President's Column: Remaining Clinically Relevant

Richard L. Prager, MD, President

STS News, Summer 2017 -- In 1989, Richard E. Clark wrote an article in The Annals of Thoracic Surgery, “It Is Time for a National Cardiothoracic Surgical Data Base.” At that time, the Society was preparing to launch the STS National Database in response to a 1986 report by the Health Care Financing Administration (HCFA, the forerunner of CMS) of US hospital coronary bypass mortality rates. In the report, HCFA noted hospitals that were above or below average; however, the report was misleading because it was based on “minimally adjusted,” non-clinical data sources.

Since the inception of the STS National Database in 1989, it has grown exponentially, both in terms of participation and stature, and has become the gold standard for clinical outcomes registries. It also has expanded the number of variables collected and has evolved from the initial Adult Cardiac Surgery Database (ACSD) to include the Congenital Heart Surgery Database (CHSD) and the General Thoracic Surgery Database (GTSD).

Each of these component databases evolves as practices and procedures evolve and measurement metrics are refined. It is imperative that the Society adapt these databases so that they remain clinically relevant and address new concepts and advances in our field. It also is imperative that these databases appropriately address specialty, societal, and governmental needs such as Medicare quality reporting requirements, national coverage determinations, and device surveillance.

Our databases are sources of critical data points, operative techniques, and device information; they are important repositories for us, our patients, CMS, the FDA, and industry. As such, the process of adapting and decision making relies heavily on input from all of us, as well as from committed STS members who serve on the task forces for each database (chaired by Rich D’Agostino/ACSD, Marshall Jacobs/CHSD, and Benj Kozower/GTSD) and report to the Workforce on National Databases (chaired by Jeff Jacobs). This Workforce, in turn, reports to the STS Quality, Research, and Patient Safety Council Operating Board (chaired by Dave Shahian).

ACSD Spec Upgrade

In July, the Society launched the latest version of the ACSD (v2.9). As noted in an STS Headquarters announcement, a team of surgeons, data managers, statisticians, and staff spent a year balancing a need for updated and expanded fields with the reality of additional data acquisition burden.

Heart valvular procedures, thoracic aortic procedures, and arrhythmia operations are all evolving. As a result, sections pertaining to valvular and aortic procedures have been expanded and revised substantially, while the arrhythmia section has been updated.

The data fields are procedurally specific and highly clinical, which means that active surgeon involvement during the data capture is extremely important. To help facilitate the collection and entry of valid and useful data, STS offers online training manuals and procedure-specific worksheets for surgeons. The Society also plans to offer a series of webinars and teaching videos for aortic, valve, and arrhythmia procedures that would help supplement annual educational presentations at our data manager meeting, Advances in Quality and Outcomes. The meeting this year will be held October 18-20 in Chicago.

While we recognize the burdensome reality of database upgrades, the Society is committed to improving and evolving the databases for the specialty and our patients.

MIPS Reporting

Another important point to recognize is that the STS National Database remains a Qualified Clinical Data Registry and, with your written consent, STS will submit your 2017 ACSD data to CMS for the new Merit-Based Incentive Payment System (MIPS). With more changes anticipated in Washington, I urge you to review the MACRA Toolkit for Cardiothoracic Surgeons that's available on the STS website to learn more about MIPS, Alternative Payment Models, and how STS can help you navigate the reimbursement process.

In today’s environment, all cardiothoracic surgeons—including me—are feeling challenged as our practices, institutions, networks, and external agencies request more of our time, energy, and quality data. While it may be difficult at times to recognize the value in all that we are doing, our involvement in the STS National Database creates opportunities to improve the quality of care that our patients receive.

It was only a few weeks ago that the FDA fast-tracked approval of a TAVR valve-in-valve device after reviewing “real world” evidence from the Transcatheter Valve Therapy (TVT) Registry, which is a collaboration between STS and the American College of Cardiology. In the future, the STS National Database itself will be called upon to provide operative procedure and device-specific data in real-world timeframes to facilitate further FDA reviews.

While we recognize the burdensome reality of database upgrades, the Society is committed to improving and evolving the databases for the specialty and our patients.

On behalf of the Society, thank you for all of your efforts, as well as your commitment and patience.