All Members

On behalf of STS’s 7,600 member surgeons and their clinician partners, Thomas MacGillivray, MD, president of The Society of Thoracic Surgeons, testified before the US House of Representatives Committee on Energy and Commerce, Subcommittee on Health, about Medicare coverage pathways for innovative drugs, medical devices, and technology that saves lives.

In his statement, Dr. MacGillivray highlighted how the STS’s National Database provides a true clinical benchmark and contains data on more than 9.4 million cardiothoracic surgeries performed by more than 4,300 surgeons. The Database is a powerful quality improvement tool that facilitates increased patient access to break-through technology. He explained the value of real-world evidence and using data to monitor new technology and expand indications for new therapies.  And he underscored that through big data, cardiothoracic surgeons across the country and around the world can work together to find solutions and transform patient care.

Dr. MacGillivray’s key talking points:

• The STS National Database is the gold standard for clinical registries.
• The Database allows hospitals and cardiothoracic surgeons to identify best practices and potential gaps, and evaluate their performance against national and regional competitors. The Database is updated continuously and participants can monitor their progress and make critical decisions daily.
• Without ongoing evidence collection in the real-world setting coupled with access to longitudinal claims data, the efficacy and appropriateness of emerging innovative technologies is uncertain, impairing physicians’ ability to make the best decisions for our patients.
• The STS believes it is essential that any reforms to coverage for emerging therapies:
  • Prioritize the collection of real-world data, particularly for new, innovative medical devices.  Data collection creates opportunities to fill post-market evidence gaps and better define patient benefits and risks.
  • Permit early discussions and coordination between the agency and relevant stakeholders to allow sufficient time for the appropriate application, design, and implementation of any CED requirements.
  • Provide flexibility for data collection mechanisms to adjust based on new developments in the evidence.
  • Registries need timely, cost-effective, and continuous access to Medicare claims data to perform longitudinal studies.    
  • Dr. MacGillivray urged Congress to advance reforms such as the H.R. 5394, the Meaningful Access to Federal Health Plan Claims Data Act of 2021, from Reps. Larry Bucshon, MD, and Kim Schrier, MD, which would require that enhanced access to Medicare claims data be provided to clinician-led registries, such as the STS National Database.

Watch Dr. MacGillivray's testimony.

The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule today. STS has compiled a summary of key provisions affecting cardiothoracic surgery in the rule.  

Payment Cuts

CMS is proposing severe cuts to cardiothoracic surgery reimbursement. According to CMS, cardiothoracic surgeons will see a 3% cut in 2024. CMS estimates the CY 2024 conversion factor (CF) to be $32.7476. STS will continue to fight these cuts by lobbying Congress and CMS to provide an inflationary update to Medicare payments. While physicians have been subjected to across-the-board cuts for the last several years, Medicare continues to increase payments to hospitals, most recently proposing a 2.8% increase for inpatient hospital payments. Physicians deserve similar treatment.  

Changes to physician reimbursement are often driven by Medicare’s budget neutrality requirement combined with no built-in mechanism for inflationary or other increases in resources for the Medicare fee schedule. Disruptions to reimbursement occur when there are changes to the value of specific services, which negatively affects how other services are reimbursed to maintain budget neutrality. An inflationary update would be the first step toward resolving the constant downward pressures created by this dynamic. Urge your lawmakers to support H.R. 2474, a bipartisan bill that would create an automatic inflation update for physician payments for the first time. 

Global Surgical Codes

Once again, CMS has failed to apply the increased value of evaluation and management (E/M) codes services packaged in global surgical payments. STS has repeatedly recommended that CMS follow its own precedent and apply commensurate values for the office/outpatient E/Ms, inpatient E/Ms, and discharge day management visits packaged in the procedural global payments. This has been CMS’s policy every time E/M services have undergone a significant overhaul.  

Previously Delayed Complexity Code

CMS is once again proposing to implement payment of the flawed G2211 add-on code for E/M office visits, which was previously delayed by Congress through legislation. These visits are defined as a “visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.” STS successfully advocated for the congressional delay to this code in 2020 and continues to have significant concerns with its proposed implementation, which will impact the Physician Fee Schedule by redistributing billions of dollars between specialties. STS has and will continue to vehemently advocate against this proposal in its current flawed form.  

Telehealth

CMS is retaining Category 3 codes on the Medicare telehealth list through CY 2024. STS is supportive of this proposal as data collected during COVID-19 demonstrates the positive impact telehealth has had on both patient clinical outcomes and patient experiences.  

Additionally, CMS proposes to provide coverage and payment of certain audio-only telehealth services until December 31, 2024. STS supports the provision of continued payment for audio-only visits in appropriate circumstances to help address health disparities and individuals without strong internet access, although we do not believe audio-only is adequate for more complex visits. 

Quality Payment Program

CMS will discontinue the Alternative Payment Model (APM) incentive payment as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in CY 2024. Instead, for performance year 2024, CMS is proposing APM participants receive a higher payment rate using a specific qualifying APM conversion factor. If CMS’s goal is to encourage providers to prioritize value-based care by participating in APMs instead of the traditional MIPS program, then CMS should work with Congress to reauthorize the 5% APM incentive payment. Additionally, the Centers for Medicare and Medicaid Innovation (CMMI) will need to test APMs that directly recognize the role of specialists. 

CMS also proposes to expand the inventory of MIPS Value Pathways (MVPs), which is a new voluntary participation option aimed at providing clinicians with a more focused and cohesive MIPS experience. While MVPs offer a slight reduction in reporting burden, STS continues to believe that it fails to address fundamental flaws that have hampered meaningful participation by cardiac and thoracic surgeons.  

STS President Thomas MacGillivray, MD, recently hosted a Town Hall to get member input on how the Society can advance a more inclusive and welcoming community of cardiothoracic surgeons.

Facilitated by DEI Consultant James Pogue, PhD, the Town Hall focused on understanding member perceptions of where individuals, the specialty, and the Society are today with respect to DEI. “This work is about you, our members. We want your perspectives on the role that DEI should play in our specialty and our Society,” said Dr. MacGillivray. “This is your opportunity to speak up and have your voices heard.”

Key themes that emerged were the need for data to understand members’ general knowledge of DEI; a call to action for members to engage in real, meaningful conversations that result in tangible change; and a culture that elevates empathy, listening, kindness, and grace throughout this journey.

Dr. MacGillivray said he has listened to a wide range of opinions over the past five months, and he sees STS members at different levels of DEI understanding and engagement.

“The more we talk about things, the more we can learn. I hope all of us who are trained in science, data, and evidence take the knowledge gained from this journey and use it to help us build a better future for all,” added Dr. MacGillivray.

Leading up to the Town Hall, Dr. Pogue conducted one-on-one discussions with key stakeholders and a deep-dive DEI session with the STS Board of Directors. Next up is a member survey and focus groups. Dr. Pogue will use data and insights from this work to develop recommendations on the path forward for STS.

On June 3, 2023, in Miami Beach, Florida, cardiothoracic surgeons from around the world convened for the second annual STS Coronary Conference. Distinguished speakers and luminary surgeons painted a modern, ever-changing landscape of coronary surgery with new technologies, such as medical robotics, increasingly integrated into the specialty daily. Attendees experienced game-changing ideas, back-to-the-basics techniques, and ground-breaking science in diagnostic and therapeutic approaches to heart disease.

“The meeting brought together international leaders in the treatment of coronary artery disease and focused on the fundamentals and advanced therapies for coronary artery disease, including medical management, arterial conduits, and minimally invasive surgical revascularization,” said Joseph F. Sabik III, MD, surgeon-in-chief and vice president for surgical operations at University Hospitals Cleveland Medical Center, and a course director of the conference. “The conversations were engaging and the atmosphere was electric.”

Sessions covered a wide range of topics, including heart team patient selection and approaches; conduit selection and harvest; non-invasive and invasive preoperative workups; and postoperative medical therapy.

Here’s a look at a few key presentations:

Two Decades of Coronary Artery Bypass Grafting in Females: Has Anything Changed? ​

Elizabeth Norton, MD, Emory University School of Medicine, and a team of surgeons representing the division of cardiothoracic surgery and the division of cardiology at the institution, examined trends in females undergoing isolated coronary artery bypass grafting during the past two decades. What they found is that female CABG mortality at their institution was higher than the male cohort and the overall national average and did not improve over time.​ Females undergoing isolated CABG were increasingly diverse, experienced more preoperative comorbidities, were more likely to undergo urgent CABG, and had greater IMA utilization.

External Stenting for Saphenous Vein Grafts in Coronary Surgery

Saphenous vein grafts have high failure rates with 3% to 12% occluding before hospital discharge, 8% to 25% failing at 1 year, and only 50% to 60% remaining patent after a decade.​ As a research fellow with the department of cardiothoracic surgery at Weill Cornell Medicine, Giovanni Jr. Soletti, MD, wanted to know - can neointima formation be prevented?​

By conducting a study-level meta-analysis of randomized clinical trials and other research methods, Dr. Soletti found that VEST reduces intimal hyperplasia and thickness of SVGs after CABG. This reduction does not translate into fewer graft occlusion events or repeat revascularization compared to non-VEST SVGs at a follow-up of 1.5 years. SVGs harvested with no-touch technique or arterial conduits, when clinically adequate, may be safely used to improve long-term patency. Further long-term data and larger studies are needed.

Intraoperative Extubation After Isolated CABG and Post-Operative Outcomes

There is a well-known association between post-op ventilator time and morbidity in CABG surgery. Les James, MD, a resident cardiothoracic surgeon at NYU Langone Health, explored the impact of routine OR extubation on postoperative outcomes. She studied risk factors and outcomes based on a patient’s age, BMI, EF% STS risk score, STS prolonged vent score, CPB, and XC and concluded that routine OR extubation after isolated CABG is safe and that expanded use of planned OR extubation may be warranted.

All three highlighted abstract presentations were conducted by cardiothoracic fellows. STS encourages residents and fellows to submit original research to an international expert faculty for future presentations.

Review all conference abstracts.