American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

The Communication Pulse: Leadership and Member Perspectives

100 Words

Benjamin Franklin and Dr. Thomas Bond founded Pennsylvania Hospital in 1751 in Philadelphia. It is the home of America's first surgical amphitheater and first medical library. I routinely operate at Pennsylvania Hospital and often reflect on what operative care was like there 270 years ago. Franklin asked himself every morning: "What good can I do this day?" Before he slept, he would ask, "What good did I do today?" Despite the complexities of our modern practice environment and ongoing challenges, we should remember Franklin's questions. I believe that your answer will always be, "I did do good today!"

L. Scott Levin, MD, FACS, Chair, American College of Surgeons Board of Regents

Surgeon Voices

In this issue, Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Vice-Chair, ACS Board of Regents, and Director, Digestive Disease Institute at Cleveland Clinic Florida in Weston, FL, interviews:

Tina L. Palmieri, MD, FACS, professor of burn surgery, University of California, Los Angeles, on how her time in the military afforded her the opportunity to pursue a career in surgery, the importance of the ACS Committee on Trauma, advances in burn surgery, and more.

Raul J. Rosenthal, MD, FACS, chair, department of general surgery at Cleveland Clinic Florida, on fluorescent imaging in surgery—its history and scientific basis, recent studies on its effectiveness, Dr. Rosenthal's innovative work in this area, and more.

ACS THRIVE: An Update and Invitation to Participate

ACS THRIVE logoLeaders from the ACS and the Harvard Business School (HBS) Institute for Strategy and Competitiveness in July 2019 announced a new collaboration aimed at improving health care value: ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency).

The ACS and HBS both recognize the challenges facing our nation's health care infrastructure, including moving from volume-based to value-based payment models, changing team dynamics within hospitals and new care models that health systems must adopt. The mission of ACS THRIVE is to adequately measure today's value of treating a patient's surgical condition by considering clinical outcome metrics, patient-reported outcomes and cost of treating a surgical condition. Knowing the true cost of all the services bundled together for care will support effective redesign of the care model to deliver equivalent or better outcomes with a lower-cost mix of resources, including personnel, expendables and even use of physical space.

As Matthew Coffron, Manager, Policy Development, and Frank Opelka, MD, FACS, Medical Director, Quality and Health Policy, ACS Division of Advocacy and Health Policy, note, "Cost and price are two sides of the same coin, but they are not identical. In the THRIVE context, the term 'price' is used to describe how much is ultimately paid for something by the patient and the payor. 'Cost' refers to resources and personnel required to deliver goods and services. For a health care system to remain financially viable, the price paid for care must exceed the cost."*

Continuing Work

In 2020, the ACS team created template care cycle maps for surgical conditions. Hospitals are in various stages of adapting these template care cycle maps. Time-driven activity-based costing (TDABC) is used to calculate cost based on finished process maps. The calculation includes data such as personnel compensation, time spent engaged in patient care activities, use of expendable materials, and space usage. Data used to calculate cost are de-identified. Price information based on Medicare expenditures also is openly available for all hospitals. Program participants will be able to learn from each other, and the data inputs will inform benchmarks in the future.

The ACS team has completed cost and price studies at several health care institutions. This data has provided organizations with valuable insight into their true costs to deliver care and provided a method to compare costs within the cohort.

Now Recruiting

The ACS is recruiting hospitals to participate in one or more procedure cycles. Additional procedures are in development and soon will be added to the THRIVE care cycle scope.

Participation in ACS THRIVE at this formative stage benefits hospitals in the following ways:

  • Work with experts to develop detailed TDABC process maps reflecting workflow, personnel use, expendables use and time spent within care cycles
  • Receive detailed breakdown of cost and price for each phase of a care cycle, including the operating room
  • Use detailed price data to understand the position in the local and national market, now required by law
  • Optimize care model to deliver equivalent or better outcomes with a lower-cost mix of resources (personnel, expendables, equipment and space usage)
  • Use detailed process and cost maps to inform data-based decisions to continue their fee-for-service contract or consider risk-bearing value-based contracts with shared accountability

ACS THRIVE is an innovative program that could have far-reaching impact on measuring and improving health care value. We welcome your organization's participation.

Contact Anupam Dayal at if you are interested in joining the program as a founding member.


*Coffron M, Opelka F. Price and cost: Both are important to achieve value-based care. Bull Am Coll Surg. 2021;106(2):17-24. Accessed May 4, 2021. Available at: