News & Media

STS News, Fall 2016 -- Members now have more opportunities to fulfill their continuing medical education and maintenance of certification requirements through the Society, which has significantly increased its online educational resources as a result of its merger with the Joint Council on Thoracic Surgery Education (JCTSE). “This merger will help enhance the education of not just our trainees, but also practicing cardiothoracic surgeons seeking to expand their knowledge base,” said Ara A. Vaporciyan, MD, Chair of the STS Workforce on Thoracic Surgery Resident Issues. Many former Joint Council activities will fall under the new STS Workforce on E-Learning and Educational Innovation, chaired by STS Past President Mark S. Allen, MD.  “Now that many of the JCTSE functions are within the STS structure, members will soon have new and innovative ways to learn within the CT surgery arena,” said Dr. Allen, who was the most recent Chair of the JCTSE Board of Directors. "Now that many of the JCTSE functions are within the STS structure, members will soon have new and innovative ways to learn within the CT surgery arena." Mark S. Allen, MD Online Offerings One of the most significant assets that STS acquired as a result of its merger with JCTSE is the Thoracic Surgery Curriculum hosted on a robust Learning Management System (LMS). The Curriculum currently is accessible only by cardiothoracic surgery residency program directors, coordinators, faculty, and residents, but access will be expanded to all STS members in the future. The LMS houses a wealth of educational materials, including the entire Thoracic Surgical Curriculum and a variety of textbooks, videos, and case presentations. Program directors and coordinators easily can set up a 1-, 2-, or 3-year curriculum, as well as create customized assignments and offer National Benchmarked Quizzes for resident comparison across programs. Access the Thoracic Surgical Curriculum, textbook chapters, case presentations, and more in the Library section of the new LMS. “The core benefit of the LMS is the multitenant design of the system. Each program has access to all of the content, but the content can be organized and presented in a way that meets the specific needs of an individual program,” Dr. Vaporciyan said. In the future, all of the Society’s online educational programs, including the STS Annual Meeting Online and webinars, will be housed in the LMS. “The Society now has an innovative education resource that will serve resident education, STS member education, and individual continuing medical education for years to come,” said Edward D. Verrier, MD, who served as JCTSE Surgical Director of Education and continues to fulfill this function for the Society. In-Person Learning One of the most popular in-person educational courses developed by JCTSE was the Jeopardy competition for residents. STS will continue organizing the event, with a North American championship competition at the Southern Thoracic Surgical Association Annual Meeting in November and a grand championship competition between the North American and European winners at the STS Annual Meeting in January. For more information about the LMS, contact Amanda Wright. New Features Added to the STS Learning Center The STS Learning Center recently added two new features that allow for better tracking and completeness of your CME transcript. The first new feature allows you to add any and all CME credits that you have earned—including non-STS approved activities—to your personal transcript. Click “External Certificates” and upload or drag and drop certificates as PDFs or Word documents. The second new feature allows you to view and print your personal transcript by clicking "View Your Transcript.” You can pull from a specific year or time range or from specific certificates that align with certain credits. To check out these new features, visit learningcenter.sts.org, log in with your STS member username and password, and click “My Account” in the upper right corner. If you have any questions, contact Education.  

Robert A. Wynbrandt Robert A. Wynbrandt, Executive Director & General Counsel Robert H. Habib, Director of the STS Research Center STS News, Fall 2016 -- As we prepare to launch an exciting new initiative that will enhance the value of the STS National Database for our members and their patients, the following is the latest installment in our series of guest columns by other members of the STS management team – this one from Robert Habib, who joined us earlier this year as the new Director of the STS Research Center. Robert comes to us from the American University of Beirut, where he was a Professor in the Department of Internal Medicine, the Director of the Clinical Research Institute’s Outcomes Research Unit, Co-Director of the Vascular Medicine Program, and Director of the Scholars in Health Research Program. Robert earned a PhD in interdisciplinary studies (engineering and physiology) and a master of science degree in biomedical engineering from Boston University; as reflected below, he is making no small plans to take the STS Research Center into new and promising directions. For nearly three decades, STS and its members have led the way with an unparalleled commitment to collect comprehensive patient data in the STS National Database and analyze these data as a means of measuring quality and providing better care to patients. The Society is again poised to lead its peers in a different, albeit related way. STS surgeon leaders and senior staff are developing a high-quality clinical research infrastructure that would increase the options and opportunities for STS members to conduct research based on the Database. It certainly makes sense. Much like a great quarterback needs receivers capable of catching passes, a standout clinical database such as the STS National Database needs a commensurate standout research program that appropriately leverages its rich and comprehensive data.   STS is fully committed to building a bigger and better research enterprise for the specialty. Surgeon leaders are aiming to profoundly transform STS research with a year 2020 vision featuring a forward-looking research agenda. The Society is developing a new business plan for the STS Research Center that will provide a road map for future investment and new research opportunities. We anticipate that many of these new research initiatives could be game-changers that increase productivity and expand research capacity to previously unavailable areas. A Different Kind of PUF! By the time STS members read this article, the STS Participant User File (PUF) Research Program likely will have been announced. The PUF Program will allow—for the first time—analysis of national-scale de-identified data from the Database at investigators’ institutions. This STS initiative will be steered by a PUF Task Force and will be guided by three primary principles: 1) facilitating STS National Database participant research, 2) ensuring research output of the highest quality, and 3) protecting STS and participant data, as well as patient privacy. The Society was purposely deliberate in its planning because it wanted to present members with a truly different kind of PUF! The STS PUF Program will be rolled out in three stages, starting with the Adult Cardiac Surgery Database in the fourth quarter of this year, followed by the General Thoracic Surgery Database and the Congenital Heart Surgery Database in the first and second quarters of 2017, respectively. The STS PUF Program is unique in many respects and was designed primarily as an option for investigators to pose research questions, quickly obtain quality data, analyze these data themselves given appropriate biostatistics resources, receive feedback, and develop their efforts into abstracts and manuscripts. Key features that distinguish the STS PUF Program from similar programs offered by other medical societies include: PUF Task Force review of the submission materials (application and proposal) for scientific merit and appropriate analytic capacity of the investigative team; Data ready for analysis—investigators will receive quality-checked data for variables that are relevant to the research question only after study inclusion and exclusion criteria have been applied; Valuable feedback from the PUF Task Force on the quality and completeness of an investigative team’s analysis and interpretation of the results, as well as the ensuing abstract and/or manuscript derived from the study; and   Affordable research fees—these fees will be used to offset the technical and scientific support needed for sustained high-quality PUF research productivity. Many of these new research initiatives could be game-changers. More STS Research Initiatives on the Horizon STS PUF is only the beginning. Several other new research-related initiatives currently are being developed. In 2017, STS will launch in-house analytics capabilities that will contribute to all forms of STS research. Such new data analytics services promise to be a meaningful addition to the STS Research Center, particularly for investigators interested in PUF research who do not have statistical resources at their own institutions. Another major near-term focus of the STS Research Center is to acquire long-term follow-up data for patients in the STS National Database. This need is well recognized, and success on this front would be transformational, providing a whole new dimension to STS research. Long-term follow-up data would allow investigators to pursue clinical outcomes and comparative effectiveness questions with genuine potential for grant funding success. Please stay tuned!

The Centers for Medicare & Medicaid Services is focused on incentivizing value-based, patient-centered care. This is a shift from the traditional fee-for-service physician payment model and will place the cardiovascular service line organizational framework front and center in how we deliver care to our patients. In this edition of STS News, Heather Smith, an STS Associate Member who serves on the Workforce on Practice Management, explains how the cardiovascular service line structure enhances value-based care. --Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Heather Smith, RN, MJ Revenue Cycle Director, Department of Surgery, and Business Director, Divisions of Cardiovascular, Thoracic, and Vascular Surgery, Clinical Practices of the University of Pennsylvania STS News, Fall 2016 -- As health care reimbursement continues to shift from fee-for-service to a value-based model, organizations must continually evolve to ensure their success. Providing care in a value-based framework essentially requires delivering evidence-based, high-quality care in an efficient, cost-effective manner and being transparent about outcomes. In a 2010 article in The New England Journal of Medicine, Michael E. Porter, PhD suggested that value should be defined around the customer, set the framework for performance improvement, and be measured by outcomes and cost. The cardiovascular service line (CVSL) is well-suited to optimize success within this newer reimbursement system. The CVSL model focuses on organizing care of the cardiovascular patient collaboratively across disciplines. It has helped to change the care model from one where disciplines worked side-by-side but independently, to one where they work in close partnership. It consolidates operations, marketing, finances, quality, and strategic planning into this focus on a single patient population. The CVSL creates value by optimizing performance. It does this by guiding the development of evidence-based, standardized protocols by collaborating physicians. The CVSL can define and measure outcomes and cost and share the information across disciplines, rather than in silos, thereby influencing more of the care provided to patients. Because the CVSL also oversees marketing and strategic development activity, it also can strategically use its outcomes and cost data to attract and retain referring physicians and patients. How to Adopt the CVSL Changes to an organizational structure can challenge any organization. Creating a mission statement may seem unnecessary when groups have been providing care for a long time. However, a mission statement can help bring the team together around the change and unify the move to better care. Role clarity improves performance, so it is important to ensure roles are defined and clear to individuals and their coworkers. Collaborating to create standardized protocols, establishing quality goals, creating clear, comprehensive, but concise dashboards, and ensuring clear communication across a widespread and large group can be difficult. Knowing the potential challenges and quickly addressing those that arise is important. The ability of the CVSL to focus on quality and cost of care will be rewarded as payment systems shift to reimbursing for value, rather than volume.

Joseph E. Bavaria, MD, President STS News, Fall 2016 -- I’ve been traveling the world nearly my entire life, and I’ve had the good fortune of meeting with cardiothoracic surgeons on six continents. As I think about these meetings and my colleagues around the world, what strikes me the most is not our differences, but our commonalities. Whether you’re working in Jamaica or Japan, Italy or Iceland, once we make an incision, we see the same things. The anatomy is the same; an aorta in Belgium is the same as an aorta in Brazil. Common Questions No matter where I travel, I am asked many of the same questions. My colleagues want to know what’s new—what’s new in technology, what’s new in my health care system, what’s new in my OR, and what’s new at STS.  I always am eager to exchange information about the latest medical technology and clinical trials in cardiothoracic surgery, especially when it comes to transcatheter aortic valve replacement, aortic dissection, and rapidly developing technology (e.g., LVADs).  I also enjoy conversations about the STS National Database. Cardiothoracic surgeons around the world are realizing that patient outcomes are pivotal to their populations and their governments. We talk about how recent improvements in the Database make the data more representative and statistically significant and are a more sophisticated measure of how we help our patients. Cardiothoracic diseases are not confined within borders, and cardiothoracic surgery is not a sovereign state. Desire for Collaboration Cardiothoracic surgeons belong to a tightknit global community that craves collaboration. One of the Society’s strategic plan goals is to foster collaboration and connection worldwide. As part of this initiative, STS surgeon leaders routinely attend national and international cardiothoracic surgery meetings in Europe and Asia, and we’re taking steps to increase the Society’s presence in Latin America. Some of the articles in The Annals of Thoracic Surgery recently were published in Chinese. The Society also is working with other organizations on collaborative clinical practice guidelines and efforts to harmonize database definitions and standards to further optimize and standardize patient care. In addition, the STS foundation is looking for cardiothoracic surgeons who can provide their time and expertise to previously underdeveloped countries that are building cardiothoracic surgery programs of their own. Dave Fullerton told us during his Presidential Address at the 2015 STS Annual Meeting that the burden of noncommunicable diseases—such as cardiovascular disease and lung cancer—is growing astronomically, especially in the developing world.  The global cardiothoracic surgery community needs to come together and help out these countries and their populations. Every time I have visited a developing or emerging nation, I have been impressed by how the health care teams do more with less. We can all learn lessons about being more efficient with fewer resources; I have never left a country without learning something new. Access to Training Despite our intense willingness to collaborate, we have stumbling blocks that will be hard to surmount. One of the biggest challenges is in surgeon training. Many young cardiothoracic surgeons outside the United States want to spend 6 months or a year in the US as part of a fellowship or training program. Visa requirements and the regulatory environment make that difficult. We need to work on this as a global community; we need to provide more training opportunities for energetic young cardiothoracic surgeons. Increased use of the internet has helped ease some of the problems with access to education. STS recently expanded its online educational platform to include a robust Learning Management System, offering the entire Thoracic Surgery Curriculum, textbooks, videos, and case presentations (see related story). The Society also is considering new in-person educational programs that will be conducted outside of the United States in collaboration with our regional partners. Although the STS Annual Meeting offers an unparalleled opportunity for interactive education and scholarly debate (see related story), we realize that not all cardiothoracic surgeons have the time or the means to attend the meeting in person. Nevertheless, it’s vital that we find ways to learn from each other. Cardiothoracic diseases are not confined within borders, and cardiothoracic surgery is not a sovereign state. Our treatments and solutions are transferrable across continents and countries. We all need to take steps that will increase our exchange of information.  Cardiothoracic surgeons speak the same language, and our patients will benefit from our remembering that.

STS News, Fall 2016 -- Professional satisfaction is high among cardiothoracic surgeons. A recent survey of STS members found that 73% of practicing cardiothoracic surgeons are satisfied, very satisfied, or extremely satisfied with their careers. The findings come from the 2014 STS Practice Survey, the latest installment of surveys conducted approximately every 5 years since the early 1970s to provide the specialty with a better understanding of demographics, practice patterns, caseloads, and other trends in cardiothoracic surgery practice. The 63-question survey was sent to 4,343 STS Active and Senior Members between October 1 and November 5, 2014. A total of 1,262 (29.1%) responded. The results will be published in the November issue of The Annals of Thoracic Surgery; an article in press is now available on annalsthoracicsurgery.org. “This survey found that CT surgeons are pleased with their jobs and are managing to maintain stable operative volumes,” said John S. Ikonomidis, MD, PhD, who wrote the Annals paper. “We are expanding our armamentarium of surgical techniques and becoming very outcome and quality savvy.” Shift to Employment Model Seen A much higher percentage of surgeons than in past surveys (76%) reported being employed by a third party in some fashion. “I think the employment model is becoming more attractive because of the juxtaposition of the declining earning power of the CT surgeon with the need for increased nonsurgical resources to track and report the myriad outcome and quality metrics currently required by CMS and other reimbursement carriers,” Dr. Ikonomidis said. One way surgeons can track such information is through the STS National Database. Participation in the Database exploded in the 2014 survey—89.9% of respondents said they participated, compared with only 35.4% in the 2009 survey. This may be because participation in a comparative database has essentially become mandatory at many institutions, Dr. Ikonomidis theorized. There also is significant patient and media interest in public reporting of outcomes. Financial Burdens a Concern The length of training for a cardiothoracic surgeon doesn’t come without a financial impact. The percentage of respondents who said they had $60,001 or more of debt has steadily risen over time, from 24.4% in 2005 to 30.0% in 2009 to 34.2% in 2014. This partially may be explained by the fact that many surgeons are spending additional training time developing specialized skills that will give them a competitive edge. Similar to the 2009 survey, average malpractice insurance premiums ranged between $54,310 and $57,402, and most surgeons (71.7%) reported that their individual premiums had stayed the same over the past 2 years. "We are expanding our armamentarium of surgical techniques and becoming very outcome and quality savvy." John S. Ikonomidis, MD, PhD Workforce Aging The survey cemented the fact that the cardiothoracic surgery workforce is getting older. The percentage of surgeons aged 60 years or greater was 29.1%, compared with 25.7% in 2005. As the demographic continues to age and surgeons retire, the remaining workforce may need to perform more surgeries, and patients may need to wait a little longer to have their elective operations performed. “The primary issue here is surgeon availability. We currently are experiencing a shortage of CT surgeons to fill available jobs,” Dr. Ikonomidis said. “This could result in closure of smaller, rural programs and increased centralization of services to large, urban programs.” Perhaps unsurprisingly, given the aging workforce and current shortage of surgeons, a majority of respondents (52.3%) said that their institution was planning to hire a new surgeon in the next 2 years. This is a shift from previous surveys, in which the majority did not plan to hire. Nearly 40% of these respondents indicated that they would be looking for surgeons with “special skills” to fill these vacancies. On a positive note, the specialty is becoming more inclusive, with a higher percentage of female respondents (6.9%) than in 2009 (4.6%) or 2005 (3.0%). Operative Load Increasing Clearly, there is demand for the services of cardiothoracic surgeons, as nearly half of the respondents (42.6%) said that their total major operations performed increased in the last 12 months, while previous surveys found that operative load had stayed the same or decreased. The most commonly performed procedures included Maze (any technique) for atrial fibrillation, off-pump coronary artery bypass grafting surgery, thorascopic lobectomy, and right thoracotomy mitral valve replacement/repair. Only a small percentage of surgeons (7.6%) said that they frequently performed minimally invasive cardiac surgery; less invasive approaches were somewhat more commonly utilized among general thoracic surgeons, with 38.5% reporting that they used them 41% or more of the time. In addition, a majority of respondents (68.7%) reported that they worked at least 61 hours per week. But despite the increased workload, cardiothoracic surgeons love the job. “Cardiothoracic surgery is a fast-paced, highly technical, very satisfying specialty,” said Dr. Ikonomidis. “The best things are the patients, the cases, teaching opportunities, and the exciting research directions we are taking; I think my colleagues would agree.”

STS News, Fall 2016 -- For the first time since 1973, the STS Annual Meeting will be held in Houston, home to award-winning restaurants, nightlife, museums, and NASA’s Johnson Space Center.  The meeting will be held January 21-25 at the George R. Brown Convention Center. It kicks off with a full day of new and exciting technology at STS/AATS Tech-Con on Saturday, followed by Annual Meeting programming from Sunday through Wednesday. “The STS Annual Meeting is the epicenter of cardiothoracic surgery,” said STS President Joseph E. Bavaria, MD. “The meeting will be packed with interactive learning on hot topics. We’ll also explore practice management, work-life balance, and quality improvement issues that impact STS members on a daily basis.” Hot Topics in Each Subspecialty All members of the cardiothoracic surgery team will find educational programming relevant to everyday practice. Invited speakers and debates will be woven among scientific abstracts and surgical videos. The offerings for adult cardiac surgery include sessions on arrhythmias, mechanical circulatory support devices, the thoracic aorta, coronary artery disease, and mitral valve and aortic valve diseases.  “We have multiple abstracts on catheter-based therapy for aortic valve and mitral valve surgery, open and endovascular management of the aortic arch, and the descending as well as the ascending aorta,” said Workforce on Annual Meeting Chair Wilson Y. Szeto, MD. “New technology on rapid deployment aortic valve replacement platforms also is on the program.” For general thoracic surgeons, expect several presentations about minimally invasive surgery, long-term outcomes for cancer patients, and real-world tips that you can take home and apply in your practice. “Something that’s going to be a major focus at the meeting is the question of robotic surgery versus other types of minimally invasive surgery—does it really provide any benefits, or  is it just another way of doing things through small incisions?” said Joseph B. Shrager, MD, Co-Chair of the Surgical Symposia Task Force. “Sublobar resection for very small lung nodules also is going to be an important topic.” For the pediatric congenital heart surgery sessions, three loosely based themes have emerged. “We have a session focusing on issues around newborns and neonatal surgery, one on how patient risk factors, such as chromosomal abnormalities, affect outcomes after surgery, and one on advanced issues facing older children and teenagers,” said Jonathan M. Chen, MD, Co-Chair of the Surgical Symposia Task Force. Members of the Program Task Force met in August to plan the educational sessions. Tech-Con Moves to All Day Saturday After an extremely positive response in 2016, Tech-Con 2017 is again focusing on cutting-edge technologies and new developments in cardiothoracic surgery. The schedule has been changed for 2017 so as not to compete with Annual Meeting sessions. Tech-Con will begin at 8:00 a.m. on Saturday, January 21, and continue until 5:00 p.m., followed by a reception until 6:30 p.m.  A highlight of the day will be the Shark Tank session, in which entrepreneurs pitch their innovative cardiothoracic surgery products to the audience, as well as a panel of experts in medical device development. “There are a lot of things flying under the radar in terms of development, and you’re not going to hear about them anywhere else,” said Tech-Con Task Force Co-Chair Mark F. Berry, MD. “Attending Tech-Con is the most efficient way for every cardiothoracic surgeon to know what their practice is going to look like in a couple of years.” "There are a lot of things flying under the radar in terms of development, and you're not going to hear about them anywhere else." Mark F. Berry, MD Tips on Managing Your Practice The Annual Meeting begins at 8:00 a.m. on Sunday with sessions that include the Practice Management Summit, which will help surgeons navigate the shift from individual physician-owned practices to an employment model. Other sessions offering tips on managing your practice include two on Tuesday—the Early Riser Health Policy Forum, which will explain how to implement the new Merit-Based Incentive Payment System, and the Patient Safety Symposium, which will look at the important topic of physician burnout (see related story). You can view the program in more detail by going to www.sts.org/annualmeeting and clicking on Advance Program. A printed version of the publication will be mailed in November. Take Advantage of Early Bird Rates Registration and housing for the STS 53rd Annual Meeting are available at www.sts.org/annualmeeting. Early bird registration rates will end Tuesday, November 15. Additionally, you must register by Thursday, December 22, to reserve housing at the special Annual Meeting rates. STS/AATS Tech-Con 2017 and the STS 53rd Annual Meeting require separate registration. Tech-Con registration provides access only to the educational sessions on Saturday, January 21. Annual Meeting registration provides access only to the educational sessions on Sunday, January 22, through Tuesday, January 24. You also will receive complimentary access to Annual Meeting Online with your Annual Meeting registration. Tickets to attend the STS Social Event at the Space Center Houston (Monday, January 23) and STS University courses (Wednesday, January 25) require separate purchases with Annual Meeting registration. If you have questions about registration, contact the Society’s official registration partner, Experient, at (800) 424-5249 (toll free), 00-1-847-996-5829 (for international callers), or sts@experient-inc.com. The Society of Thoracic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. STS 53rd Annual Meeting: The Society of Thoracic Surgeons designates this live activity for a maximum of 27.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

STS News, Winter 2017 -- This past October, 20 STS members traveled to Washington, DC, and met with Congressional staff. During the course of 35 meetings, members urged lawmakers to protect reimbursement for life-saving lung cancer screenings, cautioning that cutting payments for screenings may prohibit access and endanger patient health. They also encouraged careful oversight of Medicare Access and CHIP Reauthorization Act implementation. In conjunction with the Fly-In, the Society held its first-ever congressional briefing, “Clinical Data Registries and Alternative Payment Models.” Congressional staffers, as well as Fly-In attendees, heard from STS Second Vice President and Secretary Keith S. Naunheim, MD, STS Past President Jeffrey B. Rich, MD, and Chair of the STS Council on Quality, Research, and Patient Safety David M. Shahian, MD about how the STS National Database can be utilized in Medicare physician payment reform. Learn more about how to get involved in advocacy efforts on behalf of the specialty. View photos and a video of the briefing—which may be of use to you in interactions with hospital administrators, payers, and others—below.  

STS News, Winter 2017 -- With the launch of public reporting for the General Thoracic Surgery Database (GTSD), the STS National Database is giving general thoracic surgeons the same opportunity to display their commitment to transparency and quality improvement as their adult cardiac and congenital heart surgery colleagues have had. Adult Cardiac Surgery Database (ACSD) participants have been able to publicly report their outcomes since 2010, growing from 226 consenting programs for the first data release to 607 for this month’s release. Public reporting for Congenital Heart Surgery Database (CHSD) participants started in 2015. This year, GTSD participants will be able to join the effort and publicly report their lobectomy outcomes. “Public reporting of surgical outcomes is becoming a routine expectation for patients, payers, and other stakeholders. STS has done a tremendous job of establishing a transparent and sound methodology for public reporting in the ACSD and CHSD, and general thoracic surgery is very excited to join this effort,” said Benjamin D. Kozower, MD, Chair of the GTSD Task Force. For the first stage of GTSD public reporting, a listing of all active participating institutions in the GTSD as of October 31, 2016, will be published on the STS website; individual participant surgeons at each institution also will be named. Additionally, STS will publish the discharge mortality and median postoperative length of stay for lobectomy for all GTSD participants as a group and compare those numbers to corresponding figures from the National Inpatient Sample, which is the largest, all-payer inpatient database available in the United States. Plans also are under way to publicly report participant-level outcomes for lobectomy compared to STS and national outcomes later this summer. Discharge mortality, median postoperative length of stay, and a two-domain lobectomy composite measure (including risk-adjusted mortality and major complications) will be reported for consenting programs. "STS has done a tremendous job of establishing a transparent and sound methodology for public reporting in the ACSD and CHSD, and general thoracic surgery is very excited to join this effort." Benjamin D. Kozower, MD "The GTSD is different from the other two component databases in two important ways. First, we have much lower penetrance, meaning that we only capture or represent about 50% of the lung and esophageal cancer resections being performed in the country," Dr. Kozower said. "Second, our outcomes are better than national benchmarks. Therefore, we want to continue the push for transparent reporting, while not disadvantaging an STS participant that may be a two-star program—expected performance in the Database—but still performs above national benchmarks." GTSD participants can opt in to publicly report their outcomes by signing a consent form. You also can get more information at the STS booth (#533) in the Exhibit Hall at the Society’s Annual Meeting in Houston, January 21-25. Completed consent forms for all three Database components are due from new public reporters by March 13, 2017, for inclusion in the summer data release. “This is an iterative process,” Dr. Kozower added. “As our long-term outcomes, like 5-year survival, mature and we move toward adding patient-reported outcomes, our ability to improve the public reporting effort will grow.” If you have questions regarding GTSD public reporting, contact Sydney Clinton, Quality Metrics and Initiatives Coordinator, at Sydney Clinton. To view a webinar on STS Public Reporting, visit www.sts.org/webinars. Toolkit Available to Promote Public Reporting Participation STS has developed a toolkit for Database participants wishing to promote their ratings to the public. The toolkit contains answers to frequently asked questions about STS, the Database, and the public reporting process, sample press releases, and quotes from STS leaders that may be used in press releases. View the toolkit at www.sts.org/media, and contact Jennifer Bagley, Media Relations Manager, at Jennifer Bagley with any questions.

STS News, Winter 2017 -- With the launch of the STS Participant User File (PUF) Research Program last fall, participants in the STS National Database now have the opportunity to request national-scale de-identified data for use in research projects. The PUF Program was designed primarily as an affordable option for investigators to pose research questions, quickly obtain quality data, analyze these data themselves with appropriate biostatistics resources, receive feedback, and develop their efforts into abstracts and manuscripts. "Over the last several years, it had become clear that STS members wanted to use our data locally and that local use would increase the amount of research using STS data," said Fred H. Edwards, MD, Chair of the STS Workforce on Research Development. "After a recent strategic planning meeting, a group was formed to develop an approach that would allow the concept to become a reality." Felix G. Fernandez, MD is serving as Chair of the PUF Task Force, which will review applications by focusing on various key criteria, including the scientific merit of the proposed research, the feasibility of the research, overlap with ongoing approved STS research, and the analytic resources available to the investigative team. "The goal of the PUF Program is to make it easier and quicker for programs to access data, while maintaining the high quality of all publications that use STS data," said David M. Shahian, MD, Chair of the STS Council on Quality, Research, and Patient Safety. For some researchers, the PUF Program may be an alternative to the STS Access & Publications program. There are some key differences between the programs, however. "Since the PUF data are de-identified, you can’t link them to long-term data, such as Medicare data,” Dr. Shahian explained. “Also, the data received through the PUF Program are analyzed by the requesting institution, rather than the Duke Clinical Research Institute, which is why we require that submissions include a qualified biostatistician on the investigational team." The Task Force began accepting applications for data in the Adult Cardiac Surgery component of the Database last fall. Data from the General Thoracic Surgery Database and Congenital Heart Surgery Database will become available in early 2017. More information about the PUF Program can be found at www.sts.org/PUF. Eligibility for participation in the PUF Research Program is limited to STS National Database surgeon participants and research scientists affiliated with STS National Database hospital participants in good standing. If you have questions about the PUF Program, contact STS Research Director Robert Habib at Robert Habib.

Robert A. Wynbrandt, Executive Director & General Counsel STS News, Winter 2017 -- Regular readers of this space (both of you, not counting members of my family) know that I regularly use this issue of STS News as an opportunity for a personal “year in review” and “what’s on deck preview” from the vantage point of an STS staffer who has witnessed a lot over the course of these past 30 years working with and for the Society. Those who are really attentive also know that I see much of life through the prism of professional sports. And so, it is no surprise that as I simultaneously look back on 2016 and ahead to 2017, I see a parallel between this organization and a striking trend in the National Basketball Association: picking up the pace. This story fittingly begins on Friday evening, January 22, 2016, the eve of our 52nd Annual Meeting in Phoenix, when I received a text message from Cousin Amy: “Did you hear? The Cavaliers just fired David Blatt!” This news of a coach’s dismissal came as something of a shock, as my hometown basketball team possessed a 30-11 record at the time and was solidly on top of the NBA’s Eastern Division. The next shock coming out of Cleveland occurred 2 days later, after newly appointed head coach Tyronn Lue had lost his first game; he lamented that the team was “out of shape” and would not achieve its full potential until its players were physically able to pick up the pace. The rest, as they say, is history. The Cavaliers—led by LeBron James—proceeded to meet Coach Lue’s demands, picked up the pace, and won the NBA championship in dramatic fashion, bringing a major sports crown to Cleveland and ending a 52-year drought. Either the stars were magically aligned that January weekend in Phoenix or newly elected STS President Joe Bavaria and others within the Society’s surgeon leadership were listening to Tyronn Lue. As evidenced in these pages throughout the course of the STS year now ending, as well as in our STS Weekly e-newsletter, on www.sts.org, and through social media and our other communication vehicles, this has been a year of enhanced pace, starting with the Board of Directors’ adoption of a new strategic plan in Phoenix and extending to such achievements as the launch of a new patient website (www.ctsurgerypatients.org), the expansion of the STS Research Center (including the rollout of a game-changing PUF Program and a new Business Plan; see related story), and the enactment of a US law that includes STS-driven language on “clinician-led clinical data registries” (see December 2016 issue of Advocacy Monthly). This acceleration of the pace has even translated to our corporate life, where the dial was turned up a notch or two in 2016 with the Society’s merger with the Joint Council on Thoracic Surgery Education and our reorganization/expansion of the STS governance structure that added a fourth Council. Even our admission of Active and International Members occurs more rapidly now, with three opportunities for applicants to be admitted by the Board of Directors each year pursuant to a Bylaws amendment approved by the membership in Phoenix. Students of the NBA who are reading this column know that Tyronn Lue was definitely on to something when he brought a new philosophy of accelerated pace to the Cleveland Cavaliers last January. The entire league appears to have heeded his call, and both pace and scoring are up—way up—throughout the NBA a year later. And so it is with The Society of Thoracic Surgeons. In line with the plan adopted by our Board in Phoenix, strategic initiatives are well under way in the spheres of database optimization (with exciting developments in process for 2017 as to both functionality and scope; see related story), education (where we will be rolling out a new symposium on robotic mitral valve repair this spring in Chicago, just a few weeks after our second annual ECMO course in Tampa), and globalization (with a number of initiatives aimed at serving the global interests of all cardiothoracic surgeons and their patients). There are of course risks and challenges associated with this world of accelerated pace, as well as benefits and opportunities, whether in professional basketball or in cardiothoracic surgery. In that context, I am looking forward to reading New York Times writer Thomas L. Friedman’s recently published book, Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations. The jacket note accompanying this book indicates that it “serves as a field manual for how to . . . think about this era of accelerations. It’s also an argument for ‘being late’ – for pausing to appreciate this amazing historical epoch we’re passing through and to reflect on its possibilities and dangers.” On behalf on the entire STS staff, I hope that the holiday season now ending has afforded you adequate opportunity to “pause and reflect,” particularly on the good things in life, as all of us prepare for what undoubtedly will be another year of accelerated pace. We wish you and yours the best for 2017, and look forward to seeing you soon for a special 53rd Annual Meeting in Houston!

The Centers for Medicare & Medicaid Services (CMS) has made it clear that the future of physician payments will be linked to quality and value. It is more necessary than ever for cardiothoracic surgeons to stay informed on how these payment models will affect their practices. In this issue of STS News, Dr. V. Seenu Reddy explains a CMS rule to bundle payments for coronary artery bypass grafting (CABG) surgery.  --Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management V. Seenu Reddy, MD, MBA TriStar Cardiovascular Surgery, Nashville, TN Editor's Note: This text is accurate as of December 20, 2016. In August 2017, the Centers for Medicare & Medicaid Services announced a proposed rule that would cancel the Coronary Artery Bypass Graft Episode Payment Model. STS News, Winter 2017 -- Since the passage of the Affordable Care Act, CMS has been seeking to promote cooperative, value-based care. Alternative payment models are one way CMS is attempting to drive quality and value. This past April, CMS implemented a bundled payment model for hospitals participating in the mandatory Comprehensive Care for Joint Replacement (CJR) program. A few months later, without any results from the CJR program, CMS proposed to mandate that randomly selected hospitals throughout the country participate in new bundled payment models for cardiac care, specifically the care of acute myocardial infarction (AMI) and CABG surgery. What this means for cardiothoracic surgeons may be gleaned from what has gone on in the orthopedic specialty regarding the care of patients undergoing joint replacement. The key premise for CMS is that bundling payments for the episode of care surrounding bypass surgery will incentivize increased quality, lower costs, and more care coordination. Here are some highlights from the final rule, which was issued on December 20. Cases related to Medicare fee-for-service patients admitted for heart attacks and bypass surgeries are eligible for the new cardiac bundled payment program. Cases covered by Medicare Advantage plans and Accountable Care Organizations are excluded. The bundle will make hospitals accountable for the cost and quality of care provided during the inpatient stay and for 90 days after discharge. Hospitals initially will be paid at the current reimbursement rates under the Inpatient Prospective Payment system. However, a retrospective reconciliation will occur relative to a predetermined fixed target price for each episode of care. At the end of each performance year, hospitals will have the opportunity to earn shared savings based on how they performed relative to the target price. Hospitals will be chosen from 98 randomly selected metropolitan statistical areas for the cardiac bundling program. Initially, hospitals outside of these selected areas will not participate in the cardiac bundles. Hospitals in rural counties will be excluded, and financial risk will be limited for rural hospitals that fall into the areas selected. More information on the selected hospitals is available. The bundles will begin on July 1, 2017. CMS will roll out the bundles in phases so that hospitals can adapt to the new payment scheme and establish support processes. Penalties will not be levied until the third program year (although participants are allowed to assume risk in 2018 if they so choose). For those who assume risk in 2018 and for all participants beginning January 1, 2019, through the third program year, penalties will be capped at 5% (referred to as the stop-loss amount). The stop-loss amount will increase to 10% in the fourth year and 20% in the fifth year. Potential gains also will be phased in. In the first two performance years, hospitals will be able to earn maximum bonuses of 5% (referred to as stop-gain amounts). These potential gains will then grow, in step with penalties, up to 20% in performance year 5. Hospitals will receive quality-adjusted target payments for each episode of care. These target payments will be based on a blend of historical hospital-specific and regional data and will be adjusted to account for case complexity. Hospital targets also will be adjusted for quality, so that hospitals delivering the best care have the opportunity to share in more savings. If hospitals do not meet the baseline standards for quality, they cannot share in savings. At the end of each performance year, hospitals that meet quality standards can earn additional payments based on cost. This means CMS will compare the actual spending for each episode to the target prices paid to the hospital. Those that are able to deliver care for less than the target price will be paid the achieved savings. Hospitals that exceed the target will be required to repay Medicare. The proposed rule also includes a model for cardiac rehabilitation services. The model aims to test whether payments incentivize use of cardiac rehabilitation during the 90-day period following hospital discharge. The AMI and CABG bundles can qualify as Advanced Alternative Payment Models in 2018 under the Medicare Access and CHIP Reauthorization Act (MACRA). The cardiac bundled payment program established pathways for physicians potentially to qualify under the Quality Payment Program for Advanced APMs. Surgeons participating in Advanced APMs will earn a 5% bonus payment from 2019 to 2024. The mandatory CABG bundle will qualify as an Advanced APM. Physicians in participating hospitals can get credit for participating in an APM (and therefore be exempt from participating in the Merit-Based Incentive Payment System) as early as January 2018, provided that their hospitals are willing to assume downside financial risk sooner than is required under the rule finalized on December 20. Physicians in these hospitals will be eligible to receive bonus payments in 2019. Much like the "usual and customary" fee schedule of the past, the future of physician payments will be based on and linked to quality, care coordination, and overall value. STS has actively advocated on behalf of cardiothoracic surgeons in relation to this new payment program, including meeting with CMS in person last September and sending a subsequent comment letter outlining specific concerns. In particular, the Society has noted that there are already too many payment policy changes in store for 2017 for physicians to have a reasonable expectation of success under this proposal. STS also has argued that clinical data, such as those in the STS National Database, should be used instead of Medicare claims data to determine the risk methodology of such payments. The final rule issued in late December incorporated some of the Society’s recommendations on quality measurement. The key for cardiothoracic surgeons, whether in an employment or private practice model, is that the system of independent physician payment for volume of services provided will soon be of historic interest. Much like the “usual and customary” fee schedule of the past, the future of physician payments will be based on and linked to quality, care coordination, and overall value.

Joseph E. Bavaria, MD, President STS News, Winter 2017 -- Advances in cardiothoracic surgery have been nothing short of remarkable over the past few decades. We’ve progressed from crude surgical techniques that kept patients in the hospital for weeks to minimally invasive operations that allow patients to be released from the hospital in only a few days. These innovations are good for patients and their families; in many cases, patients experience better outcomes and easier recoveries, which also lead to lower health care costs. Adoption of new technology can be a very slow process, especially in cardiothoracic surgery. We have a mandate for quality, which is critically important, but sometimes great quality can be at odds with innovation, especially for “early adoption.” We can’t stay stuck in old paradigms, however. Quality and innovation need to travel on the same path—in the same direction—so that our patients can lead longer and better lives. Technology at our Doorstep Some of the most recent technological advancements in our specialty relate to treating heart valve disease. Transcatheter aortic valve replacement has evolved rapidly with good outcomes. In late 2011, TAVR received regulatory approval; a few months later, CMS issued a National Coverage Determination for the technology. In the months leading up to the regulatory approval, I personally worked closely with several organizations to establish criteria for the safe introduction of TAVR into clinical practice for high-risk patients. These criteria included participation in the STS/ACC TVT Registry to track short- and long-term outcomes. Now, more than 5 years later, TAVR use has expanded to patients at moderate operative risk and even some with low operative risk. A recent STS survey of surgeon participants in the STS Adult Cardiac Surgery Database found that, among those surgeons with TAVR programs at their hospitals, 91% played an active role in the TAVR process, including participating in multidisciplinary meetings, performing TAVR procedures, and conducting follow-up patient care. I’ll provide more results from this important and revealing survey on Tuesday morning during the upcoming STS Annual Meetingin Houston, which also will feature dozens of presentations on use of new technology, including results from early feasibility trials for transcatheter mitral valve replacement. Other innovations that will be highlighted, discussed, and debated at the Annual Meeting include novel ways to treat the thoracic aorta and the lungs. All of these innovations have been made possible by new technologies and treatments, such as sutureless valves, TEVAR devices, state-of-the-art cardiopulmonary bypass platforms, third or fourth generation LVADs, and advanced VATS techniques. If you’re like me, you get really excited about new technology and dream about ways it can help your patients. But then you realize that the traditional rollout paradigm makes it difficult to adopt these technologies as quickly as we would like. That’s where STS can play a crucial role. Quality and innovation need to travel on the same path—in the same direction—so that our patients can lead longer and better lives. Steering Innovation and Quality in the Same Direction The Annual Meeting and upcoming STS standalone educational programs, including an ECMO course, a robotics course, and a structural heart course, will help you see and experience the present and future of cardiothoracic surgery. It is through educational activities such as these that we learn from the experts, experience hands-on training, and review and analyze outcomes data—all vital in the process to adopt new technologies. Clinical outcomes databases, such as the STS National Database and the STS/ACC TVT Registry, also play a role in the process. Our databases are valuable assets in medicine because they provide opportunities for quality improvement and patient safety. It is through participation in the STS National Database that you also can take part in STS Public Reporting. The initiative, one of the most sophisticated and highly regarded overall measures of quality in health care, offers risk-adjusted outcomes for common cardiothoracic surgical procedures. STS Public Reporting was launched in 2010 and has expanded over time (see related story). Because continuous improvements in quality and rapid adoption of innovation can be inherently at odds with one another, I will use my Presidential Address on Monday at the Annual Meeting to examine these colliding imperatives. Complementary to my address will be the C. Walton Lillehei Lecture on Tuesday by Dr. Samer Nashef, who co-developed the EuroSCORE risk-assessment system. Dr. Nashef, author of The Naked Surgeon: The Power and Peril of Transparency in Medicine, will provide his overview of quality initiatives and their unintended consequences. Clarion Call Although medicine adopts technology very slowly, we can shatter that paradigm by working together to drive innovation and quality along the same path. We need to see the big picture; we need to connect the dots. Please join me in Houston at the STS Annual Meeting so that we can begin an accelerated journey into a new era of medicine where patients benefit more quickly and today’s innovations truly become tomorrow’s standard of care.