News & Media

STS News, Winter 2020 — The third annual STS/EACTS Latin America Cardiovascular Surgery Conference attracted its largest audience yet—more than 300 cardiac surgeons, scholarship recipients, and industry representatives from 33 countries—to Cancun, Mexico, in late November. The international faculty explored new developments and best practices in treating cardiac and congenital heart diseases and encouraged audience members to challenge the science and use the best treatment options possible for their patients. A session featuring rapid-fire presentation of recent trial data proved very popular. One of the most engaging sessions of the 2.5-day conference was a rapid-fire presentation of recent trial data that had the potential to change clinical practice. Program Director Joseph E. Bavaria, MD, moderated the session that explored more than a half-dozen studies, including the Tendyne Early Feasibility trial. When Dr. Bavaria asked if Tendyne would change the gold standard from mitral valve repair to mitral valve replacement, panelist Steven Bolling, MD, replied: “Our fear was that as soon as we get a transcatheter mitral valve replacement that works well, we’ll get rid of the concept of mitral repair. If you remember 5 years ago, some believed that these transcatheter mitral replacement devices were going to suddenly take off. But they didn’t. However, I do believe that there will be innovation in transcatheter mitral valve repair. There will be a transcatheter recreation of the surgical tools we have for mitral repair, and mitral repair will remain the gold standard.” "I do believe that there will be innovation in transcatheter mitral valve repair. There will be a transcatheter recreation of the surgical tools we have for mitral repair, and mitral repair will remain the gold standard." Steven Bolling, MD Joseph F. Sabik III, MD, provided context for the ISCHEMIA trial, which concluded that watchful waiting combined with medical management was better than percutaneous coronary intervention or coronary artery bypass grafting for patients with stable angina. “Despite the hundreds of millions of dollars that were spent on this study, it means very little for cardiac surgeons. The devil is in the details, and this trial included very few patients who were even eligible for surgery,” Dr. Sabik explained. Panelists and audience members also discussed the MOMENTUM 3, PARTNER 3, RECOVERY, EVEREST II, and Evolut Low-Risk TAVR trials. (From left) Panelists Steven Bolling, MD, and Vinod H. Thourani, MD, shared their perspectives on how clinical practice may change going forward. The final day of the conference featured hands-on activities, where the experts worked very closely with the attendees. Many of the participants were scholarship recipients. The Society’s charitable arm, The Thoracic Surgery Foundation, provided travel scholarships to 65 individuals who wouldn’t otherwise have been able to attend. Dr. Bavaria, who was the impetus behind the Latin America conference along with Juan P. Umana, MD, said he was thrilled that the meeting continues to grow and provide knowledge to surgeons throughout Latin America. The first two conferences were held in Cartagena, Colombia. The fourth annual conference will be held in November 2020 in Santiago, Chile. Photos from the conference are available in the Society’s flickr album at sts.org/LatAmPhotos. Videos of two keynote addresses are available on the STS Facebook page @societyofthoracicsurgeons.

Frank L. Fazzalari, MD, MBA Chair, STS Workforce on Practice Management STS News, Winter 2020 — Practicing cardiothoracic surgeons have multiple pathways for entering into formal financial arrangements with hospitals or health systems. The most common include physician employment agreements, medical directorships/co-management agreements, and professional service agreements. Understanding the intricacies of each pathway can help surgeons choose what will be most beneficial for their careers. Physician Employment The most common situation in current cardiothoracic surgery practice in the United States is a physician employment agreement, or PEA. A majority of cardiothoracic surgeons today are hospital employed, whether it be in an academic setting, a community hospital, or a large, multihospital health system. In this scenario, individual surgeons enter into a contract with the hospital or, more specifically, a multispecialty group that is part of the hospital system. The major components of a PEA include the length of term, compensation methodology, provision of support personnel, responsibilities (clinical, administrative, teaching, research), restrictive covenants, and coverage of malpractice and practice expenses. Contracts typically last from 1 to 5 years, and there often are provisions for automatic renewal based on satisfactory performance. It should be noted, however, that most contracts also have the ability for either party to withdraw with 90-day notice, generally without cause. Compensation can be complicated, and there is no perfect method. Most contracts have a base salary, plus a bonus component related to productivity (such as Relative Value Units) and/or other benchmarks such as quality outcomes and administrative or academic performance. Restrictive covenants (also known as noncompete clauses) are almost always present and enforceable, so care must be taken to understand these upfront. A majority of cardiothoracic surgeons today are hospital employed. Although it can be expensive, surgeons may want to consult an experienced health care attorney when negotiating a PEA. Good attorneys are skilled at understanding and negotiating the various subtleties of these contracts. Also, it may be useful to have someone on board early if issues should arise years later. Co-Management Arrangement In a co-management arrangement, one physician out of a practice is hired and paid by the hospital to serve as a medical director of a particular service line. For example, a senior cardiologist from a private practice would serve as the cath lab director at a hospital and receive a stipend for that service. Typically, the individual will maintain a private clinical practice as well. This is beneficial for the hospital because it automatically establishes a level of expertise in the management of the service line. Co-management arrangements are particularly useful for new service line development such as establishment of a transcatheter aortic valve replacement program or a minimally invasive surgery program. The medical director can assist in strategic planning and budgeting, value purchasing, and clinical protocol/pathway development. The stipend for this service (like all payments to physicians from hospitals) must be of fair market value, and work hours are usually formally documented. This is to ensure that neither party is violating federal regulations prohibiting the exchange of anything of value for referrals to a hospital that receives US taxpayer funding through the Centers for Medicare & Medicaid Services. Professional Service Arrangement In a professional service arrangement (PSA), a group of private practice cardiothoracic surgeons would provide the spectrum of hospital or health system. This would include 24/7 clinical coverage, medical directorship duties, and quality assurance. That group may or may not be the only group at that hospital, but it usually is exclusive. The group still remains an independent private practice and may have arrangements with other independent hospitals in the area, depending on geography and terms of the agreement. The main advantage for the hospital is that the facility has stable quality coverage for a service line that it can then use to attract other high-quality physicians such as interventional cardiologists or pulmonary oncologists. Usually in the PSA, the hospital will pay a management fee to the group, and then either the group will collect their own professional fees or the hospital bills for the professional services. Although the group still remains in private practice—with all the associated overhead costs—the PSA allows for a lot of freedom and flexibility without the restrictions of complete hospital employment. Since the group often represents the entire service line, it has significant bargaining power with the hospital. Terms of the arrangement typically are 1 year. Regardless of the specific type of agreement, all hospitals generally want the same things: to be profitable, be the local market share leader, and boast a high-quality program. Hospitals also want to encourage a positive culture that attracts and retains the most talented physicians, nurses, and technicians—and therefore also attract the most patients for care. Cardiothoracic surgeons who can help deliver these goals will be the most successful. View more practice management columns at sts.org/practicemanagement.

Robert S.D. Higgins, MD, MSHA STS News, Winter 2020 — On November 29, 1944, Dr. Alfred Blalock and his associates, guided by the watchful eye of his steadfast laboratory assistant Vivien Thomas, performed the first “blue baby operation” on a tiny child named Eileen Saxon. This frail 18-month-old with Tetralogy of Fallot benefited from an extraordinary team effort that included legends in surgery named William Longmire, Denton Cooley, and Helen Taussig, who collaborated and successfully created a shunt that increased blood flow to the lungs and initiated the dawn of a new era in cardiovascular care. A courageous partnership between Vivien Thomas, a black carpenter’s apprentice with a genius for surgery, and Alfred Blalock, a visionary white surgeon, made it possible to perform the first “blue baby operation” in 1944. I recently had the good fortune to meet Hugh M. Edenburn, a 74-year-old patient of Drs. Blalock and Taussig who underwent the lifesaving Blalock-Taussig shunt procedure in 1945. Edenburn continues to thrive and demonstrate the extraordinary benefits from the surgical care that was born out of a remarkable collaboration between professionals dedicated to saving lives of those with heart disease. Today, 75 years later, we have the opportunity to bask in the reflected glow of these extraordinary pioneers and watch millions of patients who have benefited from these groundbreaking efforts. But it might not have happened if it were not for the courageous partnership between Thomas, a black carpenter’s apprentice with a genius for surgery, and Dr. Blalock, a visionary white surgeon who chaired the Department of Surgery at Johns Hopkins. Blalock and Thomas played a key role in the innovation and pioneering efforts in these early years. Hugh M. Edenburn (left) underwent the lifesaving Blalock-Taussig shunt procedure in 1945 and continues to thrive. Thomas remained in the teaching laboratories to train residents, although he never attended medical school. After 30 years, he was honored with the title of Instructor Emeritus in Surgery at The Johns Hopkins Medical School. But it was Thomas’s collaborative efforts with Dr. Blalock that unlocked the future of cardiovascular surgery. We recognize these efforts with pride and respect for what can be accomplished in even the most challenging of times. “Rough seas make strong sailors...” It has been a privilege to serve STS members despite the many challenges we have faced—the transition to the IQVIA data warehouse, congenital heart surgery public reporting concerns, and 8% Medicare reimbursement cuts proposed for 2021. Yet, we are encouraged by the resolve of our surgeon leaders and senior staff and emboldened by the conviction to our mission and core values—Quality, Innovation, Professionalism, Inclusiveness, and Teamwork. Over the past few months, STS has sponsored and directed several critically successful programs, including the Multidisciplinary Cardiovascular and Thoracic Critical Care Conference (September), a state-of-the-art forum to advance knowledge and bring expertise in critical care to participants; Advances in Quality & Outcomes: A Data Managers Meeting (October), enhanced training for our data managers; and the STS/EACTS Latin America Cardiovascular Surgery Conference (November) in Cancun, Mexico. This extraordinary collaborative effort with our valued colleagues from Europe addressed the latest developments and best practices in adult and congenital heart diseases. More than 300 participants benefited from an exciting program featuring a world-class international faculty. These programs have been directed towards improving patient care and preparing our cardiothoracic surgical workforce for the future. STS President Robert S.D. Higgins, MD, MSHA (right), and EACTS Secretary General Domenico Pagano, MD, FRCS(C-Th), FESC, discussed future collaboration between the two associations at the STS/EACTS Latin America Cardiovascular Surgery Conference in Cancun. We have now entered into a 5-year strategic partnership with EACTS focused on expanding our collaborative educational offerings and leveraging the power of our respective clinical data registries for quality improvement and research (see page 9). The Future of STS Is Our Next Generation Critical to the success of our Society and our specialty will be a forward-looking approach to patient care and innovation as we work together to tackle the next big challenges. We must collaborate in the face of evolving patient care paradigms like transcatheter aortic and mitral valve procedures (TAVR and TMVR) and in fighting major reimbursement cuts proposed by CMS. We must continually modernize our STS National Database, embrace new educational and training approaches, and invest in the next generation of cardiothoracic surgery leaders. On January 24, we will sponsor a new leadership course designed to help develop the next generation of leaders. Leadership Beyond the Operating Room for Early Career Surgeons will focus on core skills—managing people, managing finances, and managing yourself—with a business school-like curriculum for cardiothoracic surgeons in their first 8 years of practice. We are hopeful that our collaborative investments in developing the next generation of surgeon leaders will pay extraordinary dividends, now and in the near future. It is clear that our horizons are brighter because collaborating on innovative and potentially lifesaving clinical interventions will amplify the impact of these efforts and create a lasting legacy. It is the dawn of a New Era in Cardiothoracic Surgery at STS. We welcome your support, as the Future Is Now!

STS News, Winter 2020 — The STS Annual Meeting begins on January 25 in New Orleans, and it will feature one of the largest gatherings of cardiothoracic surgery professionals, exciting research, thought-provoking lectures, and collegial networking in the world. “I enjoy going to the Annual Meeting every year for several reasons,” said STS Secretary Joseph F. Sabik III, MD. “It’s the best opportunity to hear about the latest science and innovative techniques that will help me take better care of my patients. It’s also a great way to see people I’ve come to know over the course of my career—learning not just what they’re doing professionally, but also personally.” If you haven’t registered yet, you still have time to save $100 off onsite pricing if you secure your spot by January 23. Onsite registration also is available. Plan Your Schedule Before you arrive in New Orleans, view the educational program at sts.org/annualmeeting so you can build your calendar around “must attend” sessions. Whether you want an update on the latest low-risk transcatheter aortic valve replacement trials and what they mean for your practice, actionable strategies for solving tough surgical situations, or guidance on how to build a thoracic robotic surgery program at your institution, the Annual Meeting offers sessions on each of these topics—plus so much more. The educational lineup also includes sessions developed in conjunction with surgical societies from Canada and Europe, helping to ensure that the content reflects the realities of surgeons practicing in many different countries. STS and the Canadian Association of Thoracic Surgeons have developed a session looking at how approaches to surgery for advanced stage cancer differ between Canada and the United States. In addition, an STS and Canadian Society of Cardiac Surgeons session will outline how coronary surgery can evolve to improve patient outcomes. Bicuspid aortic valve repair with aortic root aneurysm will be the focus of the STS/European Association for Cardio-Thoracic Surgery session, while “Getting Out of Trouble—Rescue Surgery after Common Nightmare Situations” will be offered in conjunction with the European Society of Thoracic Surgeons. Explore NOLA Although the main reason you’ll be in New Orleans is for the education, make sure you also take advantage of the history, food, music, and more that the Crescent City has to offer. The city’s multicultural heritage is reflected in its architecture—everything from Creole cottages and shotgun houses to Southern mansions and ornate cathedrals. Stroll through the lively French Quarter, stately Garden District, or bohemian Marigny on your own, or book a professional tour. If you’re hungry after all that touring, indulge in the area’s signature dishes, including jambalaya, crawfish etouffee, gumbo, red beans and rice, po’ boy sandwiches, muffulettas, and, of course, beignets. Favorites include Bourbon House, GW Fins, Red Fish Grill, Commander’s Palace, Mr. B’s Bistro, Central Grocery & Deli, and Café Du Monde. And while you often can come across outstanding musicians on street corners, check out the Spotted Cat Music Club or Preservation Hall for soulful jazz. Add Tech-Con to Your Meeting Itinerary Prepare yourself for game-changing cardiothoracic surgery technologies by attending Tech-Con on Saturday, January 25 in New Orleans. New for 2020: Tech-Con is a ticketed session and will offer the option to claim CME credit. Exciting additions to the program include two Lunch and Learn sessions, during which industry experts and surgeon moderators will discuss the latest products and technology. Tech-Con will conclude with a keynote lecture by innovation expert Mark S. Cohen, MD, the always popular Shark Tank presentations, and a cocktail and networking reception in the exhibit area. Attendees can practice specific surgical techniques in an intimate environment. Hone Your Skills at STS University If you want to learn a new surgical procedure or perfect your skills, add an STS University course to your Annual Meeting registration. These ticketed sessions provide hands-on experience that you can take back home and apply in your practice. “STS University offers an opportunity to interact with internationally known experts and gain confidence with the various techniques,” said STS University Task Force Co-Chair Ahmet Kilic, MD. Each of the courses below will be offered twice on Saturday morning, January 25. View descriptions of each course at sts.org/stsuniversity. Course 1: VATS Lobectomy Course 2: Complex Chest Wall Issues for the Thoracic Surgeon: Reconstruction after Tumor Resection, Pectus Deformities, and Rib Fractures Course 3: Robotic Lobectomy Course 4: Aortic Root Enlargement Procedures and Aortic Valve Leaflet Reconstruction Course 5: ECMO Cannulation NEW! Course 6: Essentials of TAVR Course 7: Mitral Valve Repair Course 8: Valve-Sparing Aortic Root Replacement—Reimplantation Course 9: Minimally Invasive Aortic and Mitral Surgery Course 10: Transseptal Puncture for Surgeons Don′t Miss These Inspiring Keynote Lectures New this year, the Annual Meeting will feature a third keynote lecture to complement the existing Ferguson and Lillehei Lectures. The Vivien T. Thomas Lecture will honor the surgical technician who worked with Alfred Blalock, MD, and pioneered the anastomosis of the subclavian artery to the pulmonary artery, among other accomplishments. Vivien T. Thomas Lecture Clyde W. Yancy, MD Sunday, Jan. 26, 3:30 p.m. Thomas B. Ferguson Lecture Domenico Pagano, MD, FRCS(C-Th), FETCS Monday, Jan. 27, 4:00 p.m. C. Walton Lillehei Lecture Bartley P. Griffith, MD Tuesday, Jan. 28, 9:45 a.m. Residents Battle for Jeopardy Championship Title Don’t miss the exciting Jeopardy Championship at the Annual Meeting, modeled after the popular television game show. The competition will feature cardiothoracic surgery residents from the University of Michigan and Deutsches Herzzentrum Berlin showing off their knowledge of the Thoracic Surgical Curriculum. The winners will receive a cash prize and international bragging rights. Stop by the Exhibit Hall at 4:45 p.m. on Sunday, January 26 to cheer on your favorite team.

STS News, Winter 2020 — Following months of extensive testing and feedback, the next generation STS National Database will launch in just a few weeks. Participants in the STS Adult Cardiac Surgery Database (ACSD), General Thoracic Surgery Database (GTSD), and Congenital Heart Surgery Database (CHSD) will soon have secure, cloud-based, interactive dashboards, with 24/7/365 access to their data. “This release is the culmination of a deliberate initiative that began in 2017 to transform the STS National Database and provide our participants with a state-of-the-art, cloud-based platform,” said Felix G. Fernandez, MD, MSc, chair of the STS Workforce on National Databases. “This has been a very thoughtful and thoroughly vetted process that was based on the needs of our participants; it will continue to evolve based on their feedback.” The platform is powered by the Society's new data warehouse, IQVIA, a leading global provider of advanced technology solutions. “The transition represents an evolution for all consumers of the STS National Database, especially users and participants,” said Vinay Badhwar, MD, chair of the STS Council on Quality, Research, and Patient Safety. “This is an exciting time for our specialty as we collectively strive to improve our experience, reduce data burden, and save time and resources, while maintaining a unified platform for surgical quality." One way the user experience will be improved is by immediate feedback about potential errors. For example, data that are out of range will be flagged so that data managers can quickly make corrections. Users also can rapidly view high-level case details such as total cases, readmissions, and unadjusted mortality. Instead of waiting for a static PDF that is hundreds of pages long, participants will be able to easily sort data, conduct targeted searches, and download specific graphs or datasets. “Sometimes technology is imposed externally and you have to change everything to work with it. That’s the opposite of our approach,” said Jonathan Morris, MD, vice president and chief medical informatics officer, GM Healthcare Solutions, at IQVIA. “We’ve designed these dashboards to work the way that data managers and surgeons do.” “This is an exciting time for our specialty as we collectively strive to improve our experience, reduce data burden, and save time and resources, while maintaining a unified platform for surgical quality.” Vinay Badhwar, MD The new Database launch and subsequent updates will be an iterative process, so participants are encouraged to provide feedback at STSDB@sts.org. “Through engagement with surgeons and data managers, STS will be responsive to the needs of dashboard users,” Dr. Fernandez said. “A major strength of the IQVIA platform is that it provides a robust substrate for easily implementing enhancements to the dashboard reporting and other Database functions as they become available.” What’s Next? The upcoming release of these dashboards is just the first milestone in the Database’s evolution. This spring, ACSD participants will be able to access risk-adjusted outcomes data in their dashboards, while GTSD and CHSD participants will be able to do so in July. Also in July, the new specification upgrade for the ACSD will go live, with approximately 30% fewer data entry variables. Work also is progressing on a project to dramatically expand the Database’s quality improvement and research capabilities. In November, the Society obtained socioeconomic data from the US Census and American Community Survey corresponding to records in the ACSD, GTSD, and CHSD. The data include information on income classification, education level, household crowding, deprivation score, and other details. In addition, reoperation follow-up data have been derived by internally linking procedure records corresponding to the same patient within the entire Database. The Society also has been working with the Centers for Disease Control and Prevention to obtain National Death Index data. These supplemental datasets should be available later in 2020 for research inquiries. Find more details on the next generation Database at sts.org/database. In addition to the new look, feel, and functionality that you will experience with the next generation STS National Database, the Database logo also has a new look and tagline to match the excitement and significance of these improvements. The tagline is a simple, powerful, and credible statement that quickly conveys the importance of the Database. Trusted, Transformed, Real-Time: trusted because it’s built on a 30-year legacy of credibility; transformed because the advanced IQVIA platform gives the Database never-before-seen features, including customizable dashboards; and real-time because you will have highly secure, interactive, web-based access to your outcomes data. To keep the excitement building and ensure that the message about the new Database breaks through the noise, updates about the phased-in launch and user stories will be shared in every way possible, including on our website (sts.org/database), in our newsletters, and on our social media platforms. We also are producing a video that will tell you more about the dramatic, practice-changing Database improvements coming throughout 2020. The full video will premiere at the STS Annual Meeting in New Orleans, but you can see a preview at sts.org/database.