News & Media

STS News, Winter 2019 -- Despite many years of clinical training, most cardiothoracic surgeons aren’t provided with sufficient education in a key area of career development—optimizing their value to their organizations. Speakers at the upcoming Practice Management Summit during the STS Annual Meeting in San Diego on Sunday, January 27, will seek to close that knowledge gap, helping attendees understand their value and obtain appropriate compensation. “We certainly don’t get this education in our training, so we’re ill-prepared when starting our careers,” said Frank L. Fazzalari, MD, MBA, Chair of the Workforce on Practice Management. “The landscape is evolving very quickly, so cardiothoracic surgeons must adapt.” A major change in the employment environment over the last few years has been the increasing number of surgeons employed by hospitals rather than private practices. During the Summit, attendees will learn how to weigh factors in their local areas when making decisions regarding their employment arrangements. The US government also has made a number of recent changes that impact reimbursement for cardiothoracic surgical procedures. The Summit will provide an overview of STS efforts to advocate for regulations and programs that fairly compensate surgeons for their work. Expanding Roles With a greater push for health care quality over quantity, how do surgeons continue demonstrating their value to the hospital administration? “The work Relative Value Unit model does not value the presence of a cardiothoracic surgeon on a hospital staff,” said Workforce member Paul S. Levy, MD, MBA. “Compensational value has to be shown in other ways.” “We certainly don’t get this education in our training, so we’re ill-prepared when starting our careers.” Frank L. Fazzalari, MD, MBA One option is to take a more active role in hospital administration—a path that is especially suitable for surgeons, given their leadership in the operating room. Of course, that means knowing how to negotiate a contract with suitable compensation for these efforts. “Surgeons may not have a lot of experience with contract negotiation,” Dr. Fazzalari said. “It can be difficult to know whether you should accept what you’re offered or walk away.” Attendees will hear from a health care attorney on the potential landmines to avoid and important components to address. Answering the Tough Questions An important component to this Summit is giving surgeons an opportunity to ask the questions that they may not feel comfortable asking in the workplace, including questions about salary. “We’ll provide hard numbers regarding what you can expect in compensation,” said Dr. Levy. “We’ll also share what employers look for when recruiting. The Summit will help you best position yourself for success.” View the full agenda for the Summit in the Program, Registration, and Housing brochure at sts.org/annualmeeting. Get Tips on Excelling Early in Your Career A new Annual Meeting session on Monday, January 28, will focus specifically on career advice for cardiothoracic surgeons in their first 7 years of practice. Speakers will explain how to balance clinical and research responsibilities, establish a strong mentor-mentee relationship, and connect with colleagues and patients on social media. The session also will feature ample time for group discussion on hot-button issues facing early career surgeons, including dealing with a difficult job, what to do when you’re in over your head, and developing a niche. “This is often a critical time in one’s career, and it can be difficult to access information on navigating challenges outside of the operating room,” said Vinay Badhwar, MD, Chair of the Workforce on Career Development. “We’ll answer all burning questions, no matter how simple or complex.” See page 12 for information on registering for the Annual Meeting.

Keith S. Naunheim, MD, President STS News, Winter 2019 -- I realized I had come to the end of my presidential year and still owed the Society one column’s worth of “wisdom,” but had no idea what to tackle. To help inform my choices, I first reviewed my past editorials. My first column dealt with the issue of gender bias, and my second was about the Society’s appropriate role in the opioid crisis. So to summarize: First column was about sex…  Second column was about drugs…  That must mean I'm overdue for one on rock and roll! I initially started down that path and actually picked appropriate rock songs for each cardiothoracic subspecialty (see the end of the column for my choices). Then I decided I probably needed to be just a little more mature… for a change.  While reminiscing about the last year, I was reminded about the amount of time and effort required of the STS President and, God knows, I would love to be portrayed as a selfless martyr in the service of a greater good (Saint Keith?). But the real, less altruistic motivation is finally being given the chance to lead. And make a difference. Though our specialty includes surgeons who vary in age, gender, religion, and ethnicity, we all share one characteristic—we are all alpha personalities who want to be in charge and recognized as leaders. There is no small amount of pride (read “ego”) in being elected as the “Big Dog” of an organization, and any president who says that’s not true is likely fooling him/herself. But after the first month or so, the bloom comes off the rose and you realize that the real joy comes when you get to really make a difference on a larger scale, not just for yourself or your department or your hospital, but for your specialty. To be given that chance is, in and of itself, a great gift; one for which I am grateful. In preparing this column, I was reminded of a quote from the recently deceased President Bush 41: “There could be no definition of a successful life that does not include service to others.”  Has this last year been “successful”? In 2018, we integrated the Intermacs LVAD registry into the STS National Database, culminating an effort spanning 4 years. In addition, the Society began to confront two major issues by conducting surveys to determine the current status of gender bias, as well as the patterns of opioid utilization within the specialty; these surveys may be just the first steps, but you can’t address a problem until you have begun to understand it. Our organization is collaborating with international cardiothoracic surgical societies to jointly provide significant education opportunities for both cardiac and thoracic surgeons in Latin America, hoping to offer affordable courses to surgeons who otherwise would be unable to attend. Domestically, the Society has continued its major education efforts by assisting our members in upgrading their skills with regard to percutaneous valve placement, mechanical circulatory assistance, and robotic surgery. The real joy comes when you get to really make a difference on a larger scale, not just for yourself or your department or your hospital, but for your specialty. On the political front, we were a major player in reversing the move toward a CABG bundle and made significant strides in connecting data in the STS National Database with Medicare data, a step that would enable us to establish the true cost effectiveness of our procedures. And efforts in conjunction with the ACC and CMS have helped ensure our ongoing participation in percutaneous valve procedures for the foreseeable future. Finally, the charitable arm of STS, The Thoracic Surgery Foundation, has provided a record amount of funding (nearly $900,000) for cardiothoracic surgery research. In addition, TSF continues to underwrite multiple philanthropic cardiothoracic missions to underserved populations throughout the world. In just a few weeks, I will get to stand on the podium, deliver a Presidential Address heralding these accomplishments, and nominally take a bow. But I know the real truth, as does every president before me. While we get to act as the face of the specialty, we cannot take credit personally for those accomplishments. We are privileged for a 1-year period of time to be the caretaker of a well-oiled and efficient machine comprising hundreds of volunteer surgeons and staff. They are the ones who do all the work, and they are the ones who deserve all the credit. Let me take this opportunity to thank all of you who, throughout the year, have given your Blood, Sweat, and Tears (rock and roll analogy) to make my presidential year both successful and gratifying. I owe you a huge debt of thanks… as do all of our members and their patients. Happy New Year to you all. Answers to rock and roll quiz: Adult Cardiac: “The Heart of Rock & Roll,” Huey Lewis and the News General Thoracic: “Every Breath You Take,” The Police Congenital: “A Hole in My Heart,” Cyndi Lauper

STS News, Winter 2019 -- The STS 55th Annual Meeting is just a few weeks away, but it’s not too late to plan to join your colleagues in San Diego, California, for one of the largest cardiothoracic surgery meetings in the world. Save $100 from onsite pricing by registering on or before January 24 at sts.org/annualmeeting. Registration provides access to educational sessions on Sunday, January 27, Monday, January 28, and Tuesday, January 29. Additionally, you will receive complimentary access to Annual Meeting Online, a web-based video presentation of most sessions offered at the Annual Meeting that will provide the opportunity to earn more than 100 continuing medical education credits. Separate tickets are required to attend STS University courses and the President’s Reception (both on Sunday, January 27). Registration also is separate for Tech-Con 2019, which will be held on Saturday, January 26. Browse the educational program, save favorite sessions/presentations to your custom itinerary, read scientific abstracts, and more by downloading the STS Meetings app. Search for “STS Meetings” in the Apple iOS App or Google Play stores, or visit sts.org/mobileapp. Please note that printed copies of the meeting program will not be distributed onsite. The Best Forum for Scientific Research The meeting schedule has been reorganized, and the opening plenary session will be held on Sunday afternoon instead of Monday morning. This session will include presentation of the J. Maxwell Chamberlain Memorial Papers, which represent some of the top-rated abstracts at the meeting. The Chamberlain paper for adult cardiac surgery examines the relationship between a hospital’s surgical aortic valve replacement volume and its transcatheter aortic valve replacement outcomes. The congenital heart surgery paper reviews patient-perceived functional health status for adults who underwent transposition of the great arteries repair as children during the transition from atrial to arterial repair. And the general thoracic surgery paper takes a look at whether thoracic surgery regionalization within an integrated health care system improves outcomes of major pulmonary resections for lung cancer. The Richard E. Clark Memorial Papers highlight research utilizing data from the STS National Database. These papers will be featured during specialty-specific parallel sessions on Monday and Tuesday. The Clark paper for adult cardiac surgery looks at reoperative surgical aortic valve replacement for bioprosthetic failure. The congenital heart surgery paper describes outcomes of the Fontan operation with and without Down syndrome, and the general thoracic surgery paper evaluates survival for lobectomy versus segmentectomy for clinical stage IA lung cancer in elderly patients. Hear from Experts Around the World The STS Annual Meeting brings together surgeons from across the globe to share their unique experiences and also features a number of joint sessions with international medical societies. A session to be presented on Sunday by STS, the Canadian Association of Thoracic Surgeons, and the Canadian Society of Cardiac Surgeons will review trends in the utilization of minimally invasive surgical techniques for anatomic pulmonary resection, including both video-assisted thoracoscopic and robotic surgery. On Monday, the Society will team with the European Association for Cardio-Thoracic Surgery in a session on alternatives to the standard classic repair for DeBakey type I aortic dissection. Experts will discuss the outcomes of innovative extended arch repair techniques, including the distal aortic frozen elephant trunk, novel branched arch endografts, and valve retention root reconstructive surgery. Also on Monday, STS will join the European Society of Thoracic Surgeons to discuss controversial issues in general thoracic surgery, including invasive staging in early stage lung cancer, multimodal approaches for the treatment of stage IIIAN2 lung cancer, and the use of induction therapy in patients with T2N0 esophageal cancer.  Finally, STS and the International Society for Heart and Lung Transplantation will hold a symposium on Monday looking at how ventricular assist devices are utilized in European and Asian populations, as well as the latest innovations in univentricular and biventricular support. And that’s just the tip of the iceberg. The Annual Meeting will feature dozens of oral abstract presentations, invited talks by renowned speakers, lively debates, and surgical videos. If you are not registered for the Annual Meeting, you can register online at sts.org/annualmeeting or onsite in San Diego beginning Friday, January 25. Put Knowledge into Practice at STS University STS University, a popular series of hands-on learning activities, will take place during two sessions on Sunday morning, January 27. Several courses still have space available, so add one or more to your schedule. Each course is $175. These courses feature both didactic lectures, to be viewed online before January 27, and hands-on experiences in a wet lab or on a simulator in San Diego. You can view the lectures for all STS U courses at sts.org/stsuniversity. Course 1: Essentials of TAVR Course 2: TEVAR and Aortic Arch Debranching Procedures Course 3: Mitral Valve Repair Course 4: Valve-Sparing Aortic Root Replacement – Reimplantation Course 5: Aortic Root Enlargement Procedures and Aortic Valve Leaflet Reconstruction Course 6: VATS Lobectomy Course 7: Advanced Open Esophageal and Tracheal Procedures Course 8: Complex Chest Wall Issues for the Thoracic Surgeon: Reconstruction After Tumor Resection, Pectus Deformities, and Rib Fractures Course 9: Minimally Invasive Aortic and Mitral Surgery Course 10: Peroral Endoscopic Myotomy (POEM) Skills Course 11: Robotic Lobectomy Course 12: VATS Sleeve Lobectomy Course 13: Percutaneous Transseptal Access, Transcatheter Mitral Valve Repair, and Mitral Valve-in-Valve Replacement Keynote Lecturers to Address Immunotherapy, Artificial Intelligence Two intriguing and inspiring keynote lectures are planned for the Annual Meeting. In a change from previous years, the lectures will be presented on separate days—Sunday afternoon and Tuesday morning. Thomas B. Ferguson Lecture Laurie H. Glimcher, MD Sunday, January 27, 3:30 p.m. Dr. Glimcher is an immunologist who has made seminal discoveries in cancer immunology research, particularly in the fields of transcriptional regulation, lymphocyte differentiation, immunology, and osteobiology. She is President and CEO of the Dana-Farber Cancer Institute in Boston—the first woman to hold that position—and also is Principal Investigator and Director of the Dana-Farber/Harvard Cancer Center, as well as the Richard and Susan Smith Professor of Medicine at Harvard Medical School. Her address is titled “Cancer Immunotherapy: The End of the Beginning.” C. Walton Lillehei Lecture Eric Topol, MD Tuesday, January 29, 9:45 a.m. Dr. Topol is a cardiologist and geneticist specializing in the use of artificial intelligence, “deep” data, and smart technology for individualized treatment approaches. He holds the Gary and Mary West Endowed Chair of Innovative Medicine at Scripps Research, is the Director and Founder of the Scripps Research Translational Institute, and is Chief Academic Officer of Scripps Health in La Jolla, California. His talk will explore “High-Performance Medicine: The Convergence of Artificial Intelligence and Health Care.” Thank You! The Society of Thoracic Surgeons gratefully acknowledges the following companies for providing educational grants for the STS 55th Annual Meeting. This list is accurate as of January 3, 2019. Platinum Benefactors Provided $50,000 or more Abbott Medtronic Silver Benefactors Provided $10,000-$24,999 Boston Scientific Corporation Johnson & Johnson Medical Devices Companies Olympus

STS News, Winter 2019 -- Four new e-learning modules are available as part of the Society’s effort to create relevant online continuing education materials for cardiothoracic surgeons and their teams. The topics were chosen after a careful review of continuing medical education (CME) requirements from each state medical board in the United States. Certain states mandate that physicians complete CME in specific topic areas, so STS leaders took those mandates into account and also considered which subjects would most directly impact cardiothoracic surgeons and their patients—now and in the future. These modules, on surgical ethics, shared decision-making, breaking bad news, and cultural competencies, can be accessed via the STS Learning Center (sts.org/learningcenter). Each will take approximately 30 minutes to complete, and users will be eligible for either CME credit or a certificate of participation. The surgical ethics module presents several scenarios that may not have straightforward answers. Surgical Ethics A wide variety of clinical situations present ethical difficulties in surgery. The surgical ethics module addresses four questions related to uses and abuses of technology: Should a patient be given an unindicated transcatheter aortic valve replacement before an impending loss of insurance?  Does an iatrogenic injury require that an otherwise futile procedure be done? Can a surgeon refuse to operate on an intravenous drug-abusing patient with recurrent aortic prosthesis infection? Is an experienced surgeon performing a robotic lobectomy for the first time ethically obligated to include his/her limited experience in the informed consent discussion? “The e-learning module on surgical ethics helps surgeons analyze a variety of difficult situations in which more than one option may seem reasonable, or in which there is disagreement between the surgeon and patient or family on how to proceed,” said one of the module developers, Robert M. Sade, MD, former Chair of the STS Committee on Standards and Ethics and the 2012 recipient of the Society’s Distinguished Service Award. “The e-learning module on surgical ethics helps surgeons analyze a variety of difficult situations in which more than one option may seem reasonable.” Robert M. Sade, MD Shared Decision-Making The shared decision-making module helps cardiothoracic surgeons understand the importance of involving patients when making decisions about treatment options. “Surgeons need education to overcome misconceptions about shared decision-making; there are several inhibitors to its adoption,” said James R. Edgerton, MD, a member of the Society’s Clinical Practice and Member Engagement Council Operating Board who helped create the module. “Surgeons may believe that the practice will lead to incorrect decisions or that they don’t have the time for it. Further, they simply may not be familiar with the process. But a patient’s active participation is a key factor in establishing a strong physician-patient relationship and may improve outcomes.” The module looks at three scenarios that may be challenging, especially for a surgeon who is new at shared decision-making: A 45-year-old diabetic woman with complex coronary disease is afraid of pain from a sternotomy and wants a minimally invasive procedure combined with medical therapy, which the surgeon feels is a poor decision. A 50-year-old man diagnosed with a stage I non–small-cell carcinoma in his lung chooses to forgo the surgeon’s recommended treatment because he’s worried about losing his job if he takes too much time off from work. An 87-year-old man who experienced a postoperative stroke has become ventilator- and dialysis-dependent; the surgeon recommends that his wife withdraw aggressive care, but she is unable to make the decision. The module also explores factors that impact a patient’s ability to participate in shared decision-making, including age, socioeconomic status, and disease status. Surgeons will be given tools and techniques to aid patients in the process. The e-learning modules challenge users to apply the information they’ve learned. Breaking Bad News The breaking bad news module provides guidance on discussing end-of-life care with patients and their families. It outlines a complicated situation in which a patient’s advanced directive gave medical power of attorney to his wife, who had been institutionalized for several years with dementia. Surgeons will be provided with specific steps to take and language to use when they encounter similarly challenging situations in the future. Cultural Competencies The cultural competencies module examines how surgeons can deliver care that addresses not only patients’ medical needs, but also their social and cultural needs. It addresses topics such as sensitivity to religion, gender differences, distrust of the health system, and language barriers. “As cardiothoracic surgeons, we need to have a better understanding of our patients’ expectations based on their beliefs so that optimal care is delivered,” said Subroto Paul, MD, MPH, one of the module developers. To purchase the modules, visit sts.org/learningcenter. If you have questions, contact the STS Education Department.

Take Part in the 2018 TSF/STS Surgeon Match Challenge For the third year in a row, STS has pledged to match surgeon contributions to The Thoracic Surgery Foundation (TSF), which means your donation will have double the impact—up to $100,000! For example, if you donate $5,000, the Society will match the contribution and $10,000 would be available to fund cardiothoracic surgery research initiatives. In addition, STS supports TSF’s administrative expenses, assuring that every dollar you donate goes directly to support TSF-sponsored research programs, and all donations to TSF are tax deductible to the extent provided by the law. The 2018 Surgeon Match Challenge will end on December 31—so rise to the challenge and make your contribution today by visiting thoracicsurgeryfoundation.org/donate. STS Heads to Milan for EACTS Meeting The Society had an important presence at the European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting in Milan, Italy, in October. Several surgeon leaders gave presentations during the meeting, and staff promoted the benefits of STS membership at a booth in the Exhibit Hall. STS President Keith S. Naunheim, MD met with colleagues from around the world, including newly elected EACTS President Ruggero De Paulis, MD (left). Submit Your Proposal for STS Funding The Society recently revised its spending policy formula, with a goal of making more money available for reinvestment in the specialty (see the Summer issue of STS News). As a result, more than $1.1 million will be available in 2019 for cardiothoracic surgery projects, programs, and affiliated organizations (apart from regular STS operations). STS members are invited to submit proposals for 2019 spending policy funding consideration by emailing a letter to STS Finance Committee Chair Mark S. Allen, MD via Keith Bura. Proposals should be no more than 900 words and include the amount of the request, a detailed description of how and when the funds would be used, and an explanation of how the proposed funding would constitute a reinvestment in the specialty. The deadline for submissions is November 15, 2018. STS Leaders Join European and Chinese Colleagues at CSTCVS Meeting Several STS surgeon leaders, including President Keith S. Naunheim, MD, Past President Joseph E. Bavaria, MD, Canadian Director Sean C. Grondin, MD, MPH, Ram Kumar Subramanyan, MD, PhD, and James S. Tweddell, MD, joined their counterparts from the European Association for Cardio-Thoracic Surgery at the Chinese Society for Thoracic and Cardiovascular Surgery’s Annual Meeting in Shenyang, China, this October. All presented during the meeting, and Drs. Naunheim and Bavaria gave keynote lectures on lung volume reduction and the STS/ACC TVT Registry, respectively. One of the Society’s strategic plan goals is to foster collaboration and connection worldwide. Participating in international cardiothoracic surgery meetings is an important part of this initiative. Mathisen Delivers Keynote Address STS Historian and Past President Douglas J. Mathisen, MD gave the prestigious Royal College Gallie Lecture at the Canadian Surgery Forum in St. John’s, Newfoundland, on September 15. The forum was organized by the Canadian Association of Thoracic Surgeons and several other societies. His talk was titled “Surgeon Scientist in an Era of Declining Revenue, RVUs, and Work Hours.” Society Co-Sponsors General Thoracic Conference in China Several STS members joined colleagues from the European Association for Cardio-Thoracic Surgery, the European Society of Thoracic Surgeons, and the Shanghai Medical Association at the “5th Oriental Congress of Thoracic Surgery” in Shanghai, China, in September. John D. Mitchell, MD (sixth from left), Ara A. Vaporciyan, MD (seventh from left), Valerie W. Rusch, MD (sixth from right), and STS Past President Douglas J. Mathisen, MD (fourth from right) represented the Society and gave presentations on topics such as the management of tracheal stenosis, neoadjuvant therapy for stage III cancer, and extended resection for thymic malignancy. Sylvia M. Laudun, DNP, MBA, RN won the best poster award. View Photos from AQO 2018 and Purchase Online Meeting Access More than 400 data managers and surgeons participating in the STS National Database recently gathered in Hollywood for Advances in Quality and Outcomes: A Data Managers Meeting, September 26-28. Speakers addressed all aspects of data collection, including the recently launched spec upgrade for the General Thoracic Surgery Database, the spec upgrade planned for the Congenital Heart Surgery Database, and hot topics related to the Adult Cardiac Surgery and Intermacs Databases. See more photos from the meeting at sts.org/2018AQOphotos. If you or your data manager weren’t able to attend AQO, experience the exceptional content delivered during the meeting by purchasing AQO Online. This year’s online product features unlimited on-demand viewing and—new for 2018—the ability to earn CE or CEU credit. Visit sts.org/AQOOnline to place your order. Note: Meeting attendees will be given free online access to the sessions for which they were registered. Complexities of CVT Critical Care Explored The multifaceted nature of cardiovascular and thoracic critical care cases—including their unique physiology, array of procedures, and potential complications—was the focus of the 15th Annual Multidisciplinary Cardiovascular and Thoracic Critical Care Conference, held October 4-6 in Washington, DC. More than 200 cardiothoracic surgeons, cardiologists, anesthesiologists, nurses, pulmonologists, and other medical professionals learned about new concepts, management protocols, and clinical experiences from a multidisciplinary faculty. In addition, STS Past President Richard L. Prager, MD delivered a special keynote address on “The End of Average.” View more photos at sts.org/2018criticalcarephotos.

STS News, Fall 2018 -- The Centers for Medicare & Medicaid Services is reevaluating the scientific evidence supporting volume requirements for hospitals and heart team members who perform transcatheter aortic valve replacement (TAVR) procedures. The current TAVR National Coverage Determination (NCD), which was released in 2012, requires that hospital programs and heart team members perform a certain number of surgical aortic valve replacements and percutaneous coronary interventions in order to begin or maintain a TAVR program. On July 25, a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel met in Washington, DC, to hear recommendations regarding procedural volume requirements. Among the presenters were Joseph E. Bavaria, MD, David M. Shahian, MD, and Thoralf M. Sundt, MD. During the presentation, Dr. Bavaria stressed that programmatic TAVR volume requirements are essential: “Quality cannot be reliably determined at low-volume centers—good or bad. That is the conundrum.” The MEDCAC panel will now advise CMS as the agency prepares a new TAVR NCD due for release in June 2019. In addition, CMS will consider written comments, including those in a joint letter from STS, the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), and the Society for Cardiovascular Angiography and Interventions (SCAI). Prior to the MEDCAC meeting, the four societies published an expert consensus document on TAVR in each of their respective peer-reviewed journals, including The Annals of Thoracic Surgery. The writing committee for the “2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement” was co-chaired by Dr. Bavaria and Carl L. Tommaso, MD. The document updates a 2012 version and identifies criteria for performing TAVR procedures safely, while optimizing patient outcomes. A related editorial, “TAVR 2.0: Collaborating to Measure, Assure, and Advance Quality,” by Dr. Shahian and colleagues, also was published in The Annals. Read the multisociety comment letter, the expert consensus document, the editorial, and slide decks from the MEDCAC meeting below. Multisociety Comment Letter 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement TAVR 2.0: Collaborating to Measure, Assure, and Advance Quality Joseph Bavaria slide deck David Shahian slide deck Thoralf Sundt slide deck Meet Your Lawmakers at Home One of the best times to connect with your legislators is when they’re at home in their districts. Take advantage of their proximity and schedule time to advocate for cardiothoracic surgery. Read about the different opportunities available to you below, and then contact Madeleine Stirling, Government Relations Coordinator, to get the ball rolling. Facility Tour Site visits are a great way to provide your legislators with firsthand knowledge about the challenges you face delivering high-quality patient care. Once scrubbed in, it’s impossible for them to ignore your message as you proceed to show them around your facility. This is the most hands-on way to make an impression on your elected officials. Time Commitment: 1 hour or more Fundraising Event  Members of Congress rely on contributions, both big and small, to run their campaigns and continue working for you. If you believe your representative is doing a great job, a huge way to show your support is to participate in or host a political event. Depending on the circumstances of your district, STS staff may be able to arrange your participation. Time Commitment: 1 hour District Office Meeting A one-on-one meeting at your legislator’s local office is an excellent way to bring important issues to the forefront. STS can help you schedule the meeting and can thoroughly prepare you with relevant materials. Time Commitment: 30 minutes Town Hall If your schedule makes daytime meetings difficult, attending a town hall might be perfect for you. Town halls, which are often held in the evening, allow constituents to gather in a public space and speak with their Senators and Representatives. The presence of a physician is always welcome, and your perspective is sure to be respected. STS staff can help you prepare a question and reasonable argument in advance. Time Commitment: variable Phone Call  If you can’t make it out to a district office but really want to educate your member of Congress on your priorities, a phone call may fit the bill. Just like a meeting, STS staff will handle scheduling and briefing materials so that you’re prepared. Time Commitment: 20 minutes  

Keith S. Naunheim, MD, President STS News, Fall 2018 -- On occasion, a graduating resident or STS member will ask me if membership in the Society is really “worth the money.” It’s true that $750 is more than just pocket change, and it can cover the purchase of many cool things: 1. A summer-weight suit from Brooks Brothers (winter-weight will run another $300) 2. Drinks and dinner for six at a fine steakhouse (with an inexpensive California varietal) 3. Three opening day box seats at Fenway, Wrigley, or Dodger Stadium (get ready for $12 beers) 4. One year of Active Member dues in The Society of Thoracic Surgeons Many, if not most, cardiothoracic surgeons would splurge for the first three items listed above without a second thought; yet some question the value of that last item and balk at the idea of paying those annual dues. The common question is “What the heck does that get me?”. Yeah, we all know that your dues get you a subscription to The Annals of Thoracic Surgery (currently $509 alone for non-members), an opportunity for substantial savings on participation in the STS National Database, free quality measure reporting to CMS that prevents reimbursement penalties, complimentary subscriptions to STS News and other newsletters, as well as discounted registration rates for the Annual Meeting and other educational programs. Yet some wonder if that is enough, and the question is still asked: “Am I getting real value for my annual dues?”. As the current President and former Secretary, I have been on the “inside” for many years, so some would accuse me of bias and being a “homer.” Still, while I have no doubt that we get the full bang for our bucks, I also am certain there are those who remain skeptical. To them, I would suggest: Come to the STS offices in Chicago (21st floor at Erie and Saint Clair). Spend a day watching 65 people working at hundreds of tasks, all of which are designed to make your practice more successful. The ongoing education you require to stay at the forefront of care is among their highest priorities. Go ahead and shadow STS staff for the week before the Annual Meeting to appreciate the thousands of hours of effort devoted to providing you a streamlined and integrated educational experience, along with unparalleled networking opportunities. Watch throughout the year as they help provide both live and electronic education for all of us in structural heart disease, coronary revascularization, mechanical circulatory assistance, critical care, and thoracic oncology—just to name a few. If we don’t continue to learn and evolve, we will be left in the dust. They make that learning possible. Go to Washington, DC, to participate in an STS Legislative Fly-In. Get educated about how government really works—not only the fantasies we were taught in high school civics class, but also the reality of Realpolitik Congressional legislation. Watch our staff and volunteer leaders attend meetings with Congressional staffers, as well as officials from CMS, the FDA, and the NIH. They are working to defend the best interests of you and your patients, whether it is regarding continued funding for cardiothoracic research, coverage for lung cancer screening, or the negotiation of fair reimbursement for new procedures. Thousands of hours of staff and volunteer time are spent each year pursuing these objectives on your behalf. It’s the best damn bargain you’ll get all year. Accompany STS volunteer leaders (there are more than 400, many donating hundreds of volunteer hours annually) to Medicare headquarters for a day and watch them fight on your behalf against the increasing regulatory burden. Listen as they argue against contrived, inexact quality measures like MIPS or Meaningful Use and instead convince CMS to utilize real, objective, clinical data from our own Database to make determinations regarding the quality of care.  Attend a joint meeting between volunteer leaders of STS and international sister societies from Asia, Europe, and Latin America (there are more than a dozen such meetings annually). Find out how we are all collaborating internationally to address the standardization of technology such as valve sizing, the optimization of ongoing education, and the delivery of care both in our own countries and to the world’s underserved populations. Review the effort and output of the 200 cardiothoracic surgeons whose research has been supported by The Thoracic Surgery Foundation, the Society’s charitable arm. Those research efforts range from blood cardioplegia and hypothermic arrest to percutaneous valve implantation, arrhythmia surgery, and minimally invasive surgery of all types. What you do all day and every day is at least partially the product of research funded by our Society. This is where we forge the tools needed to ensure our continued relevance in health care. The reality is that the $750 you pay for dues each year goes to support the efforts of a complex organization that solely exists to serve you and your patients; and thanks to careful financial management and the Society’s success in generating non-dues revenue, that dues number has not gone up since 2002. That money supports ongoing research to keep our specialty relevant. It ensures education and training opportunities throughout the year to keep surgeons, perfusionists, and nurses current. It supports our societal efforts to prevent unfair pay adjustments and to minimize burdensome regulations. And through the Database, surgeons and hospitals receive accurate, specific clinical outcomes allowing for effective quality assessment and improvement. Without your dues supporting these efforts, our modern-day surgical practices likely would not exist—and neither would our careers. So how do I answer the “Is it worth it?” question? It’s the best damn bargain you’ll get all year.

STS News, Fall 2018 -- Cardiothoracic surgeon Daniel J. Boffa, MD is the recipient of the 2018 STS/ACS Health Policy Scholarship, a joint offering from STS and the American College of Surgeons that enables a member surgeon to attend the intensive Executive Leadership Program in Health Policy and Management at Brandeis University near Boston. During the weeklong course this past June, Dr. Boffa joined surgeons from a variety of specialties for a week of lectures and small group discussions on health care policy, health care finance, leadership, operations management, and conflict negotiation. “I learned something from every session. The hospital finance session was the most shockingly high-yield,” said Dr. Boffa, who is Director of Clinical Affairs for Yale Medicine’s thoracic surgery program and a Professor of Thoracic Surgery at Yale University School of Medicine in New Haven, Connecticut. “I came into the topic with very little experience (or interest), but knew it was important. I am now much more comfortable with hospital spreadsheets.” He also learned about the mechanics of persuasion, particularly in those frustrating situations where there seems to be a preponderance of uncontested data supporting a decision, yet the opposing side persists in supporting movement in the opposite direction. “What I was missing was that my resistant audience was making critical assumptions and accepting them as facts, making the data seem less convincing,” Dr. Boffa said. “Only when you get your counterparts to recognize the distinction between assumptions and facts can you unlock them from their position.” “I learned something from every session. The hospital finance session was the most shockingly high-yield. ... I am now much more comfortable with hospital spreadsheets.” Daniel J. Boffa, MD As a scholarship recipient, Dr. Boffa will be appointed to serve a 3-year term on the STS/AATS Workforce on Health Policy, Reform, and Advocacy, starting in January 2019. Applications for the 2019 scholarship will be accepted later this year. Applicants must be members of both STS and ACS and between the ages of 30 and 55. Application materials, which include a curriculum vitae and a one-page essay discussing why the candidate wishes to receive the scholarship, are due by February 1, 2019. The scholarship will help cover the costs of tuition, travel, and accommodations during the course. The Thoracic Surgery Foundation (TSF) also offers scholarships that partially cover the cost of attending the course. Applications for TSF’s Alley-Sheridan Scholarship will open December 1 and are due by February 15, 2019. For more information on the STS/ACS scholarship, visit sts.org/healthpolicyscholarship or contact Grahame Rush, Associate Executive Director. For more information on the TSF scholarship, visit thoracicsurgeryfoundation.org/awards or contact Priscilla Kennedy, TSF Executive Director.

Robert A. Wynbrandt, Executive Director & General Counsel STS News, Fall 2018 -- Late one afternoon in 1989, a team of lawyers descended on the executive offices of the American Library Association to make a pitch for the ALA’s “business” in response to a recently issued Request for Proposals. Details of the experience are somewhat fuzzy 29 years later, but two things stand out: (a) the youngest member of the team was mostly preoccupied with keeping his lunch down, as he was more nervous about making a good showing in front of his senior partners – especially a newly recruited senior partner participating in the pitch – than he was about impressing the ALA management team; and (b) said newly recruited senior partner, Paul Gebhard, used an expression that day that was unfamiliar to his gastrointestinally challenged younger partner, but remains memorable decades later. Specifically, Paul tried to convey to the prospective client a special quality he perceived among his new colleagues in the firm’s Association Practice Group that would serve the Association well if it were to retain the firm, stating that they practiced law “with a fire in the belly.” (In hindsight, Paul’s use of that term bordered on omniscient, given the younger lawyer’s nervous stomach. One other factoid about Paul that may be of interest to readers of STS News is that he was the individual credited with having coined a term – in a 1957 brief written on behalf of his longstanding client, the American College of Surgeons – that became quite famous within the surgical community: “informed consent.”) Based on 22 years of work that exposed me to the operations of more than 200 associations before I was employed by The Society of Thoracic Surgeons, I can report with confidence that cardiothoracic surgeons and their teams possess a fire in the belly, both on matters of patient care and on matters of engagement with their medical special society. Recent cases in point with respect to the latter: earlier this year, more than 1,100 abstracts were submitted for consideration in connection with the upcoming 55th STS Annual Meeting, when only 137 could be accepted for oral presentation (see page 14 for important information regarding the opportunity to submit “late-breaking abstracts”); 74 self-nominations were submitted in September for consideration of appointment to STS governance positions, in a context where we are fortunate to be able to accommodate 20 self-nominees in a typical year; and our charitable arm, The Thoracic Surgery Foundation, received 203 applications for its various awards in calendar year 2018, when associated funding will only support a total of approximately 60 awards. And if it’s true that STS members tend to come equipped with a fire in the belly, then it’s also the case that a constant stream of STS surgeon leaders has emerged, year after year since 1964, with a five-alarm fire. Of course not all leaders express their passion for the specialty and this organization in the same way. For every Bob Replogle and Joe Bavaria (both among the more “demonstrative” in the pantheon of STS leaders) there is a Fred Grover or a Mark Allen who gets the job done more quietly; the common denominator is the fire. And our job on the staff is to match that fire in our respective areas of expertise and execution so that the organization can successfully achieve its mission of enhancing the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.  View this image in full size (zoom in to see a dedication to the Society's Past Presidents on the left and the STS Core Values on the right) STS President Keith Naunheim is one of those individuals who appeared on the STS scene, in 1989 as a member of what was then called the “Ad Hoc Committee for Cardiothoracic Surgical Practice Guidelines,” with a roaring fire in the belly. That fire later spread to the entire range of Society activities, most notably in the realms of coding, reimbursement, and broader matters of health care policy. Keith brought some of that fire with him to a special “unveiling” ceremony with the staff on September 28, as we dedicated a new Presidents Wall at our headquarters office in Chicago (see photo). After first paying homage to the 53 STS Presidents who preceded him, he turned his attention to the staff and acknowledged its critical contributions to STS success, identifying specific individuals by name as examples: a terrific way to fan the flames and motivate the team. (As all successful leaders know, recognition is a powerful accelerant.) Keith’s appearance in our office for that unveiling ceremony coincided with the Society’s Annual Meeting program planning session held the following day, with approximately 30 volunteer leaders and staff in attendance and setting the table for the call to action that follows. Under the leadership of Annual Meeting Workforce Chair Rick Lee, STS volunteer leaders and staff have joined forces to create an innovative and exciting STS 55th Annual Meeting program (see page 1). And if Keith’s 2010 STSA Presidential Address is any indication, his presentation alone on Monday morning will be worth the price of admission. Registration is now open, so make your plans to join us in San Diego; it will be the hottest event of the year!