Advocacy

This afternoon the Centers for Medicare & Medicaid Services (CMS) released the CY 2025 Medicare Physician Fee Schedule Proposed Rule. STS has compiled a summary of key provisions affecting thoracic surgery in the rule. 

Payment Cuts

CMS is again proposing significant cuts to cardiothoracic surgery reimbursement, this time by 2.8%. CMS estimates the CY 2025 conversion factor (CF) to be $32.36. Unlike hospital payments with a built-in yearly increase, physician payments do not have such adjustments. STS will continue lobbying Congress and CMS for systematic reforms and an inflationary update to Medicare payments.

Changes to physician reimbursement often stem from the budget neutrality requirement, which lacks a mechanism for inflationary adjustments. Disruptions occur when the value of specific services change, affecting the reimbursement of other services to maintain budget neutrality. STS and the physician community are advocating for Congress to legislate an inflationary update to the CF and adjust budget neutrality thresholds. For more details, see our recent response to the Senate Finance Committee’s request for information on physician payment. 

Quality Payment Program (QPP)

Thanks to advocacy efforts from STS and other stakeholders, Congress has stepped in to extend a 3.5% incentive payment for Advanced Alternative Payment Model (APM) participation in CY 2025 (based on CY 2023 participation). Additionally, starting in payment year 2026, APM participants will be eligible for a higher CF update than other clinicians: 0.75% compared to 0.25%. 

STS previously worked with CMS to provide specialty-specific, meaningful measures for our members who participate in the Bundled Payments for Care Improvement (BPCI) Advanced APM. Additionally, this will be relevant for CT surgeons performing CABG procedures under the new TEAM payment model proposed in the inpatient payment rule. CMS is considering, with STS support, allowing TEAM participation to count towards Advanced APM participation under the QPP.

Global Surgical Codes 

CMS is proposing to expand the use of transfer of care modifiers for global packages. They would require the use of modifiers (-54, -55, and -56) for all 90-day global surgical packages in cases where a practitioner (or another from the same group) expects to provide only the pre-operative (-56), procedure (-54), or post-operative (-55) portions. This applies to both formally documented and informally expected transfers of care. CMS aims to use the information collected to refine global surgical codes in the future.  

In the past, STS has actively promoted the benefits of maintaining the 90-day global code and has refuted flawed data used to advocate for their repeal. We will continue to promote the value of these bundled payments and urge policymakers to extend the increased reimbursement for E/M visits to those packaged in procedural global payments.  

Telehealth

CMS has extended telehealth flexibilities where possible, including adding new services to the telehealth list and permitting two-way and real-time audio-only communication technology for any telehealth service. Absent congressional intervention, the future of telemedicine hangs in the balance as the current telehealth flexibilities are scheduled to expire on December 31, 2024. STS urges Congress to permanently extend telehealth flexibilities established during the COVID-19 public health emergency. 

On June 21, 2024, The Society of Thoracic Surgeons, The American College of Radiology®, and the GO2 Foundation for Lung Cancer submitted joint letters to the Centers for Medicare & Medicaid Services and the US Preventive Services Taskforce that include recommendations to improve existing lung cancer screening eligibility requirements. 

The organizations formally requested reconsideration of the National Coverage Determination (NCD) for screening lung cancer with low-dose computed tomography and asked to eliminate the exclusion criteria of current smokers or people who have quit smoking within the last 15 years and the upper age limit. This would align the NCD with the updated American Cancer Society and the National Comprehensive Care Network evidence-based guidelines. 

Removing these criteria would significantly increase the number of high-risk individuals eligible for screening from 14.2 million to 19.2 million. Annual lung cancer screening with low-dose computed tomography in high-risk patients significantly reduces lung cancer deaths and may help identify cancers at an early, treatable, and curable stage.  

If you have questions about STS’s lung cancer screening advocacy efforts, contact Haley Brown, senior manager, political affairs and advocacy. 

Today, the Federal Trade Commission (FTC) announced the enactment of a final rule to ban non-compete clauses as an unfair method of competition. This groundbreaking rule prohibits employers from entering into or maintaining non-compete agreements with workers, with limited exceptions. The Society of Thoracic Surgeons has been a strong advocate for this ban, recognizing that non-compete clauses significantly hinder cardiothoracic surgeons by limiting their ability to serve their communities, maintain continuity of care, and ensure patient access to specialized surgical services.  

"STS members and the broader physician community will benefit from the ban on non-competes," says STS President Jennifer C. Romano, MD, MS, and a practicing cardiothoracic surgeon. "Eliminating non-compete clauses removes major barriers for cardiothoracic surgeons, enhancing their ability to decide where and how they practice without undue restrictions. This change is especially crucial in improving access to specialized surgical care across various regions, fostering a more dynamic and responsive healthcare system." 

The unfortunate exclusion of most non-profit hospitals from this rule significantly constrains its benefits. We encourage Congress to continue the momentum on this important issue by enacting S. 220 / H.R. 731, the Workforce Mobility Act, which would extend these crucial protections to all healthcare providers, ensuring a truly competitive and patient-centered healthcare environment.  

The U.S. Food and Drug Administration (FDA) has issued a Class I recall for nearly 14,000 Abbott and Thoratec HeartMate left ventricular assist devices (LVADs). This recall comes after reports of multiple deaths and injuries associated with these devices, which are used to aid patients with advanced heart failure. 

The recalled devices include: 

• Product names: HeartMate II and HeartMate 3 Left Ventricular Assist System (LVAS) 
• Product codes: DSQ 
  • Class 1 Device Recall HeartMate II Left Ventricular Assist System (fda.gov) 
  • Class 1 Device Recall HeartMate 3 Left Ventricular Assist System (fda.gov) 
• Model numbers:  Full List of Affected Devices 
• Distribution dates: Starting April 21, 2008 

The problem at the center of this recall is the gradual buildup of biological material in these devices develops over 2 or more years, potentially obstructing the device and diminishing its ability to support the heart's pumping action. This issue can trigger alarms for low blood flow and impair the device's effectiveness. 

Recall Action: This recall is classified as a correction rather than a complete product withdrawal. The FDA has not advised the return of all affected devices. However, heightened vigilance concerning low-flow alarms, which may indicate significant outflow obstructions, is recommended. 

Customers should have received an Urgent Medical Device Correction letter on February 19, 2024, providing detailed guidance on monitoring for and addressing potential obstructions. 

Abbott and Thoratec have made efforts to educate physicians on the importance of heeding persistent low-flow alarms as early indicators of potential obstructions and have shared diagnostic recommendations to identify obstructions and discussed treatment options available for managing such issues.  

If you have questions about this recall, contact Abbott and Thoratec directly at (844) 692-6367. To report a problem with these devices, complete the FDA reporting form