News & Media

STS News, Spring 2022 — Surgeons, residents, medical students, perfusionists, industry representatives, and STS staff showed off their best times and team spirit to raise $33,000 for surgical research and innovation during the Thoracic Surgery Foundation (TSF) Fun Run & Walk in conjunction with STS 2022. Participating solo or as part of teams, 113 registrants ran, walked, or rolled a 5k course, many bringing along children in strollers or athletic pets. They shared their finish times and photos on the TSF Fun Run leaderboard and on social media with the hashtag #TSF5K. An all-virtual STS 2022 enabled participants like Andrew Chang and his well-geared companion to join from wherever they hail, even in “sunny Michigan.” Funds raised through donations and pledges will benefit TSF, the Society’s charitable arm, and will support grants and scholarships that will enable the brightest minds in cardiothoracic surgery to perform research, education outreach, and quality improvement programs in the US and abroad. Awards and accolades were given to record-setting individuals, including “fastest woman” Emily Wood and “fastest man” Dov Gertzulin. Wood also was part of the fastest participating team, UW Stamina, led by team captain Douglas E. Wood, MD, while Gertzulin ran with the largest team, Palisades Running Group, under captain Andrea Wolf, MD.   Dr. Backhus captained the Cardinal Chest Cutters, the top fundraising team for the 2022 TSF 5K Fun Run. The top fundraising team was the Cardinal Chest Cutters, led by captain Leah M. Backhus, MD, MPH. Other notable winners were the Thoracic Surgery Medical Student Association team led by Zach Brennan, the Women in Thoracic Surgery team led by Lauren C. Kane, MD, and the Medtronic corporate team under Amy Devries. “I’m always proud to see how enthusiastically the STS community participates in this event,” said STS Immediate Past President Sean C. Grondin, MD, MPH, FRCSC. “It shows their commitment to the community, to supporting the specialty, and to literally ‘walking the walk’ when it comes to cardiovascular health.” New Leadership, Bold Award Increases Welcomed in February During its February meeting, the TSF Board of Directors appointed Joseph A. Dearani, MD, to succeed Joseph E. Bavaria as TSF President. Virginia R. Litle, MD, will serve as the new Vice President, and Anthony L. Estrera, MD, as Treasurer. In addition, the Foundation dramatically elevated funding for three critical research awards beginning in 2023. The STS Research Award increased from $100,000 to $180,000; the TSF Research Award increased from $100,000 to $170,000; and the TSF Resident Research Award increased from $80,000 to $120,000. Since its inception in 1998, TSF has awarded more than $23 million in grants for cardiothoracic surgery research and education. Learn more at thoracicsurgeryfoundation.org.   

STS News, Spring 2022 — Payments for individual physician services have been regulated for nearly 3 decades by policies that are designed to control against dramatic increases in Medicare spending. The following are existing issues that likely will impact proposals for Medicare reimbursement in the coming years. Budget Neutrality Changes to Medicare reimbursement go into effect every January 1 based on reallocation of relative value units (RVUs), which represent estimates of physician work, practice expense, and malpractice. Adjustments to RVUs that result in a cumulative change of more than $20 million must be budget neutral, meaning that increased payment for one service or procedure must result in a proportional decrease for others. Base Updates to the Conversion Factor Medicare payment is the product of RVUs and the Medicare “conversion factor,” which the Centers for Medicare & Medicaid Services (CMS) sets annually. When the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was first passed, it provided base updates to the conversion factor through the 2019 payment year to encourage providers to migrate from the Merit-based Incentive Payment System to Alternative Payment Models (APM). Beginning in payment year 2026, MACRA will provide small base updates to the conversion factor that will differ based on whether CMS views the provider as delivering the service under the jurisdiction of MIPS (0.25%) or under participation in an Advanced APM (0.75%). Although the Society’s efforts to create its own APM have been unsuccessful, STS negotiated to have its quality measures included as alternative measurement options in the CMS Bundled Payments for Care Improvement–Advanced program. E/M Adjustments Medicare currently pays surgeons and other specialists a single fee (global payment) covering the costs of the procedure plus related care within a 10- or 90-day timeframe. In 2015, CMS declared that postoperative visits included in the global surgical reimbursement were not taking place and proposed to eliminate global surgical payment. As a result of STS advocacy demonstrating that the elimination of global surgical payments would undermine quality of patient care and increase the administrative burden on cardiothoracic surgeons, Congress passed legislation that required CMS to collect data on global codes before making a change. CMS still claims to be studying this issue while continuing to publicly express doubt that all postoperative visits included in the global period valuation are performed. In 2020, CMS increased evaluation and management (E/M) payments for in-office visits but did not make the analogous changes to similar services included in the globals. The agency also created an add-on code that could be used to increase the relative value of an in-office E/M visit even more. The surgical community advocated against these changes, and Congress required CMS to postpone payment for the add-on code until at least 2024. Because these changes are subject to budget neutrality requirements, cardiothoracic surgeons not only miss out on the increase commensurate with the E/M adjustments and add-on payments, but end up paying for the increase out of their own reimbursement. Inflation Unlike other aspects of Medicare reimbursement, Medicare Part B reimbursement has not been updated for inflation. This year, the absence of an inflationary update could be devastating as there already has been dramatic inflation, and the global economy is in tremendous flux.   Help Fight to Preserve Medicare Reimbursement Rates Cardiothoracic surgeons will experience a 2% pay cut in 2022 (averaged over 12 months)—even as the health care system begins to recover from the COVID pandemic. Alarmingly, these cuts resulted from budgetary policies impacting the entire health care system, not just the Medicare Part B policies described above. The specialty can expect cuts from any or all of these policies in the coming year. The voices of all STS members will be needed to defend against this swelling crisis. If you are interested in getting involved in advocacy efforts, plan to attend the 2022 STS Advocacy Conference in Washington, DC, September 19-20. Additionally, to have a direct impact on legislative issues that affect cardiothoracic surgeons, sign up for the Key Contact Program at sts.org/keycontact. For more information, contact the Government Relations Department at advocacy@sts.org. Key Contact of the Year Encourages Members to Get Involved The Society’s Key Contact of the Year Award recognizes STS members who have gone above and beyond to advocate for the specialty. 2021 recipient Raymond Strobel, MD, MSc, an integrated cardiothoracic surgery resident at the University Virginia in Charlottesville, shared his thoughts on the importance of grassroots advocacy, his experience working with legislators, and why he believes his STS colleagues must become involved in advocating for the specialty. Why are you involved in STS advocacy? Why is it so important? The health of our nation depends on informed policy that ensures access to cardiothoracic surgical expertise for all Americans. My goal in participating in STS advocacy is to provide a surgeon’s perspective on issues facing our specialty and patients, with the hope that this will improve health policy. How has your experience been serving on the STS Workforce on Health Policy, Reform, & Advocacy? My involvement on the STS Workforce on Health Policy, Reform, & Advocacy has been educational and productive. As a resident, the opportunity to learn from thought leaders in the field and develop my advocacy skillset early in my career is invaluable. No background in advocacy is required; I had no prior experience when I joined. STS staff and members go out of their way to support new participants. I highly recommend participation in the workforce. How have you engaged with your lawmakers at home? In addition to using the Legislative Action Center, I participated in the 2021 STS Virtual Advocacy Conference, meeting with the offices of Rep. Bob Good (D-VA), Sen. Tim Kaine (D-VA), and Sen. Mark Warner (D-VA). This was very worthwhile and helped me establish ongoing relationships with Congressional staff. Also, I have found emailing directly with policy advisors and staff to be effective, and it provides a more personal touch and increases engagement. I encourage STS members to reach out to their representatives. The STS Government Relations team is willing and eager to help facilitate these meetings. What would you say to your fellow STS Members to encourage them to become involved? I would emphasize how easy it is to get involved, that all contributions matter, and that ultimately the future of our specialty and the health of our neighbors depends on it.

STS News, Spring 2022 — A witness to historic surgical advancements, a champion of tide-turning social reform, and the only physician to have served as Vice President of Guatemala, senior STS Member J. Rafael Espada, MD, devotes his days to repairing hearts and reforging the heart of his nation. Since he began practice in the mid-1970s at the Methodist DeBakey Heart Center in Houston, Texas, and teaching cardiothoracic surgery at Baylor College of Medicine, Dr. Espada felt Guatemala tugging him back home. His 3-decade career in the US began with a residency in general thoracic surgery at Baylor—where Dr. Espada met the hospital’s namesake and the man who had inspired him to practice medicine, Michael E. DeBakey, MD.  Dr. DeBakey was one of the first surgeons to perform coronary artery bypass surgery and among the first to successfully employ a left ventricular bypass pump; he’s also known for his pioneering work in the development of artificial hearts. STS Members and surgical pioneers E. Stanley Crawford, MD, Michael E. DeBakey, MD, John W. Kirklin, MD, and Dr. Espada came together at a Houston meeting in 1988. “I remember when I was a kid, seeing an issue of Look with Dr. DeBakey on the cover,” Dr. Espada said. “That magazine, along with Life, was our information line from the US at the time. I knew then that I wanted to do cardiovascular surgery. It was a new field, one that hadn’t yet reached Guatemala.” After an accelerated primary and secondary education, Dr. Espada enrolled as a medical student at Universidad de San Carlos de Guatemala in Guatemala City. He described himself as “kind of active politically,” and through grassroots advocacy, he developed relationships with international emissaries. In his first year of training, he received a unique invitation. “The US Ambassador asked me one day if I’d been in the States,” he recalled. “I said no, we’re not very popular there—this was 1965, just after the time of the ’61 Castro invasion. He said they were going to give scholarships to four medical students who were members of the association of medical schools, funded by Kodak and Eli Lilly. They would send us to Washington, DC, for 6 months to see how the government worked.” Dr. Espada accepted, and while he was in New Orleans visiting Tulane Medical School and Charity Hospital, he picked up a letter directing him to the office where he’d begin his internship. It was the office of Robert F. Kennedy, US Senator from New York. “I was there with three other kids from different parts of the world, one from Africa, two from Asia. I was lucky to have Bobby Kennedy—he helped me to look at injustices in power, and to see that I was responsible for helping others.” Dr. Espada, who was raised by a single mother amid stigma and poverty—he didn’t meet his father until he was 55 years old—recalled a tapestry of “two Guatemalas,” one where the rich enjoyed sheltered living flush with new technology, while the country’s poor felt the sting of the nation’s corruption, tax evasion, money laundering, and violence. Over the next 30 years, by then working and living in Houston with his wife and daughters, Dr. Espada made monthly trips back to Guatemala. He used that time to perform free surgeries for children and adults who had complex cardiothoracic conditions but limited access to sophisticated health care. Dr. Espada was part of a founding community that established a cardiac program at Roosevelt Hospital, then Guatemala’s largest health care institution. He would perform up to 10 vital surgeries during one trip—and he provided advanced training to the surgeons in residence so that they could perform even more. With the assistance of the Guatemalan Ministry of Public Health, the cardiac program grew from a six-bed charitable operation to become UNICAR, the Guatemalan Heart Institute, which since its establishment in 1989 has expanded to serve thousands of patients each year, not only in Guatemala, but from neighboring Honduras, Belize, and Nicaragua. Dr. Espada’s training and mentorship continued to bolster the surgical staff, leaving them better equipped with each visit. “It’s only a 2-hour flight,” he said. These monthly trips didn’t seem to be enough for Dr. Espada. “Every year I would say to my colleagues at DeBakey, ‘I want to move back.’ They said, you’re crazy, it won’t be good for training; the technologies are not current there; the facilities are very poor.” But that’s precisely why he wanted to return—to flatten the frontiers of those two Guatemalas. “We have a prosperous part with tall buildings and Porsches going around,” he’d said in a New York Times interview in 2007. “Then, 10 blocks away, there’s misery.” That year, Dr. Espada moved permanently home. And, recognized as a sort of folk hero in his native country—the doctor who performs heart surgeries for the needy—he successfully ran for Vice President of Guatemala. He served in office 2008 to 2012 alongside President Álvaro Colom, on a platform dedicated to boosting the nation’s economy, strengthening international relations, and improving quality of life for its underrepresented citizens. Dr. Espada spoke fondly of meetings and correspondence with world leaders, including then-Secretary of State Hillary Clinton and Presidents Barack Obama and Joseph Biden, and of the importance of maintaining relationships across countries to identify arenas—particularly in health care, public spending, and climate action—where common ground can lead to programs that uplift people. "Many in the specialty know Dr. Espada as an established and highly skilled cardiothoracic surgeon in Houston, but may not be aware of the true extent of his influence," said Douglas E. Wood, MD, FRCSEd, from the University of Washington in Seattle. “Dr. Espada has initiated and helps to lead a private foundation that provides education and health care for rural Mayan children. His efforts have affected the lives of millions of people within Central America.”  “Dr. Espada’s selfless leadership transcends his position as vice president of Guatemala and is an inspiration for each of us as we consider the ways we may make an impact on the world,” added Dr. Wood. In addition to serving as dean of the School of Health Sciences at the Mariano Galvez University of Guatemala, a consultant at the Social Security Systems of Guatemala, and as UNICAR’s senior academic surgeon, Dr. Espada is vice chair of an international think tank, Global Financial Integrity, that uses data-driven analysis to expose illicit financial flows, corruption, illicit trade, and money laundering. Guatemala has stringent term limits and party restrictions in place to safeguard against dictatorship and nepotism—lessons learned from a tumultuous past, though these limitations play out in intriguing ways. For example, former President Colom divorced his wife, Sandra Torres, in 2011, to give her a shot at the presidential election. Dr. Espada has waited out a similar situation, noting that he couldn’t serve in office because a family member was serving. But he isn’t done with politics yet. Over the noise and bustle of the heart center, where he still operates at age 78, he confided that some political groups have asked him to run for President in the 2023 election. “I can’t announce which party yet, because it’s illegal,” he said. In his aspirations for the future, Dr. Espada emphasized that leaders must pay attention to young voices. The mentality of young people is changing; in fact, the minds of young people are changing, he insisted. In his curriculum is a presentation he calls “New Brains, New Education,” in which he describes how the thought processes of younger generations are wired differently and how educators can evolve their teaching plans to fit newer generations’ learning styles. “It’s not their job to accommodate older people’s way of thinking,” Dr. Espada said. “It’s our responsibility to adapt to theirs.” If you know of a unique member experience that should be featured in STS News, contact stsnews@sts.org.

More than 2,800 professional registrants joined the Society’s virtual 58th Annual Meeting, January 29-30. To read articles from the STS Daily Bulletin, visit sts.org/annual-meeting-archive. Presidential Address Urged Factoring Satisfaction into Success to Find the Right Fit Sean C. Grondin, MD, MPH, FRCSC, closed his term as STS President with an address to STS 2022 attendees describing the evolving process of finding career fit. He relayed the concepts of understanding one’s own metrics of success and satisfaction to an assembly of live attendees who joined virtually from across the globe. In his Presidential Address, Sean C. Grondin, MD, MPH, FRCSC, shared important lessons learned during his career. In his presentation, Dr Grondin shared lessons learned over his career related to professional success and satisfaction and how these two forces can work together to create professional “fit.” “A position can look good on paper and tick all the boxes,” Dr. Grondin said. “You can be doing the job well; you can be a strong member of a strong team. It can all look good from the outside. But if it doesn’t feel right, it likely isn’t.” He illustrated to the audience that in finding the right fit, surgeons need to not only rely on standard metrics of success that are often used for promotion, but also to consider other factors that contribute to one’s own personal sense of fulfillment and satisfaction. Dr. Grondin went on to describe that the price of poor fit and low levels of satisfaction can sometimes be high, and over time they may be among the contributing factors that lead to burnout among cardiothoracic surgeons. An STS member for more than 20 years, Dr. Grondin reflected that being part of the STS community has contributed greatly to his overall career satisfaction. He expressed gratitude to a long line of surgeon mentors, including Douglas J. Mathisen, MD, who many years ago challenged him to seek greater benefit from the organization by becoming more actively involved in the Society. “Building a successful and satisfying career requires self-awareness and frequent self-evaluation,” Dr. Grondin concluded. “It requires paying attention to the things that bring you satisfaction, and finding fit is worth the effort.” Amy C. Edmondson, PhD, presented the Thomas B. Ferguson Lecture during STS 2022. Plenary Sessions Celebrated Diversity, Bravery, Psychological Safety STS 2022’s plenary sessions allowed attendees to come together as a community in real time, with lectures exploring psychological safety in the workplace, the wartime lessons of a surgeon soldier, and the revelation that diversity can save academic medicine. Henri R. Ford, MD, MHA, delivered the Vivien T. Thomas Lecture, in which he illustrated how disparities among Black and Latino populations in the United States have a precipitous effect on medicine—academic medicine in particular—and how solutions to existing health disparities will require a more racially, ethnically, and culturally diverse research workforce. Racial disparities are dragging down efforts to address impending shortages of physicians in various specialties, Dr. Ford explained. He presented compelling statistics that reveal how education opportunities—afforded and missed—from childhood onward can have a cumulative effect on an individual’s success. Thomas B. Ferguson Lecturer Amy C. Edmondson, PhD, shared insights from her groundbreaking work on psychological safety in the workplace. She described how cultivating a team that feels they can openly and honestly speak up can create a professional environment that moves beyond “just get it right” and makes strides toward excellence. “We’ve got to learn to welcome the discoveries and do our very best to prevent the mistakes and accidents,” Dr. Edmondson said. A stance of humility and of openness to feedback can help foster a psychologically safe environment, she continued. “Any person in an operating room might see something that you miss. A patient’s family member might notice that something seems wrong. Anyone’s voice can be mission-critical.” During the C. Walton Lillehei Lecture, Cameron D. Wright, MD, Army Medical Corps, USAR (ret.), shared unforgettable experiences and lessons learned while caring for servicemembers and civilians. Dr. Wright took attendees on a journey through his time served, painting vivid pictures of the physical and political climate during tours of duty in Iraq and Afghanistan. He also described several massive-severity wounds and hidden hazards that he “certainly never saw in surgical residency.” He expressed his pride in serving alongside his son James, a Marine Corps machine gunner, in Iraq, and he touted the bravery of military dogs, some of whom he cared for in the trauma bay, and how soldiers paid them tribute for their service. Dr. Wright honored fellow military surgeons and pioneers—including the lecture’s namesake, C. Walton Lillehei, MD, PhD—and told stories of survivors as well as of those lost in conflict. These lectures, along with a rich selection of additional STS 2022 content, is available via Annual Meeting Online—free to STS 2022 registrants and available for purchase to those who couldn’t attend. Visit sts.org/amonline for more information. Award Winners Recognized for Outstanding Achievements Distinguished Service Award The Distinguished Service Award recognizes individuals who have made significant and far-reaching contributions to STS and the specialty. This year, Joseph A. Dearani, MD, and Joseph E. Bavaria, MD, each were honored for their extraordinary efforts and steadfast service. Earl Bakken Scientific Achievement Award Internationally recognized medical researcher Thomas K. Waddell, MD, MSc, PhD, was presented with the Earl Bakken Scientific Achievement Award. Dr. Waddell is best known for his work in the fields of stem cell and regenerative medicine, lung and airway disease, as well as lung transplantation. The Bakken Award honors individuals who have made outstanding scientific contributions that have enhanced the practice of cardiothoracic surgery and patients’ quality of life. President’s Award Michael J. Pienta, MD, MS, from the University of Michigan in Ann Arbor, received the 2022 President’s Award, for his paper, “Advancing Quality Metrics for Durable Left Ventricular Assist Device Implant.” Selected by the STS President, this award recognizes an outstanding scientific abstract by a lead author who is either a resident or a surgeon 5 years or less in practice. STS 2022 Presentations Combat Health Disparities with Hard Data During the STS Annual Meeting, faculty tackled inequities among different racial, gender, and socioeconomic groups, not only in patient populations but among the surgeons who provide their care. “There are opportunities for intervention in health care and policy in addressing disparities to access—and in particular, in workforce diversity issues and capacity building,” said Hannah Valantine, MD, from Stanford University in California. Dr. Valantine, who serves as chief officer for scientific workforce diversity at the US National Institutes of Health, gave an invited lecture during the Vivien T. Thomas Symposium, a series of STS Annual Meeting presentations which, in addition to the Vivien T. Thomas Lecture, aim to address challenges with diversity in cardiothoracic surgery. Hannah Valantine, MD, Olugbenga T. Okusanya, MD, and others discussed important research during the Vivien T. Thomas Symposium. The Symposium and Lecture are named for Thomas, a black surgical technician who was instrumental in the landmark 1944 “blue baby” operation at The Johns Hopkins Hospital in Baltimore, Maryland—and who, in accordance with segregationist restrictions, was employed as a janitor and wasn’t allowed to use the front entrance of the hospital. Alongside Dr. Valantine, three young researchers presented data underscoring why inclusion matters. Olugbenga T. Okusanya, MD, from Thomas Jefferson University in Philadelphia, Pennsylvania, outlined a study demonstrating that black race, Asian/Pacific Islander race, and insurance status had strong  associations with patients deferring radiation therapy after surgery for non-small cell lung cancer. In the realm of clinical trials, Gianmarco Cancelli, MD, from Weill Cornell Medicine in New York City, New York, revealed that only nine of 51 recent cardiac surgery trials reported the race of participants and, when race was reported, only 11.2% represented racial minorities. Future trials should either guarantee a balanced inclusion of racial minorities or be specifically designed to enroll them, Dr. Cancelli said. It's not just patient inclusion that needs compulsory accountability, said Dr. Valantine, but also the physician workforce. She cited data illustrating that underrepresented scientists are more likely to study topics in disproportionately affected communities, and that in clinical research, quality is enhanced when the researchers are diverse themselves. Physicians from underrepresented groups are twice more likely to work in underserved communities, and patients are twice more likely to adhere to medical advice when it’s given by providers of their own race, Dr. Valantine explained. “That’s where we need to take action,” she said. “We’ve come to the point that, in order to fix these problems, we have to fix our institutions.” Also during this Symposium, Katherine A. Giuliano, MD, from The Johns Hopkins Hospital, presented survey results that illustrated subspecialization and work/life balance for women practicing cardiothoracic surgery. Among the key findings were that, while 94% of congenital surgeons reported practicing in academia, none of the women who responded were full professors. Data tracking—and incentivizing—is the first step toward culture change at institutions, said Dr. Valantine. She urged keeping records and acting on those records within an institution’s hiring and promotion policies, employing a central equity committee, and compelling department chairs to provide annual demographic data, with transparent reporting of positions and salaries broken down by gender and race. “It’s amazing how competitive departments can get and how that leads to action,” she said. “Through a systematic way, you can identify candidates from a diverse talent pool,” she continued. “Do not accept the old adage that there’s nobody in the pool—we must not use that as the excuse for not having a diverse faculty or a diverse residency.” Access STS 58th Annual Meeting Online If you were unable to attend the virtual Annual Meeting, or if you are looking for online learning opportunities, you now can purchase access to STS 58th Annual Meeting Online. This digital product offers nearly 40 educational sessions—including practice changing research, thought-provoking lectures, and cutting-edge techniques and technologies—and the ability to earn up to 44.50 CME credits. Annual Meeting attendees receive free access to Annual Meeting Online. STS members who did not attend STS 2022 receive a discount—and Resident/Fellow and Medical Student Members can access for free! More details are available at sts.org/AMOnline.