SFGH career in trauma Viet Nam Peace March Filmed at SFGH IN 60s - PowerPoint PPT Presentation

3/8/2014 Health Care Reform, The ACA, The ACS and You UCSF Naffziger Surgical Society Day Today I’m standing in for my friend Tom Russell March 7, 2014 He is in our hearts and minds We wish him well San Francisco Dr. Russell’s Lecture title in your Program: A. Brent Eastman, MD, FACS FRCSEd (Hon), FRACS (Hon), FRCSI (Hon) What Does the Patient Protection and Past President ACS 2012-2013 Affordable Care Act Mean to Us ? Past President UCSF Naffziger Surgical Society 2013 1 2 Dr. Franklin H. Martin Dr. JMT Finney T HE N EXT H UNDRED Y EARS Founder ACS First ACS President ����������������������� ����������������������� ����������������������� ����������������������� Circa 1910 1913-16 Evarts Graham Harvey Cushing George Crile W.J. Mayo William Halsted Ernest Codman A.J. Ochsner ACS PRESIDENTS: J.E. Dunphy UCSF AMERICAN COLLEGE OF SURGEONS George Sheldon UCSF PRESIDENTIAL ADDRESS Carlos Pellegrini UCSF A. Brent Eastman, MD, FACS, FRCS Ed (Hon), FRACS (Hon), FRCSI (Hon) 3 4 1

3/8/2014 If you remember San Francisco in the 60 ’ ’ s – you weren ’ ’ ’ ’ t there… ’ ’ My UCSF heritage San Francisco 1966 The Grateful Dead The Grateful Dead I started my surgical internship and residency at UCSF – Chair - Dr. J. Englebert Dunphy LBJ First met Dr. William F. Blaisdell, Chief of Surgery at the San Francisco General Hospital and began my own SFGH career in trauma Viet Nam Peace March Filmed at SFGH IN 60s UCSF-SFGH Trauma Team Circa 1966-72 “ In 1966 “ “ “ Everything changed Dr. Sheldon Dr. Trunkey Immediate Past Immediate Past Advent of Medicaid/Medicare Chair, Dept Surg, Chair, Dept UNC Psych units closed people on Surg, Oregon Died June 16, 2013 the streets – drugs – violence Health George Sheldon Born, raised. buried Don Trunkey Sciences Chief Resident Salina Kansas Viet Nam protests Chief Resident Dr. Lewis Crimes of violence doubled. ” ” ” ” Current Dir. American F. William Blaisdell Board of Interview with Dr. Blaisdell Surg SFGH Trauma Center Dr. F. William Blaisdell Pacific Coast Surgical meeting was born Past Chief of Surgery SFGFH Fairmont Hotel Frank Lewis Our Mentor in Trauma A. Brent Eastman San Francisco, Feb 15, 2009 Chief Resident Chief Resident 7 2

3/8/2014 Dr. J. Englebert Dunphy, President ACS -1963-1964 “ “ “ “ We have a global endemic of trauma, greater than AIDS or malaria. Trauma care is rudimentary in sub-Saharan Africa – we need trauma systems – need to use cell phones and wireless networks. ” ” ” ” “ “ “ “ Global health should be the pillar of US foreign policy. ” ” ” ” “ “ We should have a Diplomacy of Health. ” “ “ ” ” ” Interview Haile Debas, MD, FACS Pacific Coast Surgical Fairmont Hotel, San Francisco, Feb. 15, 2009 9 10 Call to Action T HE N EXT H UNDRED Y EARS Affirm ACS Access/Quality Rural Surgery Surgical Education Commitment to Internationalism AMERICAN COLLEGE OF SURGEONS PRESIDENTIAL ADDRESS A. Brent Eastman, MD, FACS, FRCS Ed (Hon), FRACS (Hon), FRCSI (Hon) 11 12 3

3/8/2014 Access & Quality “ “ “ “ There is no Quality without Access ” ” ” ” The Value Proposition Essential for Sustainability Value = Quality/Cost Value is What the Patient Sees “Unfortunately, your plan covers only doctors who couldn’t possibly help you in any way” 15 16 4

3/8/2014 ������������������������������������������ Sept 2009 82% OF HOSPITALS DECREASED COMPLICATIONS 66% OF HOSPITALS DECREASED MORTALITY 250-500 COMPLICATIONS PREVENTED ANNUALLY PER HOSPTAL In 1991 International Presidential Travels What is the most expensive piece of technology in medicine today? Plus many U.S. Chapter Visits 2012 - 2013 My 7 yr old daughter, Ali, wrote this paper at school � Lima Peru � London, Manchester, Oxford � Edinburgh Scotland England � London England � Dublin Ireland � Ottawa Canada � Genoa Italy CT Scanner - No � Manila Philippines � Helsinki Finland Robot - No � Mexico City Mexico � Rio De Janeiro Brazil � San Juan Puerto Rico � Hong Kong MRI - No Ali at 25 � Fukuoka Japan � Calgary, Canada 2010 ACS dinner � Auckland New Zealand Only we as surgeons should be Proton Beam - No � Cairo Egypt deciding on what is appropriate The doctor ’ s pen - Yes � Kuala Lumpur Malaysia surgical care for our patients! 20 5

3/8/2014 IN THE U.S. Universal challenges seeking common solutions HEALTH CARE REFORM OR INSURANCE REFORM OR NO REFORM ??? Presidents International Colleges & Societies ACS Headquarters Washington D.C., AUGUST 25-26, 2013 21 22 WHO IS THIS MAN ? POLITICS POLITICS Democrats and Republicans ….. 23 6

3/8/2014 HEALTH POLICY AND ADVOCACY GROUP (HPAG) WORKING IN CONJUNCTION WITH ACS DIVISION OF ADVOCACY AND HEALTH POLICY Alfred E. Packer Chair, Andrew Warshaw, President-Elect ACS Legislative Committee chair “ “ “ “ There was only six democrats in all of General Surgery Coding and Reimbursement Committee chair Hinsdale County and you … you man-eating Health Policy Advisory Council chairs S.O.B., you ate five of them … I sentence SurgeonsVoice Surgical Caucus chair, AMA House of Delegates you to hang … as a warning against further Chair, Governors Committee on Socioeconomic Issues, Advocacy Pillar representative reducing the democratic population … ” ” ” ” Representative, Young Fellows Association A Colorado Judge - Representative, Resident and Associates Society 1874 Chair, ACS Surgeons PAC ACS ONLY PHYSICIAN GROUP TO TESTIFY BEFORE ALL 3 CONGRESSIONAL WHERE HEALTH CARE REFORM GOT IT WRONG COMMITTEES WITH JURISDICTION OVER THE MEDICARE PROGRAM Failure to permanently repeal the flawed Medicare payment formula—the sustainable growth rate (SGR) • No meaningful medical liability reform • Inadequate provisions to address overall workforce shortage • The Independent Payment Advisory Board 9 27 5 7

3/8/2014 OCTOBER VERSION OF THE MEDICARE PHYSICIAN OCTOBER VERSION OF THE MEDICARE PHYSICIAN PAYMENT PROPOSAL (1) PAYMENT PROPOSAL (2) ACS opposed Medicare physician payment legislation when released in November Alternative Payment models (i.e., ACO, bundling) – left much confusion of where surgery would fit While it included a number of positive aspects, particularly repeal of the SGR … Valuation of Services � 10% penalty to any physician who doesn ’ ’ t turn over data to ’ ’ It also included a 10 year freeze in Medicare payments to doctors federal government � Requirement that Medicare finds 1% per year for 3 years in overpayments to doctors with a specific attack on global The incentive program was budget neutral - any increases to doctors would be paid for by cuts to other doctors surgical services 3 NEW DRAFT – DECEMBER 5 th ACS LED SUCCESS Language REMOVED – Attack on the surgical global payments – The 10% penalty for not giving the government data from physician offices Language INCLUDED: • The criteria for the VBP now includes surgery specific examples – surgical checklists, registries • Alternative payment model section now includes the ability to add new Alternative Payment Models that could more surgery centered. 4 8

3/8/2014 SGR REPEAL AND MEDICARE PROVIDER POLITICAL ACTION SUCCESS PAYMENT MODERNIZATION ACT (1) On February 6, Congress reached a bipartisan, bicameral deal for the repeal of Medicare's sustainable growth rate (SGR) formula and to fix the The SGR would be repealed immediately Medicare physician payment system. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 is the product of a yearlong collaborative effort between Congress and key stakeholders, including Positive annual payment updates of 0.5% the American College of Surgeons (ACS). would be provided for five years The ACS played an instrumental role in the makeup of the final bill by taking Provisions similar to the Standards of Care strong stances in opposition to bad policy and intensely lobbying for changes to the legislation. Congress took our concerns seriously and Protection Act are included made appropriate changes. SGR REPEAL AND MEDICARE PROVIDER PAYMENT STANDARD OF CARE LIABILITY LANGUAGE IN MEDICARE REFORM BILL MODERNIZATION ACT (3) ACA contained quality measures that potentially expands the The 5% added incentive payment for physicians risk of lawsuits against providers in Alternative Payment Models was retained House/Senate Medicare SGR proposal ensures that lawsuits cannot be simply based on whether providers followed Funding for technical assistance to small national guidelines created in federal health laws practices of 15 or fewer professionals was (Provider Shield legislation passed in Georgia, 2013) doubled 9