News & Media

Please note: At press time, CMS had just released its proposed decision memo regarding transcatheter aortic valve replacement (TAVR). The proposal was more flexible than what STS, AATS, ACC, and SCAI had jointly recommended. The societies are working on comments that will be submitted on behalf of their respective members. Alan M. Speir, MD, Chair of the STS-PAC Board of Advisors (left) and 2018-2019 STS President Keith S. Naunheim, MD (right) presented Dr. Headrick with the Key Contact of the Year award at the STS-PAC Reception. STS News, Spring 2019 — Rob Headrick, MD, MBA was inspired to make the leap from the operating room to Capitol Hill so that he could advocate for change that would benefit cardiothoracic surgeons and their patients. Dr. Headrick’s involvement with grassroots advocacy began after he received the STS/American College of Surgeons Health Policy Scholarship in 2017, which enabled him to attend the Executive Leadership Program in Health Policy and Management at Brandeis University in Waltham, Massachusetts. “The program brought clarity to how our country’s chaotic system was formed and the importance of advocacy to fix what’s broken,” Dr. Headrick said. “Our voices can’t be heard if we don’t get out of the operating room. My experience with the health policy scholarship empowered me to give advocacy a try.” Dr. Headrick, who is Chief of Thoracic Surgery at CHI Memorial Hospital in Chattanooga, Tennessee, recently received the Society’s Key Contact of the Year Award for his extraordinary efforts in advocating for the specialty. He attended the 2018 STS Legislative Fly-In in Washington, DC, and met with legislators and staff members from nine Congressional offices, including Rep. Chuck Fleischmann (R-TN). He even was able to visit the House floor and take a private tour of the Capitol arranged by Rep. Fleischmann. “Our voices can’t be heard if we don’t get out of the operating room.” Rob Headrick, MD, MBA “Dr. Headrick is truly a pioneer in the medical field,” said Congressman Fleischmann. “I had the privilege of first meeting Dr. Headrick in 2018 and his advocacy on behalf of thoracic surgeons and individuals suffering from lung cancer has been a driving force for increased research funding. We are lucky to have a medical professional of such a high caliber from East Tennessee, and I thank Dr. Headrick for all he has done to increase awareness, spark advocacy, and ultimately save lives.” “Our ‘asks’ were well-received by both Democrats and Republicans,” Dr. Headrick said. “The legislators were sincerely interested in what we had to say.” After attending the Fly-In, he urged his hometown newspaper, the Chattanooga Times Free Press, to write a story on the Women and Lung Cancer Research and Preventive Services Act. After the story was published, Rep. Fleischmann became a cosponsor of the legislation. "Lung cancer is rampant in my community, especially among female nonsmokers,” Dr. Headrick said. “We must understand why and how to screen these individuals.” After initially meeting with Rep. Fleischmann in Washington, Dr. Headrick further developed the relationship by hosting the Congressman at his institution in March. Rep. Fleischmann met with hospital team members and lung cancer patients, as well as toured the hospital’s new mobile lung screening bus. “Surgeons’ problem-solving skills are needed in Washington and our state governments,” Dr. Headrick said. “Change is coming and STS should be leading that change.” To learn more about how you can become involved in STS advocacy efforts, visit sts.org/advocacy or contact the STS Government Relations office at advocacy@sts.org.

STS News, Spring 2019 — The Thoracic Surgery Foundation (TSF) distributed 24 grants totaling $916,500 as part of its 2019 awards program supporting research, education, and surgical volunteerism in cardiothoracic surgery. These grants will help advance treatment options for patients with heart, lung, and other chest diseases and offer much-needed assistance to underserved patients. You can view a list of the grant recipients at sts.org/TSF2019Awards. In 2018, the Foundation offered its first International Medical Volunteer Scholarship. Cardio-thoracic surgery resident Kellianne Kleeman, MD used the award to  participate in a charitable medical mission to Nepal with STS Past President Fred Grover, MD and his team. The first part of the mission included working alongside cardiothoracic surgery teams in two different hospitals in Nepal; the second part of the trip involved patients at rural outreach clinics. “What impressed me most was the gratitude of the patients. Many of them had traveled for hours or even days. Once they arrived, they waited for many more hours to be seen,” wrote Dr. Kleeman in her report to the Foundation. “It was heart wrenching to see so many young patients affected by rheumatic heart disease. There are ongoing efforts to improve early intervention and outreach to prevent the disease, but still to see so many children and patients my own age who were in heart failure needing a valve replaced or who had already suffered a crippling stroke (from a disease that is preventable) was awful. The clinics were very successful at screening patients and hundreds of patients were referred for ongoing follow-up or scheduled for surgery.” To see more about Dr. Kleeman’s experience, a video is available at sts.org/nepal. Applications for most 2020 TSF awards will be available on July 15, 2019; submissions are due by September 15, 2019. Visit thoracicsurgeryfoundation.org/awards for more information.

STS News, Spring 2019 — STS has hired Elaine Weiss, JD as its Chief Executive Officer/Executive Director effective April 15, 2019. She replaces Robert A. Wynbrandt, JD, who retired on March 15 after more than 30 years with the Society—17 years as Executive Director & General Counsel and 15 years as outside legal counsel before STS became a self-managed organization in 2002. “When we formed the search committee last year, we knew we had some big shoes to fill, given the success of our organization under Rob Wynbrandt,” said STS President Robert S.D. Higgins, MD, MSHA, surgeon-in-chief of The Johns Hopkins Hospital, as well as the William Stewart Halsted Professor of Surgery and Director of the Department of Surgery at The Johns Hopkins University School of Medicine. “We unanimously chose Elaine Weiss for her experience, intelligence, dynamic personality, and exceptional track record in the health care arena. We are honored and privileged that she will help lead STS into the future.” Weiss joins the Society’s staff after many years in the professional association space. Most recently, she was the Executive Director and CEO of the American Academy of Dermatology; she previously served as the CEO of the Illinois CPA Society and as an Associate Executive Director of the American Bar Association. “I am honored to inherit this position after Rob’s long and successful tenure,” said Weiss. “The health care environment is undergoing seismic changes. I am excited to work with STS surgeon leaders and staff to understand how these changes impact cardiothoracic surgeons and the patients they serve. My professional background in health care policy and association management provides me with the interest, experience, and enthusiasm to ensure that STS continues helping members navigate the rapidly changing health care landscape.” Weiss has a deep understanding of health care from both the clinical and administrative perspectives. In 1993, she was appointed by President Bill Clinton to serve as Midwest Regional Director for the United States Department of Health & Human Services. In this position, Weiss represented the Administration on all health care policy matters and liaised with Midwest governors, mayors, congressional delegations, special interest groups, and the public. This experience will be important as STS continues its work promoting better patient access to lung cancer screening, addressing the impact of electronic health records on the specialty, and easing a projected shortage of cardiothoracic surgeons. She also will be valuable as the Society enhances the STS National Database—already considered the gold standard among clinical outcomes registries—and supports legislative and regulatory efforts that will allow data from clinical registries and Medicare claims to be combined for outcomes-based research that may lead to improved health care quality and cost-effectiveness. "My professional background in health care policy and association management provides me with the interest, experience, and enthusiasm to ensure that STS continues helping members navigate the rapidly changing health care landscape." Elaine Weiss, JD “Elaine has been a successful and respected leader throughout her career, and she has made positive contributions to every organization in which she has served,” added Dr. Higgins. “Her health advocacy, administrative experience, and legal background will be instrumental in helping STS advance the cardiothoracic surgery profession and improve care for our patients.” Weiss holds a bachelor of science degree from Northwestern University’s Medill School of Journalism and a juris doctorate from the National Law Center at George Washington University. She is passionate both inside and outside the office. Weiss is a news junkie, a diehard Cubs fan, loves cooking and entertaining, and is an exuberant dog lover, caring for two 80-pound goldendoodles. She and her husband, Larry Greenberg, have a blended family with five sons ranging in age from 22 to 31. To contact Elaine Weiss, email her at eweiss@sts.org.

STS News, Spring 2019 — One of the first concepts that a newly minted cardiothoracic surgeon learns from experience is that excellent patient care in our field is a “team sport”. In this installment of STS News, Dr. Walter Merrill nicely outlines how we can lead by example to improve the function of our patient care teams. Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Walter H. Merrill, MD Senior Associate Chief of Staff, Vanderbilt University Hospital, Nashville, Tenn. Good surgical skills combined with a high level of team performance are key to achieving low mortality rates. In order to achieve that high performance, you need to take a systems approach—optimizing the working environment, paying attention to equipment design and function, understanding the subtleties of decision-making in a dynamic and often fluid situation, and enhancing team communication. WHY DO TEAMS MATTER? The typical approach to health care safety focuses almost exclusively on ensuring that individuals do not make mistakes. This places most, if not all, of the blame for a less-than-perfect result on an individual; however, the latent conditions for failure reside in the work environment. Thus, the burden of responsibility ultimately lies within the entire system—not on the individual practitioner. Our current system of fragmented care and gaps in continuity cannot be overcome simply by working harder. We must introduce systems of care that align and coordinate the efforts of everyone involved, doing so in such a manner that facilitates the personal aspects of patient care rather than separating us from them. HOW SURGEONS CAN ENACT CHANGE Most busy surgeons do not have sufficient discretionary time that can be devoted to major systems design in their hospitals. We can, however, “lead from behind” by setting an example in our own practices and sharing what we learn with others. The strategies that I have learned to incorporate include: Identifying and correcting all errors, even the near-misses. Using task reminders or checklists for routine, repetitive procedures. Team training and checklist usage decrease delayed starts, case length, and turnaround times. Insisting on formal sign-outs of patients at shift changes. Including and improving upon formal briefings and debriefings for every operation. Preoperative briefings have been shown to increase job satisfaction. Encouraging “stop the line” communication in which every member of the team is empowered to speak up if they see something that appears out of the ordinary. This is one of the most effective tools that I have learned to incorporate. These steps help to ensure that team members are confident about what is expected of them. In addition, surgeons who encourage communication in the operating room and elsewhere can gain knowledge and experience unique vantage points, which are critical for good decision-making. I encourage you to start implementing these systems-based strategies today for better results in the near future. To view previous practice management columns, visit sts.org/practicemanagement.

Robert S.D. Higgins, MD, MSHA STS News, Spring 2019 — "It was the best of times, it was the worst of times …” This is the opening line of Charles Dickens’s A Tale of Two Cities, a celebrated novel about the French Revolution that describes a tumultuous time of highs and lows—not unlike our current time in cardiothoracic medicine. Notwithstanding this tumult, I am honored to have been elected this year as the Society’s 55th President. Words are inadequate to express my appreciation for all of the support I have received from former partners and trainees, mentors, and colleagues. In my career, this certainly is a capstone accomplishment that warrants pride and appreciation for the opportunities to serve STS members. In my opinion, it is the best of times! The Society is an extraordinary organization that has impacted so many people in the cardiac, general thoracic, and congenital heart communities. Through the efforts of cardiothoracic surgeons as members and leaders of multidisciplinary teams across the world, we have been responsible for treating and often saving millions of lives. Atherosclerotic heart disease and lung cancer are among the most lethal conditions in the western world, and STS members have helped to significantly reduce morbidity and mortality related to these diseases, in part through quality assessment and process improvement from participation in the STS National Database. Since 1989, the Database—the Society’s crown jewel—has evolved into the premier clinical outcomes registry in cardiothoracic surgery and, arguably, in all of medicine. It recently was recognized by The Joint Commission and the National Quality Forum with the John M. Eisenberg Patient Safety and Quality Award for being a champion of quality improvement initiatives to provide safe, high-quality care. Despite these remarkable accomplishments and accolades, we recognize that there are opportunities to enhance and optimize the current Database experience for our participants. We recognize that there are opportunities to enhance and optimize the current Database experience for our members. Our goal is to continue assessing the foundations of appropriate risk-adjusted performance measurement while enhancing participant satisfaction, reducing data entry burden, and maximizing Database utilization and ease of use. We anticipate data element reduction (without eliminating important data components), engagement with EHR platforms to facilitate the automation of data extraction, and the creation of readily accessible dashboards for easy access and “real-time reporting.” We know that these efforts can happen only with concerted efforts using new “natural language processing” to facilitate extraction from state-of-the-art, cloud-based technologies. We are actively exploring an enhanced data warehousing relationship and recruitment of a staff informatics manager to guide these activities. “It was the age of wisdom, it was the age of foolishness …” In his 2002 STS Presidential Address, Dr. Mark Orringer described the contributions of the STS National Database to improving patient care. He also focused on the value that the Database provides when the Relative Value Unit Committee (RUC) evaluates fee structures and decides on reimbursement. He provided an example of how data helped positively influence financial decisions in a time of budget constraints: “Our STS representatives, armed with credible ‘compelling evidence’ … recommended increasing cardiac surgery fees … [and] substantial reimbursement for pulmonary and esophageal resections and other general thoracic operations. … These data ‘won the day’ for the entire specialty.” That was then and this is now, but—without fail—data derived from Database participation continue to save lives and help lawmakers make decisions that favor cardiothoracic surgeons. But we can’t do this without the undivided support of the membership and our national cardiothoracic surgical leadership. It would be “foolish” for another database initiative by any organization to compete with our current highly regarded efforts. We welcome and encourage those who are not satisfied with our current database to join our efforts in improving and optimizing it. We need every hand on deck – join the effort! “It was the epoch of belief …” I am optimistic as we move forward into this new year. There is much to appreciate and be thankful for. Since the decision to become a self-managed organization, STS has enjoyed unparalleled success in part because of the conviction and efforts of our volunteer leaders and staff. Our profession has been fortunate to have had outstanding administrative leadership for nearly 2 decades from Executive Director & General Counsel Rob Wynbrandt. We thank Rob for his leadership and commitment. And now we herald the start of a new era with the selection of Elaine Weiss as CEO/Executive Director. With her extremely impressive background and experience, she will make a real contribution to the Society, and we look forward to her arrival on April 15. We have many important mission critical issues on our plate—optimization of the Database, public reporting, onboarding a new executive director, and so many other important opportunities. Please join us in this renaissance journey as we honor our illustrious past and create a new and sustainable future! With our membership, volunteer leaders, and staff engaged to direct our future, I am optimistic that it will be the best of times!

STS News, Spring 2019 — New STS officers and directors were elected during the Annual Membership (Business) Meeting on Monday, January 28, at the 55th Annual Meeting in San Diego. The membership elected Robert S.D. Higgins, MD, MSHA as STS President for 2019-2020. Additionally, Joseph A. Dearani, MD was elected First Vice President, and Sean C. Grondin, MD, MPH, FRCSC was elected Second Vice President. The following also were elected or reelected by the STS voting membership at the Annual Meeting: SECRETARY Joseph F. Sabik III, MD TREASURER Thomas E. MacGillivray, MD DIRECTORS-AT-LARGE Leah M. Backhus, MD Ara A. Vaporciyan, MD INTERNATIONAL DIRECTOR Alan D. Sihoe, MD, MA, FRCSEd CANADIAN DIRECTOR Marc Ruel, MD, MPH RESIDENT DIRECTOR Andrew B. Goldstone, MD, PhD See more information on the full STS Board of Directors.

STS News, Spring 2019 — The Society is offering a new opportunity for self-assessment and quality improvement in cardiothoracic surgery—surgeon-specific outcomes reports from the Adult Cardiac Surgery Database (ACSD). For those who opt in, these reports will be available beginning in fall 2019 and will include data on coronary artery bypass grafting (CABG), aortic valve replacement (AVR), CABG+AVR, mitral valve repair and replacement (MVRR), and CABG+MVRR. “We spent several years developing the methodologies that will most accurately reflect surgeon performance,” explained David M. Shahian, MD, Chair of the STS Task Force on  Quality Measurement who has been involved with the STS National Database since its launch in 1989 and most recently chaired the STS Council on Quality, Research, and Patient Safety. “The composite measure is very complex and includes outcomes data from five surgical procedures over a 3-year period, both risk-adjusted mortality and risk-adjusted morbidity. Because of the multiple procedures, multiple endpoints, and multiple years of data, the reliability of this measure is actually the highest we’ve ever had. We feel very comfortable that it is a good reflection of surgeon performance.” To avoid confusion with the hospital or group-level reports, the surgeon-specific feedback reports will not use the term “star ratings”; instead, overall performance will be categorized descriptively—as expected for the participating surgeon’s case mix during the relevant time period, better than expected for the surgeon’s case mix during the relevant time period, or worse than expected for the surgeon’s case mix during the relevant time period. This voluntary surgeon-specific feedback represents a natural evolution of the Database as a tool to help surgeons assess and analyze how they work. “The roles of the intensivist, hospitalist, and other consultants have become more important within the care delivery module,” said Alan M. Speir, MD, Chair of the STS Council on Health Policy and Relationships. “But, at the end of the day, the surgeon is still primarily involved in the direction of patient care. This is reflected in the composite [score], and these reports will give us a better understanding of how we are performing at an individual level.” Those surgeons participating in the ACSD who want their feedback will need to affirmatively opt in by submitting an election form, which is available at  sts.org/surgeonspecific. The first report will reflect outcomes data from January 2016 through December 2018. "The reliability of this measure is actually the highest we’ve ever had. We feel very comfortable that it is a good reflection of surgeon performance." David M. Shahian, MD Many surgeons are expected to take advantage of this new service. A recent survey found that a clear majority of surgeons participating in the ACSD (88%) thought it would be valuable for them to have an accurate measure of their own personal performance on a core set of procedures. “The results were striking,” said Dr. Shahian. “I thought most surgeons would want to see these data, but often it takes a while for a new program to gain acceptance. To their credit, the members of our community want to have credible, reliable estimates of their performance, especially since there are so many inaccurate measures of physician performance on the web and elsewhere.” STS Past President Richard L. Prager, MD, who participates in a statewide quality collaborative, said that he also was pleasantly surprised by the survey results. "Socialization of data is the norm in states like Michigan and Virginia. Within our quality collaborative in Michigan, surgeons are accustomed to seeing data and all wished for their individual composite feedback reports; while I was hopeful, I was not certain that would be the case elsewhere and I am very pleased.” Before members of the STS Board of Directors decided to make surgeon-specific feedback reports available on an opt-in basis, they discussed this topic at length during two successive meetings. It was extremely important to surgeon leaders that the initiative be used to further the interests of surgeon self-assessment and quality improvement—not for marketing or other publication. Consequently, and as a matter of STS policy enforceable under the Society’s existing disciplinary procedures, the surgeon-specific feedback is not for public or other external release. It is important to note, however, that because many surgeons participate in the ACSD jointly with their hospitals and are both signatories to the contract, some hospitals may seek the reports. As a result, STS cannot guarantee that surgeon-level reports will not be accessed by hospital administrators. “At the end of the day, this initiative is about finding ways to deliver better care for our patients. Surgeons should be empowered to not only isolate areas that need improvement, but also—and more importantly—identify best practices to drive greater improvement,” added STS International Director Domenico Pagano, MD. “We can only do that through objective feedback.” Although these new surgeon-specific feedback reports will be available on a periodic basis, both Drs. Shahian and Prager said that it is their hope the reports would one day be available on a continuous basis in real time with much more granular feedback. Drs. Shahian, Speir, Prager, and Pagano participated in a recent roundtable discussion about surgeon-specific feedback. The video of this discussion is available on the Society’s YouTube Channel at sts.org/surgeonspecificvideo; the audio is available as an STS Surgical Hot Topics podcast at sts.org/surgeonspecificpodcast. If you have questions or comments about the surgeon-specific feedback initiative, please email surgeonspecific@sts.org.