Healthcare Economic Committee

The Committee on Healthcare Economics of Acute Care Surgery was created in 2017 by President Rotondo to help guide the AAST membership and leadership on economic factors that relate to the practice of Acute Care Surgery. The economics of the practice of Acute Care Surgery is inherently tethered to the country’s overall healthcare economic landscape. In addition to macroeconomic trends, the financial viability of local practices is often dependent on shifting policies and reimbursement strategies. As US healthcare economics continue to evolve, it is in the interests of the AAST to stay in front of these trends, maintaining flexibility and ensuring we meet the needs of the population.

In this way, the goal of the Healthcare Economics Committee is to support the larger objectives of the AAST. These objectives include:

1. Grow the Acute Care Surgery mission by applying lessons learned in trauma to EGS with emphasis on horizontal integration to the AAST efforts of other committees
2. Advance EGS, trauma, and SCC training to suit all practice models
3. Collaborate with other US and international efforts to ensure financial viability of the ACS model
4. Create reports and studies to inform the AAST membership
5. Establish economic models for care delivery

In the first year, the primary objective was the creation of a report, The Current and Future Economic State of Acute Care Surgery and the AAST. The report provides a background to the complex US healthcare environment and explores how current trends are affecting the ACS model of care. The report further examines threats and opportunities for ACS and concludes with a set of key priority areas for action by the American Association for the Surgery of Trauma. This report, which will be presented to the AAST membership at the 2018 Annual Meeting in San Diego, serves as the framework for ongoing Committee action. The committee also conducted research and concluded that the economic “footprint” of ACS is quite large—20 percent of acute inpatient hospitalization costs are associated with an acute care surgical diagnosis. This indicates that ACS and AAST leadership in economics is not just important, but necessary.

November 2020 Update:

Committee work products included:

1. Report to AAST Board of Managers (enclosed)
2. Accepted manuscript from AAST podium presentation - annual meeting 2019
   Zogg, Cheryl K. MSPH, MHS1,2; Bernard, Andrew C. MD3; Hirji, Sameer A. MD, MPH2; Minei, Joseph P. MD, MBA4; Staudenmayer, Kristan L. MD5; Davis, Kimberly A. MD, MBA1 Benchmarking the Value of Care Variability in Hospital Costs for Common Operations and Its Association with Procedure Volume. Journal of Trauma and Acute Care Surgery: February 7, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/TA.0000000000002611

Work Products: 

White Papers/Publications

1. Measuring costs in healthcare: This paper describes the various methodologies and perspectives that can be used to determine costs.
2. Measuring quality in healthcare: This paper mirrors the above, but focuses on describing on the universe of mechanisms to measure quality.
3. Costs for Research: Related to the first project above, this project will develop a white paper describing cost variables that can be used in healthcare economic research. There has been initial interest by the editorial board of JAMA Surgery for this submission.

Planned Webinar Series: Development of a webinar series covering cost/quality/value topics that will be made available to the AAST membership and delivered during the 20-21 academic year.

Resource Development:

1. Development of an FTE calculator. The concept is to develop an FTE calculator that accounts for clinical, teaching, research and administrative roles that faculty in an Acute Care Surgery Division will hold. The goal of the FTE calculator will be to assist Division Chief in defining the number of faculty to hire to cover these responsibilities.
2. Development of a Research Cost Catalogue: There is an increasing number of studies conducted using economic and financial data. The committee plans on creating a resource document to help inform researchers on available cost tools and best practice. This will also be submitted for publication. 

Research Projects: To perform a “deep dive” into costs for Emergency General  Surgery, we are conducting  two studies (both led by Andrew Bernard) that explore costs both horizontally across institutions, and in-depth (within institutions).

1. Project 1: Measuring cost analyzing the Vizient database and comparing across institutions. The results of this project have been submitted as an abstract to the upcoming AAST annual meeting
2. Project 2: Measuring cost by performing a multi-institutional trial of centers that are willing to share actual cost data for this procedure (PI: Andrew Bernard, MD). This is currently in the planning stage with interested centers working with their financial counterparts to determine interest and feasibility.