Symposium participants, from left: Drs. Hoyt, Haider, and Gawande; Patricia L. Turner, MD, FACS, Director, ACS Division of
Member Services; Drs. Britt, Maddox, Pellegrini, and Dankwa-Mullan; and Edward E. Cornwell III, MD, FACS, ACS Secretary.
Dr. Hoyt outlined the four-step process that the ACS
has used as the model for its trauma and other quality
improvement programs. “You start by setting standards—
what you expect to happen at a certain point. You then
build out the infrastructure, you measure performance
through the analysis of data, and, finally, you subject
yourself to external verification,” he said.
In addition, Dr. Hoyt commented on the Affordable
Care Act (ACA). “What [the legislators who crafted] the
ACA hoped to do was improve access to care through
insurance reform, control costs through payment
reform, and create delivery system redesign through
performance measurement and incentives,” he noted.
“So how have we done? The good news is that
insurers can no longer deny patients coverage due to
preexisting conditions, and patients have more coverage options,” Dr. Hoyt said. For instance, the ACA led
to the expansion of Medicaid in most states. As a result,
the percentage of uninsured Americans dropped from
18 percent in 2013 to 13 percent in 2014.
“Have we bent the cost curve? I would argue that
we have,” Dr. Hoyt said. Although health care costs
are still rising faster than inflation, the cost of care
per worker in 2014 rose just 4. 6 percent from 2013, he
said. Previously, health care spending was increasing
by more than 6 percent annually.
A transformation in how policymakers view health
care reform has been a shift in focus “from volume to
value,” Dr. Hoyt noted. This changing focus is central
to H.R. 2, the Medicare Access and CHIP (Children’s
Health Insurance Program) Reauthorization Act and
its Merit-based Incentive Payment System.
To truly eliminate disparities, however, the health
care system must ensure that all patients have optimal
access. “I would argue that verifying access has not
been a priority in the United States. It has not been an
adequate priority at the American College of Surgeons,
and we can start today to change that,” Dr. Hoyt said.
Providing an overview of the NIH’s efforts to address
health care disparities were Lawrence Tabak, DDS,
PhD, Principal Deputy Director, NIH, and Yvonne T.
Maddox, PhD, Acting NIMHD Director.
Dr. Tabak noted that the NIMHD recently
announced funding with intent for research that would
focus on health care disparities with precision in medicine. He added that the NIH is excited to be partnering
with the College on this initiative. “These types of collaborations assist in the development of the solutions
needed to resolve these types of multidimensional problems,” he said.
Dr. Maddox described the NIMHD as “the entity
within the NIH that is responsible for leading scientific research to improve minority health and
eliminate health care disparities. Most importantly,
we are responsible for translating and disseminating
the research results that are created across the NIH,”
Dr. Maddox said.