American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world.

Quality Verification Programs and THRIVE

The THRIVE program, which analyzes the cost of specific surgical procedures, is built on existing quality and safety programs. It aims are to reduce variation in the cost, quality and safety of surgical procedures. How does this build trustworthiness? The program builds trust by promoting reliability and safety of surgical procedures and fair costs; it engenders patient confidence in surgeons’ competence by letting patients know that health systems are monitoring and improving the cost, quality and safety of their procedures.

How It Works

These programs are designed to ensure the public trust in quality and safety in surgery. The quality verification programs consists of creating disease based standards, building the infrastructure to deliver these services in a hospital, creating databases to measure performance against these standards for quality improvement, and external peer-reviewed verification of these programs to create a public trust that performance of what is assessed exists. There are currently 15 programs that include cancer, breast disease, colorectal cancer, trauma, bariatrics, childrens surgery, preoperative assessment and strengthening, perioperative continuity of care, practices to improve outcomes of geriatric patients, thoracic surgery, vascular surgery, high-risk GI surgery, emergency surgery, rural surgery, and the overall quality verification program (RED Book). Each of these programs follows the standard model of creating standards based on evidence for expert consensus, building out the infrastructure, and data measurement systems which are assessed through a verification proces.

More recently the THRIVE program has been added to these quality programs. THRIVE attempts to drive value by calculating the quality of care using process measures, outcome measures and patient reported outcomes, divided by cost determined by the methodology of time derived activity based costing (TDABC). This program will be useful in assuring patients and surgeons that the costs of actual care are real and benchmarked and transparency with expected clinical outcomes will be publically available.

Skills and Competencies

The College has a series of programs that are well designed and thought out following the above mentioned quality model. The implementation requires hospital commitment and the verification process occurs by expert reviewers. The costs determination requires mapping the care delivery of a particular operation and then calculating the individual costs of everything in the production cycle.

Origins

Through the quality programs we have substantial evidence that mortality, complication reduction, cost reduction, and overall effectiveness and consistency are improved with these programs. This evidence has been the basis for expanding the programs to multiple other diseases over the last ten years. The THRIVE program in determining costs is newer and at present does not have specific objective data however, by analyzing the cost structure of care delivery it is highly likely that opportunities for improvement in cost reduction will be identified.

Effectiveness

Scalability

There are currently 2500 hospitals that participate in these programs and we are presently in the process of increasing the scalability and generalizability of these programs for all surgical care in a hospital. The THRIVE program is growing quickly in terms of interest and the next step involves teaching the methodology to hospitals so they can proceed with determining their costs. Fortunately despite the COVID-19 crisis the ability to deliver the quality programs and the costs >reduction program (THRIVE) virtually has been demonstrated and will likely be the way these are done in the future.