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Special Communication
September 2014

American Surgery and the Affordable Care Act

Author Affiliations
  • 1Department of Surgery, Albany Medical College, Albany, New York
  • 2American College of Surgeons, Chicago, Illinois
  • 3Department of Surgery, Oregon Health Sciences University, Portland
  • 4Schaeffer Center for Health Policy and Economics, Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles
  • 5Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
JAMA Surg. 2014;149(9):984-985. doi:10.1001/jamasurg.2014.1343

The Affordable Care Act (ACA) attempts to change the way we finance and deliver health care by coordinating the delivery of primary, specialty, and hospital services in accountable care organizations. The ways in which accountable care organizations will develop and evolve is unclear; however, the effects on surgeons and their patients will be substantial. High-value care in the ACA emphasizes quality, safety, resource use and appropriateness, and the patient’s experience of care. Payment will be linked to these principles. Department chairs overseeing a clinical enterprise in academic medical centers now must add financial and quality measures to the traditional missions of education, research, and clinical service. At a time when surgical training is in dramatic evolution, with work hour limitations for residents and an emphasis on quality, productivity, and increasing oversight of trainees for faculty, residency programs will need to meet the increasing demands of an aging population and newly insured patients under the ACA. The American College of Surgeons, with its century-long commitment to quality improvement, research-based standards, and performance measurement and verification, has begun its Inspiring Quality Campaign, is developing new educational tools, and is preparing proposals for payment reform based on surgeons’ participation in quality programs.

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