News & Media

STS News, Summer 2022 — While the fighting in Ukraine rages on, global congenital heart surgeon William M. Novick, MD, can be found in the operating rooms of hospitals throughout the war-torn country, saving lives of the littlest patients. These operations are considered challenging; they are complex, dynamic, and often time- and resource-constrained. Not to mention the additional risks that result from the fighting and life-threatening danger on the other side of the hospital walls. “When I hold a child’s heart in my hands, I experience an extremely scary, humbling, and challenging series of thoughts,” said Dr. Novick. “Scary, because that child might die. Humbling, in that God gave me the ability to do this. Challenging, because we want to save every child no matter how bad the defect is.” Dr. Novick, from the University of Tennessee Health Science Center in Memphis, and his team from the Novick Cardiac Alliance have traveled to Ukraine several times over the years, and they’ve committed to four visits in 2022. So far, they have completed three—traveling to the country in January, March, and, most recently, in June. “The physical damage being caused in the country is going to set back medical care in Ukraine years, maybe decades,” he said. “We were in the country during the last week of January and the first week of February. While our team was there, there was a developing threat of a Russian invasion, with troops already staging on the border and in Belarus.” Dr. William Novick champions the expansion of pediatric cardiothoracic surgery in under-resourced countries, both operating on children and training others to do so. Then, while the team was in Lviv this spring, the far western Ukraine city was bombed, said Dr. Novick. Even so, they worked day and night, desperately trying to complete as many surgeries as they could in a short amount of time. “They put us up in the hospital,” he said. “There’s no room anywhere in the city, in any hotel, because of all the refugees. We took a nap, I talked to the administrator, and then we got started.” Dr. Novick and his team operated on six children: three newborns, and another three who were just days old. Each year, 1 million children in low- and middle-income countries are born with congenital heart disease, according to Dr. Novick, and most do not have adequate pediatric cardiac care. The most challenging place in which he’s operated was Tashkent, Uzbekistan. The conditions included ancient equipment, unclean operating rooms, and dangerous power supplies. “There was a bypass machine—unplugged—on a counter,” said Dr. Novick. “Sitting on the floor next to the machine was a pair of heavy rubber gloves and rubber boots. Our perfusionist went to plug in the bypass machine. Simultaneously, six Uzbeks screamed, ‘NYET! Put on gloves! Put on boots!’ So he did, and when he plugged in the machine, sparks flew.” Dr. Novick explained that many of these countries don’t have any options for heart surgery unless it’s charitable. “And, what makes this work special is we are doing it in places where no one else wants to go,” he said. So Much More than Surgery In addition to their surgical skills and expertise, Dr. Novick and his team in March brought to Ukraine 14 massive bags of supplies to support pediatric heart surgery and pediatric cardiology, and for the trip in June, he shipped 12 pallets of equipment and materials. This is important to note because the Cardiac Alliance works to save lives, but also helps local teams assemble and sustain cardiac centers. In fact, the centers that the Cardiac Alliance builds typically are sustainable within 3 years. “We do pediatric heart surgery, but we also train pediatric cardiologists, and nurses in the ICU, respiratory therapists, those who run the heart-lung machine, and the catheterization lab technicians. We try to get all these people trained up to improve their diagnostic skills, or work on catheterization or anesthesia, and we do a lot of it in conflict zones,” said Dr. Novick. Dr. Novick and the Cardiac Alliance team visited Lviv, Ukraine in June 2022. ‘You Protect People…That’s Your Job’ Dr. Novick is not only doing much of the surgery himself, but he’s also gathering donated supplies, lining up financial contributions, and organizing training programs. Described as the undisputed leader of the Novick Cardiac Alliance, he’s known to run the team with a “thundering hand.” And his work in these countries—especially in Eastern Europe—holds personal significance for Dr. Novick. His grandmother, who is Ukrainian, and his grandfather, who is Russian, escaped Soviet Russia many years ago to settle in the US. With these roots, Dr. Novick credits his father for his “Russian temperament, tenacity, and persistence.” From his mother, he learned “all the soft things” such as his concern for children regardless of where they are in the world and his deep desire to repair children’s hearts. Just as importantly, his parents taught him, “You never, ever intimidate anybody. You protect people that are intimidated or bullied by other people. That’s your job. You’re big enough to do it.’ So that’s the way I was brought up: help those who are not able to help themselves,” Dr. Novick said. Over the years, he has done just that—made saving and protecting lives his life’s work, helping more than 10,000 children in 30+ countries, including places like Libya, Iraq, the Democratic Republic of the Congo, Russia, and China. “I’m very passionate about this work,” Dr. Novick said. “Unless you go to these places, I don’t think you can really grasp how desperate the situation is for these kids and their parents. Our team showing up, and their kid getting operated on—they truly consider it a miracle. I’m very humble about what we do, but you’re in a country of 85 million people and there’s no heart surgery for kids, and your child is one of 18 who gets operated on? I mean, holy moly.” For more information about the Novick Cardiac Alliance, visit cardiac-alliance.org.

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.