical congress that would be appealing to urologists. We also try to schedule sessions that might appeal to folks who operate in fields similar to ours; for example, orthopedic surgeons enjoy our pelvic trauma sessions. Incontinence attracts specialists in OB/GYN. Undescended testicle brings in pediatric surgeons. We try to be universal in appeal.

Something else we’ve done recently has been to schedule the congress by tracks so that you don’t have to attend the entire congress to get the urology content.

The 2013 American College of Surgeons clinical congress was held in October. Can you give us some of the highlights?

Last year was exciting, as it was the 100th anniversary of the College, so the congress featured a number of celebratory activities. A hundred years ago, the founders of the College started the organization with the intent of certifying that hospitals were providing good surgical care. They really were the “JCAHO” of 1913; much of what was done at the initial clinical congress related to promoting standards of excellence that improve quality and outcomes.

Specifically, in terms of urology, we had sessions on prostate cancer and trauma, among others. We also had our surgical forum, which I find the most attractive of our congress offerings. We get residents to present very interesting work. I remember when I was much younger, you, Dr. Nakada, presented your work on cryoablation versus radiofrequency ablation of renal tumors.

One step that has been taken to revitalize the forum is to invite experts such as you to come and discuss the residents’ papers. The residents find it thrilling to have someone like you critiquing their paper in a meaningful, intimate sort of way. That’s the highlight of what we offer at the congress, and the 2014 installment in October will be no exception.

What services outside the clinical congress does the College offer to urologists?

The major offering is the advocacy that takes place in Washington on behalf of all surgeons. The College has 77,000 members, and as a consequence we rightfully think of ourselves as being the “house of surgery.” The advocacy efforts are something you’re a part of and benefit from simply by being a member.

Over and above that, there are tremendous educational benefits. There is certain knowledge that you need in surgery that is not specific to urology; perioperative care, fluids/electrolytes, pain management, and patient safety are all examples of educational offerings that can be accessed by fellows. It’s a very robust educational platform.

There are also amazing insurance programs available to fellows. Some of the premiums on these plans compare extremely favorably with plans that are normally available to surgeons.

The activities of the College are broad and deep. For example, the College worked very hard to create certification of trauma centers, not just in the U.S. but also around the world. The courses taught in these centers are amazing in terms of what they’ve done to prepare people for traumatic injuries and disasters.

I’d also like to mention that the College continues to work on tort reform, and that’s something that I think all surgeons are very eager and enthused about.

How does one become a fellow of the College?

The process requires you to undergo peer review within your locale. We have committees around the country. Once you’ve submitted your credentials to the College and demonstrated your board certification, you then interview with the local committee. A recommendation is made and if accepted, you are conferred into fellowship at the clinical congress.

What are the key benefits for the practicing urologist compared to the academic urologist?

The urologist in clinical practice needs the help of organizations like the American College of Surgeons and the AUA more than anyone. I grew up in South Dakota; the population density there is quite different than major urban centers. The College and the AUA are able to represent the activities of people who are providing clinical care, and for urologists who are in private practice, the efforts that are being made to preserve a reasonable degree of compensation for surgeons are critical.

Dr. David Hoyt, who is the executive director of the College, testified in front of the House Ways and Means Committee last May, arguing that it is critically important for physicians in general and surgeons in particular to know ahead of time from an expense standpoint that they’re going to be receiving certain levels of payment. He also argued against penalties; instead, for episodes of care there would be a guaranteed base and then for better outcomes and participation in certain other activities, physicians would be eligible for bonus payments. This would also be tied to some form of an index that moves your payment along if cost of living and practice expenses go up.

For an academic urologist, the activities in the College are almost limitless. The board of governors has been realigned in terms of different groups with different perspectives and different assignments.

The College really welcomes specialty surgeons. Urology is viewed very favorably by the College. I think that has a lot to do with Dr. Jack McAninch and Dr. Howard Snyder, who have both done wonders in promoting urology within the College. We’re also served extremely well by our advisory council, chaired by Dr. Tony Atala, which provides programatic themes and activities at the clinical congress that make it especially attractive for academic urologists, residents, and fellows.

To wrap up, make your best case for a young urologist who’s on a tight budget to pursue membership in the College.

The educational opportunities that you can access through the American College of Surgeons website are one reason to become a fellow. Another is that the College is working very hard to make it possible for fellows to participate in a surgeon-specific registry through the College that should do a tremendous amount to satisfy physician quality reporting system, maintenance of certification, and maintenance of licensure requirements. Membership in the College will provide an easier opportunity for young urologists to meet the growing and continuing certifications, accreditations, and documentation requirements.UT

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