News & Media

Joseph A. Dearani, MD STS News, Fall 2020 —Fall has arrived, which means the Program Planning Committee and the STS staff are concentrating on developing the upcoming STS Annual Meeting.  This year hasn’t been typical, though, so the planning has been different than anything we’ve ever experienced. We had hoped that the COVID pandemic would have subsided and a vaccine would have been available to the masses. That hasn’t happened yet, so we made the difficult decision to change STS 2021 into a virtual meeting, rather than an in-person meeting in Austin, Texas.  At first, I was disappointed that I wouldn’t have the opportunity to see many of my friends and colleagues and other STS members. But as we explored the options for a virtual meeting and I saw what was possible, I thought “that’s incredible!” I realized that we could put together a meeting that would welcome more cardiothoracic surgeons and their team members than ever before AND that we still could offer high-quality science, interactive presentations, networking and mentoring opportunities, and a chance to interact with our colleagues in industry and learn about new medical devices and technologies—we just had to embrace every side of innovation. And that’s what we are doing. We are taking advantage of the latest virtual platform innovations to create an immersive experience that will allow attendees to engage, learn new things, be inspired, and have an amazing experience. See our cover story for more details. Behind the scenes, we also are embracing device, product, and process innovations from industry representatives and expanding our educational programs to include an online robotics curriculum, a  transformed Learning Center, a new cardiothoracic surgery e-book, and a new podcast series that will help us—and the world—get to know the people behind the surgical mask better. This new series, “Same Surgeon, Different Light,” is part of our growing efforts to embrace diversity, equity, and inclusion, and help build a strong cardiothoracic surgical specialty that reflects the patient population it serves. You can learn about the new podcast series and many of the other new initiatives throughout this publication. Fighting for You and Our Future The COVID pandemic has put a strain on all of us. We have served on the front lines during the height of the crisis. We have worked extraordinarily long hours, been exposed to physical and emotional trauma, and thrust into very difficult circumstances. The cessation of elective surgery by state governments, salary reductions to help compensate for hospital and health care institutional losses, and illnesses as a result of COVID-19 have devastated many practices. Now, as we work to rebuild our practices and prepare for a potential surge in new COVID cases this fall and winter, we face the additional burden of an impending 9% Medicare reimbursement cut beginning on January 1. I want to assure you that STS is doing everything it can to fight these proposed cuts, and we thank everyone who has made the effort to contest these reimbursement reductions. Please continue battling with us; our voices are stronger together. More information on how you can get involved is available on page 19. Managing Stress Few career paths require relentless tests of resolve and commitment as the path to becoming a cardiothoracic surgeon. That’s why – especially now –we all need to take the time and conduct regular self-assessment checks and maintain a good balance between our personal and professional lives. One way that I help manage my own stress is through music. I played piano during grade school and began playing the saxophone in college. Every morning before work, I play my saxophone for an hour in a soundproof room—“the 4:30 room”—in my home. I love rhythm and blues and classical standards, and I also have a passion for jazz. Playing music helps put me in the right frame of mind to handle the obstacles that I may find later in the day. Many parallels exist between the bandstand and the operating room—team members are able to exercise leading or supporting roles, as well as develop communication and listening skills. In addition, studies have shown that music not only helps a surgeon perform better in the OR, but also can calm a patient’s nerves before an operation. Music is an important part of my life for a number of reasons, and whether you are a musician or just an avid listener, I hope that music is an important part of your life as well. So as we adapt and evolve because of the COVID pandemic, let’s remember that although we face many new challenges, I am confident that we will prevail—as a specialty and as a community of health care workers around the world that always will face challenges with purpose and passion. Each day I count my blessings and reflect on the silver linings from this pandemic. And as I see how the Society is adapting and changing with the times, I’m getting jazzed about sharing that experience with you through content, collaboration, and community during the STS 2021 meeting. Although I won’t be wearing my cowboy boots or enjoying barbeque with you in Austin, I look forward to the new year, the growth of our Society, and the evolution of our specialty. Be well and be safe.

STS News, Fall 2020 — The Society has fought hard over the last few years not only to ensure that cardiothoracic surgeons could participate in Advanced Alternative Payment Models (APMs), but also that these APMs appropriately measured quality and performance for the specialty. As a result, STS members who participate in the Adult Cardiac Surgery Database (ACSD) and the Bundled Payments for Care Improvement (BPCI) Advanced Model—an APM—now have an opportunity to increase their Medicare reimbursement. The Society worked closely with the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation to make sure that data submitted to the STS National Database are an integral part of BPCI Advanced. Why? BPCI Advanced is a new initiative that supports health care providers who invest in practice innovation to improve patient care while reducing expenditures. This model, which ties payment to relevant quality measures within 35 clinical episodes, rewards providers for delivering services more efficiently, supports enhanced care coordination, and recognizes high quality care. “The importance of this critical linking of the STS National Database with a Medicare bundled payment program is monumental,” said Keith A. Horvath, MD, who is a member of the STS Workforce on Health Policy, Reform, and Advocacy. “For the first time, the quality outcomes achieved by cardiac surgeons will directly impact not only the patients’ well-being, but also the reimbursement for their care.” In addition, the model shifts payment incentives away from fee for service (which focuses on volume) to value. Participation in BPCI Advanced offers many potential benefits, including a 5% bonus and exclusion from the Merit-Based Incentive Payment System. Hospitals and physician group practices that already are enrolled in BPCI Advanced can elect to use the Alternate Quality Measures Set for various clinical episodes. This addition allows participants in BPCI Advanced to have more choices regarding how the quality of care is measured in the model. “The importance of this critical linking of the STS National Database with a Medicare bundled payment program is monumental.” Keith A. Horvath, MD STS has been a vital part of these updates, providing extensive input to CMS and making sure that the quality measures used within these episodes are relevant, applicable, and appropriate for real-world care delivery. Additional Alternate Quality Measures are on the way. “In this transition to value-based care, use of the STS National Database for the assessment of quality finally puts the metric of valuation in the hands of the surgeons and not claims administrators,” explained Dr. Horvath who also is senior director, clinical transformation at the Association of American Medical Colleges. “Additionally, this is just the crucial first step in the eventual goal of establishing the true value of cardiothoracic surgery as defined collaboratively by the STS and payers.” The Society encourages Database participants to take advantage of BPCI Advanced by selecting the Alternate Quality Measures Set when classifying clinical episodes such as coronary artery bypass grafting and cardiac valve through the BPCI Advanced model. Under the program, data submitted to the ACSD can be reported via the new Alternate Quality Measures Set, which, in turn, results in reporting more meaningful and accurate quality measures and potentially increasing Medicare reimbursement payments for surgery. Selecting Alternate Quality Measures also can help reduce the administrative burden associated with quality measure data capture for BPCI Advanced participants and help demonstrate a return on your investment in the STS National Database quality improvement efforts. Fight Continues for CT Surgery Reimbursement In early August, CMS released its proposed Medicare Physician Fee Schedule (PFS) rule for 2021. The rule, scheduled to go into effect on January 1, slashes Medicare payments by as much as 9% for the specialty, threatening the value of evaluation and management (E/M) services provided by cardiothoracic surgeons. Under this new rule, CMS would set the 2021 PFS conversion factor at $32.26 when accounting for the budget neutrality adjustment—down $3.83, or more than 10%, from the conversion factor of $36.09 in 2020. This is due largely to changes in Relative Value Units for E/M codes. The final rule will be delayed until December, but policymakers already are working to implement the proposed changes. As a result, STS already has submitted its formal comments and is working with members of Congress to ensure that the final rule is fair to cardiothoracic surgeons and their patients. In addition to working with the Surgical Care Coalition in the battle against Medicare payment cuts, the Society is fighting the proposed cuts separately by meeting with elected officials, facilitating grassroots advocacy, and signing onto various letters and meeting with stakeholders who are involved with Medicare reimbursement decisions. How You Can Help STS strongly encourages you to take action by connecting with your members of Congress and explaining how the proposed reimbursement cuts and a weakened health care system as a result of COVID-19 will hurt your patients. These meetings will allow you to share your personal story, which can have a lasting impact on advocacy efforts. At this time, all meetings with lawmakers are virtual, presenting a unique opportunity for you to engage with your legislators without having to travel. STS can help you schedule a meeting and provide you with talking points. The time commitment would be less than 30 minutes. Another course of action would be to write an opinion piece or letter to the editor in your local newspaper. Recently, the San Antonio Express-News published a commentary written by John Calhoon, MD, STS Second Vice President, on why Medicare reimbursement cuts will hurt patients. For more information on how you can help, email advocacy@sts.org or visit sts.org/keycontact. Take Action Now Urge your legislators to reverse these reimbursement cuts! Even during this difficult time, there are still many ways to get involved virtually. STS can help you with scheduling and provide briefing materials. Schedule a phone call or virtual meeting with your representatives or members of their health care teams to provide details on how these cuts may impact patient care. Become a Key Contact. This program is a great way to stay informed while building relationships and advocating for the specialty. Get access to timely legislative updates and opportunities to engage. Encourage your STS colleagues to become involved. STS members are the heart of our grassroots advocacy efforts. The more participation we have, the greater impact STS can make.

STS News, Fall 2020 — Through its charitable arm, The Thoracic Surgery Foundation (TSF), the Society grants several awards and scholarships each year that support research and education in cardiothoracic surgery and advance treatment options for patients with heart, lung, and other chest diseases. One such award is the TSF Research Award, which offers operational support for original research efforts by early career cardiothoracic surgeons. Recipients are awarded up to $40,000 per year for 2 years. In 2019, Arman Kilic, MD, from the University of Pittsburgh in Pennsylvania, received the award, which he’s currently using to research artificial intelligence (AI) and machine learning in cardiothoracic surgery in the hope of improving risk prediction and patient outcomes. AI and Its Place in CT Surgery AI is part of a growing field that incorporates a variety of algorithms to model data and predict outcomes. Machine learning is a form of AI that refers to the ability of systems to learn from data, identify patterns, and automate analytic model building. According to Dr. Kilic, there is a huge and largely untapped potential for both in clinical medicine. He has a longstanding interest in clinical risk modeling and big data, and the rapidly expanding application of AI and machine learning to health care spurred his interest in applying these tools to cardiac surgery, where risk modeling plays an important role. The alignment between Dr. Kilic’s research background and experience, and the growing potential of AI in medicine was further augmented by the collaborative environment in which Dr. Kilic found himself. “I’ve been fortunate to have world-class collaborators who are internationally recognized experts in AI,” he said. Arman Kilic, MD, received the TSF Research Award in 2019. Risk prediction in adult cardiac surgery is important because it can have profound implications. For example, the current STS National Database risk models are able to accurately state that 10% of a certain population will have operative mortality, but cannot identify specifically which patients are included in that percentage, Dr. Kilic explained. This is an area in which AI and machine learning may be able to make a difference. This research examines machine learning algorithms to help identify risk prediction in adult cardiac surgery. Dr. Kilic said he hopes that, through the use of machine learning, surgeons will be able to provide individualized counseling to cardiac patients and determine whether there are more sophisticated methods of risk modeling in adult cardiac surgery. Dr. Kilic envisions AI and machine learning impacting cardiothoracic surgery in several other ways as well, particularly how it relates to predictive analytics, automated imaging interpretation, and natural language processing. According to Dr. Kilic, the ability to improve the predictive performance of imaging tests using AI and machine learning will be worthwhile. Chest x-rays, echocardiograms, and angiography routinely are used in cardiothoracic surgery, thus the ability to develop AI algorithms and software to interpret these representations with acceptable accuracy and improved efficiency would be appealing, especially from a triaging perspective. “There would likely be financial, logistical, and patient care benefits,” he said. In the project’s first year of research, the team has collected and analyzed data from more than 11,000 patients undergoing cardiac surgical operations. The initial findings culminated in a manuscript published in The Annals of Thoracic Surgery, but more is to come. “We continue to work on refining and working with these algorithms, and applying them to various outcomes,” Dr. Kilic said. The STS National Database—considered the gold standard in clinical outcomes registries—has served as a major data source for subsequent research. Importance of TSF Award Being awarded the TSF Research Award has played an important role in helping Dr. Kilic develop his research career. “It’s provided the funds and support to lay the groundwork for my research,” he said. “And it’s allowed me to initiate, not just the funded project, but other research projects, as well. This award not only allowed me to compile preliminary data, but perhaps, more importantly, helped solidify collaboration with AI experts and national leaders in cardiothoracic surgery.” Dr. Kilic encourages other cardiothoracic surgeons to apply for the TSF awards and scholarships. “This type of funding and support can be integral when trying to initiate research projects or focus, and it provides you recognition in the world of cardiothoracic surgery,” he said. “It’s a premier funding mechanism for thoracic surgery, and in that focused space, it gives you recognition among your peers.” For more on the TSF awards program, visit thoracicsurgeryfoundation.org/awards. Double Your Impact: Donate to TSF Today The Thoracic Surgery Foundation (TSF) 2020 Surgeon Match Challenge is under way, and—to date—$70,311 has been raised toward research, education, and philanthropic initiatives that advance cardiothoracic surgery. For every dollar donated by surgeons during the challenge, STS will match contributions up to $200,000. So far this year, the Society’s charitable arm has awarded approximately $1.1 million in funding to support surgeon-scientists in cardiothoracic surgery.  Award recipients are investigating topics such as the predictive utility of machine learning algorithms in adult cardiac surgery, functionality of T cells in advanced lung cancer, and sphingosine-targeted therapies in heart transplants. They’re training with experts to learn new skills, including robotic esophageal surgery, cone repair, valve sparing root replacement, the Bentall procedure, and complex tracheal surgery.  The funding also has allowed surgeons to provide lifesaving care to underserved patients in developing countries, including Armenia, Honduras, India, Kenya, Nepal, Nigeria, Pakistan, and South Africa. In addition to matching surgeon donations, the Society covers all of TSF’s administrative expenses so that 100% of each donation is applied to award programs. Plus, TSF donations are tax-deductible to the extent permitted by law.  If you have not given to the Foundation recently, please consider a gift at this time when your donation will have double the impact. For more information, visit thoracicsurgeryfoundation.org/donate.