Advocacy

STS 2023 DAY 3 — Today is your chance to give input as cardiothoracic surgeons work to establish vital guidelines in pediatric surgery for congenital heart defects. Several of the nation's foremost surgeons will present their studies to date that will be the foundation for STS practice guidelines and consensus documents.  On Monday, January 23 at 11:55 a.m. PT, Jeffrey P. Jacobs, MD, a professor of surgery and pediatrics at the University of Florida in Gainesville, and Tara Karamlou, MD, MSc, from Cleveland Clinic in Ohio, will chair the highly collaborative session "It's All About the Data—Evidence Based Guidelines for Congenital Heart Surgery." These and other surgeons involved in the multi-institutional research want your feedback. This session will showcase the extensive research conducted to date by the Evidence Based Task Force for Congenital Heart Surgery and offer participants opportunities to contribute their own insights. Dr. Jacobs leads the task force, which is undertaking three projects where consensus on optimal care approaches does not exist: Strategies for Left Ventricular Recruitment in Neonates and Borderline in Left Heart Structures, chaired by Dr. Karamlou, Bahaaldin Alsoufi, Chief of Cardiothoracic Surgery at Norton’s Children’s Hospital in Louisville, Kentucky, and Eric Feins, MD, from Boston Children’s Hospital in Massachusetts. Management of Neonates and Infants with Coarctation, chaired by Elizabeth Stephens, MD, PhD from Mayo Clinic in Rochester, Minnesota, and Hani Najm, MD, from Cleveland Clinic in Ohio. Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot, chaired by Jennifer Nelson, MD, from Nemours Children’s Hospital in Orlando, Florida, and James St. Louis, MD, Section Chief of Pediatric and Congenital Heart Surgery from Children’s Hospital of Georgia in Augusta. "It has truly been an honor for me to observe the dedication and professionalism of these STS leaders as they pursued, with great scientific rigor, the best answers available to three very challenging clinical dilemmas," Dr. Jacobs says. "I am certain that the tremendous effort devoted to these studies will generate important knowledge that will ultimately improve the lives of many babies and children with congenital heart disease." These initiatives followed the call in 2022 by STS President John Calhoon, MD, to improve cardiothoracic surgery across the world. From there, the STS Workforce on Evidence Based Surgery created three Task Forces addressing some of the most pressing and unanswered surgical issues, including the congenital heart surgery group.    Research presented today will lead to publication of an STS Clinical Practice Guideline in The Annals of Thoracic Surgery and two STS Expert Consensus documents later this year.

Last month, Congress passed legislation that helps mitigate a nearly 9% cut to Medicare reimbursement for cardiothoracic surgery. Instead, cardiothoracic surgeons will experience a 2.08% decrease in reimbursement—which went into effect Jan. 1, 2023.  While the Society’s goal was to eliminate 100% of the pending cuts, its efforts as part of the Surgical Care Coalition (SCC) succeeded in substantially reducing the impact on surgeons in the interim. Throughout the course of 2022, the Society and its SCC partners engaged with legislators to stop the planned cuts.  “STS members who participated in advocacy efforts this year are to be commended for their contributions toward fixing a broken system,” said STS President John H. Calhoon, MD. “Our work will continue in 2023 or until Congress takes action on developing a long-term solution for Medicare payment.”  “These cuts are not sustainable going forward,” added Joseph Cleveland Jr., MD, chair of the STS Council on Health Policy and Relationships. “A long-term solution to Medicare reform is the most important thing in all of this in order to give cardiothoracic surgeons a degree of financial certainty to operate their practices. We need to be here so that we can take care of all patients with heart disease and cancer when they need us most.”  In addition to the Society’s individual efforts, STS’ legislative advocacy is greatly bolstered by its proactive role in the Surgical Care Coalition, a national coalition of 14 medical associations and societies that collectively represent 150,000 surgeons and anesthesiologists. Targeting Congressional leadership, the Surgical Care Coalition unifies the voice of the surgical profession on policy issues related to patient access and care quality. In addition to the Medicare cuts that just happened, Dr. Cleveland urges surgeons to think about some of the most profound long-term consequences that loom if drastic Medicare cuts continue; aging Baby Boomers may not be able to find cardiothoracic care if surgeons are forced to limit patients covered by Medicare. Further, he notes that tomorrow’s promising surgeons may choose not to enter the profession because of lengthy training, high educational debt, and unpredictable reimbursement—and patients will ultimately suffer. The US shortage of cardiothoracic surgeons is expected to reach severe levels by 2035, according to estimates derived from the STS Adult Cardiac Surgery Database and the American Cancer Society.    Although any surgeon who serves Medicare-covered patients will be impacted by these latest cuts, Dr. Cleveland adds that surgeons in rural or under-served areas and independent surgeons may be affected most. He urges STS members to take the following actions: 1. Make your views known to your federal and local lawmakers. Tell them that you want to take care of Medicare patients in their districts, but cuts might jeopardize this. Find contact information for members of Congress at congress.gov/contact-us. 2. Contribute to the STS Political Action Committee, which helps get surgeon advocates in front of legislators who can support surgeons. Donations can be made at pac.sts.org. 3. Participate in volunteer health policy work with STS that fits your preferences and time. Explore proactive opportunities at sts.org/advocacy or email advocacy@sts.org. “If we continue on the current path, we face an unsustainable crisis in providing care to our patients with heart and lung disease,” Dr. Cleveland said.

STS News, Fall 2022 — More than 50 cardiothoracic surgeons, residents, and medical students participated in the Society’s first in-person Advocacy Conference since 2019. STS members met with lawmakers to discuss several key issues of critical importance to STS members and their patients. “The Advocacy Conference is really important for each and every one of us in STS—to get together with colleagues and discuss what is really important in our specialty and, more importantly, for our patients, so that we can make health care better,” said Patrick T. Roughneen, MD, from UT Health Houston McGovern Medical School. “We are here together to talk with members of Congress, and they are very receptive to our voice.” Participants connected with several legislative decision makers during the conference. In addition, STS President John H. Calhoon, MD, presented Rep. Kim Schrier, MD (D-WA), with the STS Legislator of the Year Award. Rep. Schrier discussed the physician workforce shortage and her continued efforts to help stall physician Medicare payment cuts. “What we need is a permanent solution to Medicare reimbursement cuts,” she said. “Every year, the payment cuts come up, and it always is a crisis at the end of the year. I happen to think this is a good time for doctors to make their case, as we are losing physicians to retirement and resignation. This is a moment to make a play for that permanent solution, and I'm working with my committee to help.” STS members also heard from Rep. Larry Bucshon, MD (R-IN), a cardiothoracic surgeon, and Rep. Mariannette Miller-Meeks, MD (R-IA), an ophthalmologist, who provided perspective about the current Congress and its focus for the remainder of 2022. Reps. Bucshon and Miller-Meeks emphasized the importance of surgeon participation in advocacy and answered questions from participants. They explained their roles in temporarily halting Medicare reimbursement cuts for surgeons this year and their hopes to work with health care providers on a more permanent solution. Rep. Bucshon also discussed the bill he cosponsored with Rep. Schrier that would help registries like the STS National Database to facilitate innovation and quality improvement. Dr. Joseph Cleveland Jr. sits down with Rep. Jason Crow (D-CO) during the STS Advocacy Conference. During the conference, STS members met with House and Senate representatives in Congress and their staff, urging them to take action on three issues that are especially important to the specialty. “It’s a great experience to be in the city of Washington, DC, and connecting face to face with members of Congress and legislative assistants, talking about issues that help our specialty and our patients. There’s nothing like it—a lot of energy,” said Karen M. Kim, MD, from the University of Michigan in Ann Arbor. Ask #1: Stop Medicare Reimbursement Cuts The Centers for Medicare & Medicaid Services (CMS) has proposed to cut the Medicare conversion factor—the multiplier used to calculate the amount of Medicare payment using the relative value unit of a procedure or service—by 4.42%. Even worse, additional budget-related cuts will be layered on top starting in 2023. In addition, some estimates show the cost of running a medical practice has increased by 37% between 2001 and 2020. The startling reality is that, when adjusted for inflation in practice costs, Medicare physician pay actually declined 22% from 2001 to 2020. Unless Congress steps in again, cardiothoracic surgeons could see Medicare payment cuts of up to 8.5% in 2023. Reductions of this magnitude represent a very real threat to the financial viability of clinical practices and could limit patient access to care. Ask #2: Support Access to Claims Data Medicare claims data, when linked with clinical outcomes data in registries such as the STS National Database, allow researchers to conduct longitudinal analyses to measure quality improvement and improve patient safety. Currently, regulatory barriers prevent registries from linking claims data with clinical outcomes data. In order to help improve quality of care and perform important research, registries need timely, cost-effective, and continuous access to these data. Ask #3: Support the Resident Physician Shortage Reduction Act A key factor impacting the shortage of physicians is the artificial cap placed on Medicare-supported graduate medical education (GME) positions. This bill would help mitigate the physician shortage by creating 14,000 new GME slots over 7 years.  In December 2020, Congress provided 1,000 new Medicare-supported GME positions—the first increase of its kind in nearly 25 years. While this is progress, more support is needed. The Resident Physician Shortage Reduction Act of 2021 is a step in the right direction. Dr. John Calhoon and other STS members met with Rep. Larry Bucshon (R-IN) and other members of Congress. Miss the STS Advocacy Conference? You Still Can Be Involved! If you could not attend the STS Advocacy Conference, you still have a chance to meet with your federal representatives. STS members are the most effective advocates for the specialty and patients; contact the STS Government Relations office at advocacy@sts.org or 202-787-1230 for help with setting up a meeting or site visit. 

STS News, Summer 2022 — Grassroots advocacy is action that grows organically from the heart of a constituency—its members. And, one of the most powerful types of this grassroots work is patient advocacy. Meet two STS members who have taken patient advocacy to the next level.  The 2019 STS Key Contact of the Year, Rob Headrick, MD, MBA, from CHI Memorial Chest and Lung Cancer Center in Chattanooga, Tennessee, traveled to the White House in late spring to advise the Administration on the mobile lung cancer screening program that he started. The program, known as “Breathe Easy,” features a built-from-scratch bus with a portable computed tomography scanner and brings opportunities for early detection of lung cancer directly into the community. Learn more about the program and Dr. Headrick’s grassroots efforts in the Q&A below. Former STS President Douglas E. Wood, MD, from the University of Washington in Seattle, has taken his patient advocacy to a global level, demonstrating that early detection of lung cancer can have a significant impact in reducing overall cancer mortality. Dr. Wood chaired the Lung Cancer Screening Panel of the National Comprehensive Cancer Network (NCCN) when it was created in 2009. The panel was in the process of creating the first lung cancer screening guidelines when the National Lung Screening Trial (NLST) was published in 2010 (the trial was launched in 2002, and the initial findings were released in November 2010). The NLST demonstrated that a lung cancer screening program could reduce lung cancer mortality by 20%. As Dr. Wood explained, until that point, lung cancer screening hadn’t been accepted as a screening modality and the NLST results “changed the conversation.” However, there was still considerable work to do to get patients access to low-dose CT (LDCT) lung cancer screening. In December 2013, the United States Preventive Services Task Force (USPSTF) granted a B rating for lung cancer screening in adults aged 55 to 80 years who had a 30 pack-year smoking history and were currently smoking or had quit within the past 15 years. The B rating required that private insurance companies cover LDCT scans, but did not extend to Medicare beneficiaries. A Medicare advisory panel advised against screening for Medicare beneficiaries, withholding early detection from those at highest risk for lung cancer. Dr. Wood helped lead a coalition of health professionals to work with Medicare administrators on the safe implementation of screening. In February 2015, Medicare issued a National Coverage Decision providing lung cancer screening as a covered benefit for Medicare beneficiaries. The USPSTF updated its LDCT lung cancer screening recommendations in March 2021 to include adults aged 50 to 80 years who have a 20 pack-year smoking history, and Medicare followed a year later. Unfortunately, they both maintain an upper age limit and the requirement that eligible patients must currently smoke or have quit within the past 15 years. Dr. Wood more recently worked with the President’s Cancer Panel on a report issued in early 2022 that highlighted lung cancer as one of the top four cancers of focus. He also is the vice chair of the National Lung Cancer Roundtable from the American Cancer Society, a consortium of public, private, and voluntary organizations that work together to fight lung cancer by engaging in research and projects that no one organization can take on alone. In addition, Dr. Wood participates in the Lung Cancer Collaboration—a partnership between the World Economic Forum and the Lung Ambition Alliance. This coalition of patient organizations, scientific and medical societies, and industry—which shares the urgent ambition to double 5-year survival in lung cancer by 2030—developed a report that examined lung cancer as global public health issue. The report was presented to the World Health Assembly in May 2022. More information, including important lung cancer references and documents, is available below.   References and Documents from Dr. Doug Wood A report from the President’s Cancer Panel—Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access A report from the President’s Cancer Panel—Lung Cancer Companion Brief Lung Cancer Companion Brief  About the American Cancer Society National Lung Cancer Roundtable World Economic Forum: Urgent, Coordinated Global Action on Lung Cancer Q&A with Dr. Rob Headrick How did you get invited to the White House? We lobbied Washington, DC, and the Tennessee state government for funding to expand the mobile lunger cancer screening concept, but the pandemic put those efforts on hold. In 2021, we announced a partnership with the GO2 Foundation for Lung Cancer, AstraZeneca, Merck & Co., Inc., Bristol Myers Squibb, and a nonprofit foundation to expand the program. This collaboration caught the attention of the Biden Administration and the Cancer Moonshot initiative, and we received an invitation to the White House to help highlight important public-private partnerships that are critical to achieving the Cancer Moonshot goal of decreasing overall cancer mortality by 50% over the next 25 years. It was the highlight of my career to have our many years of work recognized by the White House and used as an example for the type of partnership they are looking for. What did you learn about the Administration’s work to advance lung cancer screening? It was clear to all involved that the quickest way to make progress toward the goal of reducing cancer mortality by 50% is through screening. Lung screening is the biggest first step that will start improving overall cancer mortality rates—which is why the White House was highlighting our mobile program and its effort to reach at-risk rural and underserved populations. The Moonshot leadership recognizes the importance of supporting continued improvements in screening policy. What is the latest on the mobile lung cancer screening bus initiative? The next mobile lung cancer screening bus is currently in the build stage and will hopefully be on the road by January 2023. In order to provide further value to these high-risk patients, the bus will include continued advancements in screening technology such as artificial intelligence (AI), calcium scoring, and possibly bone density assessment. Reliability, remote connectivity, and throughput also will remain priorities in the design. What innovations are there in the lung cancer screening space that STS members and patients should know? Low dose lung screening is much more than just finding lung cancer early. This population also is at high risk for ischemic cardiac mortality. We already use non-gated calcium scores with each lung screening to help protocolize patient risk and make sure appropriate medications are being prescribed. Smoking cessation also is encouraged. There is an opportunity to reduce the cardiac mortality in this population by 30%—similar to the lung screening benefit. In addition, so much data from these scans are not being used. For example, AI will play a role in our future by helping the radiologists read these scans and make better use of the data on the scans to improve the overall health of this population. We will become more efficient at predicting future risk for disease and focusing efforts to help mitigate that risk—all while staying within the low dose parameters and with a short single breath CT scan. How can STS members get involved in supporting the mobile lung cancer screening initiative? The Lung Ambition Alliance—with our help—currently is organizing an international mobile lung screening meeting that will feature all current mobile programs in the US (3) and United Kingdom (1). This meeting will allow those who are interested in developing such a program to learn from the existing programs and ask questions. We are hoping to have the meeting by the fall of 2022. It will likely be held in conjunction with one of the international lung meetings and will include a virtual option for those who cannot attend in person. Mobile lung screening isn’t for everyone, but for many, it is a great way to find lung cancer at an early stage and educate patients in areas where geographic or economic barriers prevent patient engagement. We are always willing to talk with STS members about the business model, discuss how we set up our program, and organize site visits to see the bus.