News & Media

STS News, Winter 2018 -- The STS National Database now has a fourth component. The Interagency Registry for Mechanically Assisted Circulatory Support, or Intermacs, became part of the STS National Database on January 1, 2018, joining the Adult Cardiac Surgery Database, the Congenital Heart Surgery Database, and the General Thoracic Surgery Database. Established at the University of Alabama at Birmingham (UAB) in 2005 as a joint effort of the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and others, Intermacs is a North American registry for patients who receive an FDA-approved mechanical circulatory support (MCS) device to treat advanced heart failure. Participation in Intermacs is required by the Joint Commission for all US centers implanting MCS devices for destination therapy. “We are very excited about this new chapter for Intermacs and STS. We believe Intermacs will continue to advance through the recognition of the STS National Database in the arenas of quality and improvement methodologies and National Quality Forum metrics, as well as our understanding of treatments,” said STS President Richard L. Prager, MD. “By including Intermacs as a component of the STS National Database, the Society will expand the scope of its registry activity, while providing Intermacs with a foundation for its future.” Smooth Transition for Participants The Society is taking a number of steps to help ensure that current Intermacs participants experience a smooth transition. Participants will submit data in the same manner as they have in the past, and UAB will continue serving as the registry’s data warehouse and analytics center. Although current Intermacs participants are now entering into new participation agreements with STS, the documents are familiar to them; they are modeled after those currently provided for STS National Database participants. Another way the Society is helping to provide a seamless transition is through a new STS Intermacs Database Task Force, chaired by Robert L. Kormos, MD. He has been an Intermacs co-investigator since 2005 and is very familiar with the registry.  With nearly 30 years of experience and a designation as a Qualified Clinical Data Registry, the STS National Database offers Intermacs an opportunity to become an even more valuable resource for participants, their institutions, and ultimately, their patients. “We will use the STS experience to help grow Intermacs into a resource for quality measurement and patient safety,” said Dr. Kormos. “By including Intermacs as a component of the STS National Database, the Society will expand the scope of its registry activity, while providing Intermacs with a foundation for its future.” Richard L. Prager, MD STS Intermacs Database Task Force members were chosen to represent the multidisciplinary nature of MCS teams. “This Task Force is uniquely designed—some of its members are cardiologists,” Dr. Kormos said. “A lot of the data that are collected within Intermacs come from work performed by cardiologists. So we’ve made sure to incorporate leadership from all areas.” Among other responsibilities, the Task Force will help define how Intermacs stakeholders can best benefit from the available data. The process for reviewing and approving data licensing requests is under development; details will be communicated to participating institutions and industry when available. The addition of the Intermacs registry represents a new chapter in the history of the STS National Database in light of the registry’s collection of longitudinal data. Intermacs collects longitudinal data throughout the life of a patient with an MCS device; the other components of the STS National Database track patients only for 30 days postoperatively. “The Intermacs metrics for long-term follow-up are very good. Adverse events, quality of life variables, device malfunctions, and several other data points are tracked, along with risk modeling for survival,” Dr. Kormos said. The Society will be communicating with participants, researchers, government, industry, and other stakeholders in the weeks and months ahead about this new chapter for Intermacs. Additional information can be found at sts.org/intermacs. “Everyone is very excited, and we look forward to being able to take Intermacs to the next level,” Dr. Kormos said.

Rob Headrick, MD, MBA Health Policy Scholarship Encourages Physician Leadership Rob Headrick, MD, MBA saw the ongoing health care crisis in the United States and realized he needed a deeper education.  “My health policy experience had been limited to meeting with state legislators regarding local issues and superficial conversations with my US senator and congressman,” he said. “I lacked the knowledge of how health policy and legislation is made, along with a true understanding of how complicated health care reform can be.” To expand his understanding, Dr. Headrick attended the intensive Executive Leadership Program in Health Policy and Management at Brandeis University as the 2017 recipient of the STS/ACS Health Policy Scholarship, a joint offering from STS and the American College of Surgeons. During the weeklong course this past June, Dr. Headrick joined surgeons from a variety of specialties for a week of lectures and small group discussions on health care policy, health care finance, leadership, operations management, and conflict negotiation.  “Two of the most valuable topics covered in this course were leadership development and operating room efficiency,” said Dr. Headrick, who is Chief of Thoracic Surgery and Co-Director of the Rees Skillern Cancer Institute at CHI Memorial Hospital in Chattanooga, Tenn. “We learned how standardization, reducing surgical variability, and synchronizing our teams can help improve efficiency.” Dr. Headrick said that his attendance at the course had an immediate impact on his career. “This leadership course has already improved my confidence in being a leader within my institution,” he said. “It also has made me an expert in health care policy within my community. I’ve been asked to give lectures at the Civitan Club and Rotary Club, as well as be an expert commentator on our local news during the national health care policy debate. And I’ve been able to interact with my elected officials in a more meaningful way.” As a scholarship recipient, Dr. Headrick will be appointed to serve a 3-year term on the STS/AATS Workforce on Health Policy, Reform, and Advocacy, starting in January 2018. Applications for the 2018 scholarship will be accepted later this year. Applicants must be members of both STS and ACS and between the ages of 30 and 55. Application materials, which include a curriculum vitae and a one-page essay discussing why a candidate wishes to receive the scholarship, are due by February 1, 2018. The scholarship will help cover the costs of tuition, travel, and accommodations during the course. For more information, visit www.sts.org/healthpolicyscholarship or contact Grahame Rush, Director of Information Services, at Grahame Rush or (312) 202-5848. Communicate with STS Members and Meeting Registrants by Blast E-mail The Society is now offering you, your colleagues, and your institution the ability to share news about your events, clinical trials, or other information directly with STS members and/or Annual Meeting registrants by e-mail. For a royalty, STS will distribute the pre-approved message on behalf of the sender. Learn more about the new STS eBlast Communication program, which complements the existing mailing list license program, at www.sts.org/mailinglists. If you have any questions about these programs, contact Samantha McCarthy, Industry Relations Manager, at Samantha McCarthy. Domenico Pagano, MD, FRCS(C-Th), FETCS New International Director Selected Domenico Pagano, MD, FRCS(C-Th), FETCS has been appointed by the STS Board of Directors as an International Director to fulfill the remainder of the 3-year term vacated on August 1 by A. Pieter Kappetein, MD, PhD (see page 5). Dr. Pagano is a Consultant Cardiothoracic Surgeon and Clinical Director of the Quality and Outcomes Research Unit at the University Hospital Birmingham in England. He previously served on the STS Workforce on National Databases and the STS Quality, Research, and Patient Safety Council Operating Board. As International Director, Dr. Pagano will work with fellow International Director Haiquan Chen, MD, PhD and other members of the STS Board of Directors to advance the Society’s role and relationships within the international cardiothoracic surgery community. Learn How to Maximize Your Reimbursement Keep yourself and your office at the forefront of coming changes to physician coding and reimbursement. Register yourself and/or your billing manager for the STS Coding Workshop, November 16-18 in Hollywood, Calif. Attendees will learn about new and revised codes for 2018, as well as other important reimbursement changes, through scenario-based questions, problematic coding examples, extensive Q&A, and attendee interaction. New for 2017: Video Challenge: Watch narrated videos of various procedures to identify the codes for the services. Faculty will then provide the recommended codes and associated documentation supporting the service. Stump the Experts: Ask questions or present complex coding questions to faculty for open discussion. See the full agenda and register at www.sts.org/codingworkshop. Dedicated CT Surgeons and Their Teams Hurricanes Harvey and Irma couldn’t stop cardiothoracic surgeons and their team members from providing care to their patients and sharing information on current trends in the specialty. Jeffrey P. Jacobs, MD (in white coat on right), Chair of the STS Workforce on National Databases, and his colleagues at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, camped out in the Cardiovascular ICU to make sure patients and their families received the care they needed. Despite travel problems because of Hurricane Irma and lingering cleanup from Hurricane Harvey, cardiothoracic surgeons gathered in Houston September 8-9 for the 11th Current Trends in Aortic, Cardiac, and General Thoracic Surgery conference. Speakers included (from left) Drs. Shanda H. Blackmon and Joseph E. Bavaria, both members of the STS Board of Directors, as well as Drs. Ourania Preventza and Steven Lansman.

STS News, Fall 2017 -- A major program that will increase access to lung cancer screening for veterans is moving forward, thanks in part to advocacy efforts by STS surgeon leaders, staff, and Public Director Chris Draft. The new VA-PALS Implementation Network (Veterans Administration-Partnership to increase Access to Lung Screening) will be funded through a grant from the Bristol Myers Squibb Foundation and will dedicate $5.8 million over 3 years to implement evidence-based lung cancer screening programs at 10 VA medical facilities. Lung screening services will begin at the Phoenix VA Health Care System by December 2017 and expand to nine additional VA medical facilities starting in 2018. “STS has had a critical role in helping to establish lung cancer screening as a new covered health benefit for both private and publicly insured patients,” said STS Past President Douglas E. Wood, MD, who has been a tireless advocate for access to lung cancer screening. Dr. Wood is Vice-Chair of the National Lung Cancer Roundtable and Chair of the Lung Cancer Screening Panel for the National Comprehensive Cancer Network. “The VA-PALS project is an incredibly important program to improve access to lung cancer screening for one of our most vulnerable populations—our nation’s veterans, who have put their lives on the line to protect all of us.” "The VA-PALS project is an incredibly important program to improve access to lung cancer screening for one of our most vulnerable populations." Douglas E. Wood, MD At an STS Legislative Fly-In this past June, Draft, who lost both his wife and an uncle—an Army veteran—to lung cancer, described the importance of low-dose computed tomography screening for veterans and urged members of Congress to support the VA-PALS project. “This program will dramatically increase the number of people screened,” Draft said. “We know that veterans have a higher smoking rate than other Americans. Prioritizing lung cancer screening is the right thing to do because we’re serving the people who have served us. Catching lung cancer early can make a drastic difference in outcomes.” Draft emphasized the efforts of many people in making the screening program a reality, including the VA leadership team, Drew Moghanaki, MD, MPH, who leads the Clinical Radiation Oncology Research program at Hunter Holmes McGuire Veterans Affairs Medical Center, and members of the International Early Lung Cancer Action Program, who are advising the VA on the program’s implementation. The 10 sites chosen for the program account for nearly 1,200 of the 8,000 veterans nationally who are diagnosed with lung cancer each year. The program will focus on finding high-risk smokers and reaching out to them, as opposed to passively waiting for primary care providers to refer them. An emphasis also will be placed on reaching rural veterans. At the conclusion of the project, a formal evaluation will measure the impact rates of earlier detection, as well as quantify the opportunity for a reduction in mortality. STS-PAC Celebrates 20 Years STS-PAC—the only political action committee that exclusively represents cardiothoracic surgery—is celebrating a milestone. Over the past 20 years, STS-PAC has helped the specialty achieve significant victories, including repeal of the Sustainable Growth Rate, approval and coverage of transcatheter aortic valve replacement therapy, and preservation of 90-day surgical global payments. Many STS members have consistently supported STS-PAC over the past two decades. However, support from every STS member who is a US citizen is needed to help mitigate the current challenges facing the cardiothoracic surgery workforce. So far this year, the PAC has raised $95,930 from 249 STS members, with an average contribution of $383. The STS-PAC Board of Advisors has set a goal of raising $200,000 in 2017. If you would like more information about STS-PAC, contact the STS Government Relations office at Advocacy or (202) 787-1230. Contributions to STS-PAC have fluctuated over the years. An election cycle is the 2-year period leading up to a midterm or presidential election.

Robert A. Wynbrandt, Executive Director & General Counsel Priscilla S. Kennedy, TSF Executive Director STS News, Fall 2017 -- On a late December day in 1988, I received a call from my client, The Society of Thoracic Surgeons. A prospective benefactor wished to make a charitable donation of stock to the Society, but the Society’s federal tax exemption was such that its donors were not legally entitled to treat donations made to STS as charitable contributions. My challenge was to set up a corporation by year-end that would be affiliated with the Society and could receive such charitable donations—and so the STS Education and Research Foundation, now known as The Thoracic Surgery Foundation, was born. In this guest column, TSF Executive Director Priscilla Kennedy describes some of the terrific work of the Foundation, with special emphasis on some of the charitable missions that it supports. Priscilla joined the STS staff as the Foundation’s Executive Director in 2012 and has played a starring role in its subsequent successes. Prior to her recruitment into the wonderful world of thoracic surgery, Priscilla served in various capacities at the Northwestern Memorial Foundation across the street, eventually as Administrator of the Lynn Sage Cancer Research Foundation. Over the past 29 years, the TSF mission has remained the same: fostering the development of surgeon-scientists in cardiothoracic surgery and increasing knowledge and innovation for the benefit of patients; however, the scope of the Foundation’s work has expanded tremendously. Awards programs that originally focused on cardiothoracic surgeons in North America now touch cardiothoracic surgeons and their patients around the world. To date, TSF has funded more than 180 research and education grants, 283 Alley-Sheridan Scholarships, and 25 travel awards. This year alone, the Foundation has provided $700,000 in awards, including six TSF/Edwards Lifesciences Foundation Every Heartbeat Matters Awards for surgical outreach missions to underserved areas. These missions, to countries including Peru, Rwanda, Nepal, Nigeria, Uganda, and Cambodia, require meticulous organization and close collaboration with local governments and not-for-profit entities. In addition to helping patients in need of health care, an important component of each mission is to utilize a “See One, Do One, Teach One” approach. This helps educate local health care providers on techniques and treatments, as well as teach them how to share that knowledge with their colleagues. In most cases, both the “teachers” and the “students” say that their experiences were life-altering and set the stage for sustainable cardiothoracic surgery programs in areas where patients often die from treatable conditions. Two examples are outlined below. Dr. Reza Khodaverdian, from Stanford University in California, leads efforts with the VOOM Foundation to care for adult and pediatric patients in Nigeria. Patients suffering from heart ailments in that West African nation historically have either traveled out of the country for surgery or suffered grave outcomes. In April, Dr. Khodaverdian’s team treated its 156th patient and noted progress in building a sustainable cardiothoracic surgery program. “The support we have received through TSF will truly impact the cardiac education program at the University of Nigeria Teaching Hospital. We have seen huge improvements in the Nigerian medical staff’s ability to understand, perform cardiac surgery, and provide standardized perioperative care,” Dr. Khodaverdian wrote in his post-mission summary. Dr. Morton Bolman, from the University of Vermont Medical Center in Burlington, leads efforts with the Team Heart organization to provide cardiac surgery services in Rwanda, where fewer than 750 physicians and 6,000 nurses provide care to more than 12 million people. In addition to developing a program that involves identifying and triaging patients with heart disease (primarily rheumatic heart disease), Dr. Bolman and his team plan to build a much-needed treatment facility and expand the number of available health care providers. “This will require the education of the next generation of nurses and physicians, as well as working with the medical school at the University of Rwanda to increase the human resources for health care delivery. It will also involve improving the available facilities for the delivery of cardiac care throughout the country in order to improve access to care,” he said. Their experiences were life-altering and will set the stage for sustainable cardiothoracic surgery programs in areas where patients often die from treatable conditions. New Awards, 2018 Portfolio New this year, TSF offered 25 travel scholarships for surgeons who care for underserved patients and wanted to attend the STS/EACTS Latin America Cardiovascular Surgery Conference in Cartagena, Colombia (see page 10). The scholarship recipients practice at hospitals and clinics in Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Paraguay, Peru, the United States, and Venezuela. They had an opportunity to learn from global experts and ask questions in a forum that is not usually available to them. The 2018 TSF Awards portfolio includes 16 grant offerings for cardiothoracic surgeons specializing in every discipline and at every career level. Applications and deadline dates can be found at thoracicsurgeryfoundation.org/awards. Surgeon Match Challenge In May, the STS Board of Directors approved the launch of a Surgeon Match Challenge campaign, whereby the Society agreed to match all subsequent surgeon donations made to the Foundation in 2017, up to $200,000. As of this writing, matching funds were still available; consequently, readers of STS News are urged to make their contributions today at thoracicsurgeryfoundation.org/donate. The Surgeon Match Challenge ends on December 31, 2017. Since the Society covers all of the Foundation’s administrative expenses, 100% of those contributions will be devoted solely to TSF awards. You also can give to the specialty by providing your time and expertise to the Foundation. Please feel free to contact Priscilla Kennedy for more information. Next year marks the 30th Anniversary of TSF. Remarkable progress has been made in the specialty over the last three decades. Through continued support from STS and its members, the Foundation’s work will have a lasting impact on cardiothoracic surgeons and their patients.

Richard L. Prager, MD, President STS News, Fall 2017 --  Recognizing the growing diversity of the population and the patients that we serve, STS recently created a Special Ad Hoc Task Force on Diversity and Inclusion. Inclusion was one of the founding principles when our Society was formed in 1964 for all cardiothoracic surgeons; creating this Task Force was a natural and comfortable move to maintain that tradition. The mission of the Task Force is to cultivate an environment of inclusion and diversity within the Society, as well as the cardiothoracic surgery specialty. David T. Cooke is the Task Force Chair. Task Force members are of diverse ethnicity, practice geography within the US, and career stage. They include Leah M. Backhus, Melanie A. Edwards, Anthony L. Estrera, Luis A. Godoy, Douglas J. Mathisen, Jacqueline Olive, Ourania A. Preventza, Jennifer C. Romano, Vinod H. Thourani, and myself. Survey on Diversity and Inclusion To benchmark perceptions about diversity and inclusion in cardiothoracic surgery and within The Society of Thoracic Surgeons, the Task Force has developed a survey for US-based members. A link to that survey will be available in a few weeks, and it is critically important to the specialty that we get a good response rate. The data and preliminary conclusions from this survey will be presented at a special session during the STS Annual Meeting in Fort Lauderdale, Florida. The session, “Diversity and Inclusion in Cardiothoracic Surgery: What’s In It for Me?,” will be held on Monday, January 29, following my Presidential Address. To benchmark perceptions about diversity and inclusion in cardiothoracic surgery and within The Society of Thoracic Surgeons, the Task Force has developed a survey for US-based members. Once we have analyzed the survey data and identified ways in which we can make positive changes, the Society will begin developing programs and resources that we hope will not only further diversify the cardiothoracic surgery workforce, but also lead to a better understanding of health care disparities among cardiothoracic surgery patients and, ultimately, better patient outcomes. We know that we have some huge hurdles ahead of us; some of the disparities that are evident in our specialty begin well before residency. They are symptoms of disparities in our early education system. A lack of diversity starts before college, continues into college and medical school, and appears evident in the mid-to-senior cardiothoracic surgeons in the United States. If we can participate in ways to affect the demographic makeup in the earlier educational years, it will only be a matter of time before our cardiothoracic surgery workforce diversifies. The Bonuses of Diversity In the business world, diversity has been shown to increase innovation and group performance, improve financial performance, and enhance marketplace reputation. Other “bonuses of diversity” include better decision making by leaders, a more robust talent pool, and deeper engagement and loyalty from consumers, members, and other constituencies. My colleague, Scott E. Page, the Leonid Hurwicz Collegiate Professor of Complex Systems, Political Science, and Economics at the University of Michigan’s College of Literature, Science, and the Arts, has been promoting diversity for many years. His landmark book, The Difference: How the Power of Diversity Creates Better Groups, Films, Schools, and Societies, describes how teams of diverse people can find better solutions than teams of like individuals. The best group decisions are those that draw upon “cognitive diversity”; they rely upon the qualities and perspectives that make each of us unique. Next Steps For STS, the initial step is recognizing where we are today. Data from the survey on diversity and inclusion will help in that regard. The next steps will be to expand the pathways into our specialty workforce and to create resources that will help us provide better quality care for patients who are culturally or linguistically different than we are. Many other societies and medical organizations are embarking on similar courses of demographic reviews, including the American College of Cardiology, the American Surgical Association, and the American Society of Clinical Oncology. The Association of American Medical Colleges also is taking a look at foundational demographic data for medical schools across the United States and Canada. By helping ourselves, we will be helping our patients. I sincerely believe that by creating a more diverse cardiothoracic surgery workforce, we will be able to better address the health care needs of our diverse population and improve the quality of care for our patients.

In this edition of STS News, Dr. Raymond Singer describes his personal journey through changes that have affected our entire profession. Many of us may find similarities with our own career experiences. --Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Raymond L. Singer, MD, MMM, CPE, Physician in Chief, Institute for Special Surgery Lehigh Valley Health Network, Allentown, Penn. STS News, Fall 2017 -- After completing my cardiothoracic surgery training in 1992, I joined a private practice cardiac surgery group in Pennsylvania. As the 90s progressed, the challenges to private practice began to mount. In November 1992, the Pennsylvania Health Care Cost Containment Council published its first cardiac surgery report card. Although public reporting is now commonplace, it was a shock to surgeons at the time. Collegiality became strained as surgeons recognized the potential benefits and risks of receiving a report card, often published on the front page of the local newspaper. Another challenge was steep Medicare cuts circa 1996. Young surgeons faced the risk of not becoming a partner in the practice. New grads were often dismissed after 2 years of service or kept on as perennial employees so that senior partners’ compensation would not diminish. In addition, the elimination of the Certificate of Need in Pennsylvania led to the opening of multiple small heart surgery programs, which typically recruited senior partners to lead these startups. Small hospitals had visions of renewed financial stability and competed to recruit experienced heart surgeons to get their programs off the ground. In the face of the chaos created by splintering private practice surgical groups, many heart surgeons, including myself, sought job security and referrals by joining private cardiology practices—a move that was considered heresy at the time. As this played out across the country, tensions rose. Surgeons who did not join such arrangements found their referrals dropping off. This resulted in many complaints at meetings and even lawsuits. I recall being at the 2003 STS Annual Meeting in San Diego where a surgeon stepped to the microphone and suggested that “any cardiac surgeon who joined a cardiology group should not be in The Society of Thoracic Surgeons.” I remained in the cardiology group for 5 years, leaving in 2004 to become part of the multispecialty hospital-employed practice where I work today. Looking back, my experience in a cardiology group, ironically, would be a preview of what is now considered clinical dogma—that is, the importance of collaboration, forming multispecialty teams, service lines, and sharing hybrid technologies. To adopt hybrid procedures, such as TAVR, cardiologists and cardiac surgeons literally need to stand side-by-side. With cardiologists as my partners in the 90s, I had direct access to educate them about the importance of early referral for patients needing mitral repair. We developed team-based clinics that might have taken longer to adopt had we been on competing teams. Fast forward to 2017. The key buzzword is “collaboration.” As technologies continue to advance, it has become clear that to adopt hybrid procedures, such as TAVR, cardiologists and cardiac surgeons literally need to stand side-by-side. Today, traditional academic departments are being remodeled into service lines and multidisciplinary clinics. The truth is, cardiac surgeons have more in common with cardiologists than they do with other surgical specialties; however, in the traditional academic model, cardiac surgeons are in the department of surgery, while cardiologists are in the department of medicine. New silos attempt to better align physicians along service lines, often within the same practice or institute. Some may say that the modern alliance is a shift from financial motivation to improving quality and value for patients. I would suggest that financial stability and growth need to remain a necessary part of any hospital’s value equation. Whether it’s hybrid procedures or clinical pathways, we strive to provide the best value to our patients; in turn, our hospitals are financially rewarded, allowing for further capital investments to improve patient care. While teaming up with cardiologists was criticized in the past, it is seen as the critical foundation for success today. Perhaps at our next Annual Meeting, a surgeon will rise to the microphone and suggest that “any cardiac surgeon not working with a cardiologist should not be in The Society of Thoracic Surgeons!”

STS News, Fall 2017 -- STS members now have a more intuitive, modern website for accessing Society resources and maximizing their membership benefits. A redesigned website debuted in September. The new www.sts.org was a collaborative effort that included input from all STS departments and focused on one main goal: Keeping the end user in mind. Along with improved navigation, an updated color palette, and more prominent photos, the site is now mobile responsive, so that no matter what device is being used, the experience will be seamless. On the homepage, users will find quick access to the latest educational offerings, videos, news releases, and Society tweets. A prominent navigation bar directly below the redesigned STS logo groups related information in tabs by category: Learning Center offers STS Annual Meeting Online, webinars, and information on claiming CME credit. Meetings groups registration and program information for the STS Annual Meeting, standalone educational courses, and educational collaborations. Quality & Safety provides access to the Society’s performance measures (including National Quality Forum-endorsed measures), patient safety materials, and surgical checklists. Registries & Research Center includes information and resources related to the STS National Database, STS Research Center programs, and the STS/ACC TVT Registry. Advocacy facilitates direct contact with legislators through the Legislative Action Center and contributions to STS-PAC; it also has a sign-up form that will enable you to become an STS Key Contact. Publications offers access to STS News, STS National Database News, and other Society newsletters. Resources provides a wealth of tools for managing a cardiothoracic surgical practice, including quick access to coding and reimbursement tips, STS risk calculators, clinical practice guidelines, and an archive of practice management columns. Foundation links to the Society’s charitable arm, The Thoracic Surgery Foundation, where the user can make an online donation or apply for one of the many scholarships and fellowships available. No matter what device is being used, the experience will be seamless. Above the main navigation bar, a Membership link at the top of the homepage allows STS members to easily renew their membership, update their contact information, or search for colleagues in the membership directory. Potential members can learn about the different membership types and fill out an online application. Media houses the latest news releases related to the Society, The Annals of Thoracic Surgery, and STS meeting abstracts, as well as a toolkit to help National Database participants publicize their STS Public Reporting star ratings and composite results. The Patients link offers resources for cardiothoracic surgery patients, including access to the Society’s patient information website, ctsurgerypatients.org. In August, the Society unveiled a special microsite, publicreporting.sts.org, that houses STS Public Reporting Online results for all three STS National Database components. On this microsite, users have a number of search and filter options, including hospital/participant name, year, state, and star ratings. Clicking on a particular institution’s name provides an in-depth look at the statistics. The microsite also includes explanations of star ratings and public reporting consent forms.  Give Us Your Feedback To help ensure that the new website fulfills your needs, please provide your feedback at Marketing. New Blog Posts on STS Patient Website The Society’s patient website, ctsurgerypatients.org, features several blog posts written by cardiothoracic surgeons for patients. Recent posts include “What Is Recovery from Heart Surgery Really Like? A Patient’s Experience” by Paul K. Minifee, MD, “Complications After Cardiothoracic Surgery: What Went Wrong?” by Robbin G. Cohen, MD, MMM, and “The Most Important Lesson I Learned From a Patient: Optimism Leads to Achievement” by Brendon M. Stiles, MD. Like most other pages on the patient website, these blog posts are available in English and Spanish. Please share this valuable resource with your patients. If you have questions or would like to contribute to the site, contact Jennifer Bagley, Media Relations Manager, at Jennifer Bagley for more details.  

STS News, Spring 2016 -- Every 5 years for the past 20 years, STS has embarked on an effort to establish and review its mission, vision, and strategic goals so that future activities align with the needs of its members and the specialty at large. In May 2015, under the direction of 2015-2016 STS President Mark S. Allen, MD, the Society began an 8-month process that involved numerous meetings with surgeon leaders, the STS management team, and an outside consulting firm, as well as a detailed member survey. “Members were really willing to chime in and help out,” said Dr. Allen. “We heard a lot of new ideas, and I think the new strategic plan covers all—or almost all—of the concerns and issues we heard during the process.” Although the Society’s mission was unchanged, the vision was updated to reflect a basic desire by members to improve the lives of patients with cardiothoracic disease. Also reflected was the understanding that many surgeons are experiencing some sort of transition. Whether it was keeping up with new technology, changing employment situations, or work-life balance issues, survey participants indicated that they had stressors they hoped the Society could help to alleviate. “I was surprised by the large number of our member surgeons who are now employed by hospital systems,” said Dr. Allen. “This is a big change from 5 years ago. The new strategic plan will help us proactively assist our members and the specialty; without it, we would just be reacting to what is happening.” Strategic Goals and Objectives The foundation for the new STS Strategic Plan, approved by the Board of Directors in January, concentrates on three main goals: Lead innovation and education; Foster collaboration and connection; and Advance quality. Among the objectives are expanding and enhancing STS educational offerings and platforms and optimizing the value, functionality, and sustainability of the STS National Database. “Our Database is one of the most valuable assets in medicine,” said 2016-2017 STS President Joseph E. Bavaria, MD. "Not only is it a credible source of clinical outcomes data that has been recognized by payers and researchers alike, but it also helps drive practice improvement, which ultimately leads to better care of our patients. In the coming years, we would like to broaden the scope of the Database, as well as make it easier for the user to understand his or her outcomes reports.” Enhancements to the Database that are under way include a web-based report dashboard and a new data collection and reporting methodology that will allow continuous data harvests. "The new strategic plan will help us proactively assist our members and the specialty; without it, we would just be reacting to what is happening." Mark S. Allen, MD As the Society begins to unfold its new strategic initiatives, two new workforces have been created—the Workforce on E-Learning and Educational Innovation, chaired by Dr. Allen, and the Workforce on Early Careerists, chaired by Vinay Badhwar, MD. Some of the initiatives that these workforces will undertake include expanding the current e-learning system and creating resources for career development. “We’re also going to work very hard with other global cardiothoracic surgery organizations to deepen our ties on the educational front, as well as on the clinical practice guidelines front,” said Dr. Bavaria. New Core Values For the first time, an STS Strategic Plan includes core values. These core values were designed to complement and replace staff core values that were developed shortly after the Society became self-managed. “Back in 2004, when our staff was a fraction of its current size of 60 employees, we put together an interdepartmental team to articulate a set of core staff values that all of us could buy into, borrowing a page from the playbook employed by many for-profit companies seeking to nurture a positive and productive culture,” explained Robert A. Wynbrandt, STS Executive Director & General Counsel. “One of the more gratifying byproducts of the Society’s most recent strategic planning exercise was our surgeon leaders’ enthusiasm for the development of core organizational values as a component of the new strategic plan. Just as our former core staff values helped to fuel the success of the Society in a variety of ways that we may not have fully anticipated in 2004, I expect that the formal adoption of our five organizational core values will further contribute to STS success on numerous fronts over the long term.” (See page 4 for additional commentary.) To view the 2016 STS Strategic Plan map, go to www.sts.org/about-sts/strategic-plan.

STS News, Summer 2016 -- Cardiothoracic surgeon Larry Bucshon, MD is both an STS member and a member of the United States House of Representatives. Rep. Bucshon (R-IN), who is running for reelection this year in Indiana’s 8th District, shares his thoughts on pressing issues facing the specialty, the value of connecting with legislators at all levels of government, and the change of pace between the operating room and Capitol Hill. What are the most important legislative issues in the health care arena right now? I think the most important thing is what CMS is doing as it relates to MACRA, the SGR replacement legislation. We need to make sure that as members of Congress, we have appropriate oversight. It does sound like for the most part, CMS has been listening to societies like STS during this process, but that’s what we’re working on.  The other thing, which is applicable to all of medicine, is the opioid situation. I have legislation, as do many others in the House and Senate, to address the opioid crisis that we have in our country. I also think that Meaningful Use [requirements related to the mandatory use of electronic health records] is an important issue, in terms of how it affects the ability of people out in the communities to practice medicine and how it’s going to be involved in assessing quality and helping to determine payment. What are some of your biggest achievements in health care? Obviously, one of the biggest achievements has been replacing the SGR with MACRA. It’s pretty hard to top that. It’s been a priority of mine since I’ve been in Congress, since the SGR was putting a lot of uncertainty into the health care system every year for seniors and providers. Also, Dr. Ami Bera from California and I worked in a bipartisan way to essentially stop CMS from eliminating global surgical payments. For cardiovascular and thoracic surgeons, this is a big deal. I feel really good about the fact that we were able to get leadership on both sides to recognize that this would be a failed policy. What can cardiothoracic surgeons do to help you resolve these issues? It’s very important to be engaged, not only at the federal level, but also at the state and local levels. As cardiothoracic surgeons, we carry a lot of credibility. When STS members talk to legislators, their voices are really heard. Here in Washington, I can tell you that it’s important for me—even though I understand cardiothoracic surgery—to continue hearing what’s actually happening in the field day to day and what challenges there are. I performed my last surgery almost 6 years ago, so things have already changed dramatically. There’s no replacement for personal contact and one-on-one conversations with your legislators. That doesn’t mean things are always going to go our way, but I can tell you that they won’t go favorably to our specialty if legislators don’t have input from people who are in the field practicing every day. That’s one of the reasons I ran for Congress in the first place. I felt like we, as physicians, needed to have more of a voice in government. Rep. Bucshon (center, holding plaque) received the Society’s Legislator of the Year Award in recognition of his extraordinary efforts promoting issues of importance to cardiothoracic surgeons. How has the Society in particular contributed to your achievements in Congress? I think STS has been an important player in moving SGR replacement forward and continues to be very important as CMS develops its rules related to MACRA. The Society also has been very involved in talking with CMS and giving advice to legislators like myself on reimbursement issues, as CMS has not necessarily been following the RUC recommendations for reimbursement decisions. I think STS and other specialty societies and primary care organizations have had a tremendous impact on the legislative direction of Congress. Without the input of these organizations, I don’t think the SGR would have been repealed and replaced with MACRA. Also, just helping members of Congress understand what our specialty does, how we help patients, and how important that is to the overall makeup of the health care system has also been very important. Is there anything else you want to say to STS members? I just want to reiterate the importance of being engaged politically at the local, state, and federal levels. The voices of surgeons in practice do matter, and people are listening. Even though the wheels of change seem to be moving slowly, without that engagement, our voices would just not be heard. Trying to advance the goals of our specialty and ensure our continued ability to treat patients would be hampered without that engagement. "The voices of surgeons in practice do matter, and people are listening." Rep. Larry Bucshon, MD Extended Version: Online-Only Questions How has your training and career as a cardiothoracic surgeon prepared you to serve in Congress? I think physicians are very well-prepared to be in government. Throughout our training, we learn to look at a problem, develop a solution, and then act. Legislating is very similar. First, you identify legislative issues, you work together as a team to find solutions, and then you act on those solutions to get to the end goal. Are there any differences between being a Congressman and being a cardiothoracic surgeon? I think the big difference, and something that I miss and that you can’t really get anywhere other than health care, is the personal interaction on a daily basis with patients and family members. You do that in politics, but it’s not as personal and as day-to-day. The other thing that can frustrate me is the pace. The pace of change, solving problems, and coming up with solutions is much more tedious and slow in government than it is in day-to-day cardiothoracic surgery practice. You have to be more patient and persistent as a legislator sometimes than you have to be as a cardiothoracic surgeon. Why is it important for STS members to contribute to the PAC? The STS-PAC is extremely important because STS needs the resources to interact with legislators in Washington. Without the financial resources given to the PAC from STS members, that interaction would not be possible.

STS News, Summer 2016 -- Data from the STS National Database are being utilized in a study to understand predictors of 30-day readmission and 30-day death after heart surgery in children and adults. The study, which began in 2014 and is expected to conclude in 2018, is funded by a $3.2 million grant from the National Heart, Lung, and Blood Institute. Jeffrey P. Jacobs, MD, Chair of the STS Workforce on National Databases, is the site principal investigator (PI) for the Society. The project PI is STS Associate Member Jeremiah R. Brown, PhD, Associate Professor of Health Policy and Clinical Practice at The Dartmouth Institute and Geisel School of Medicine at Dartmouth. More than 253,000 people undergo cardiac surgery each year, and approximately 20% of them are readmitted within 30 days for complications from surgery or comorbid conditions, Dr. Brown said. But little is known about the predictors of readmission. The researchers are working to develop a novel, multi-systemic predictive model that combines perioperative biomarkers of cardiac injury (ST2, B-type natriuretic peptide, cardiac troponin T), renal injury (cystatin C), and non-specific inflammation (galectin-3, cytokines). “Preliminary work by others in heart failure and by our investigators suggests that these novel biomarkers could help to identify patients at higher risk of readmission or mortality prior to discharge,” Dr. Brown said.  The congenital arm of the research will utilize the STS Congenital Heart Surgery Database for data on 30-day readmission. “This study is unique because it represents the first time that data about biomarkers are being linked to clinical data from the STS National Database,” said Dr. Jacobs, Chief of Cardiovascular Surgery at Johns Hopkins All Children’s Hospital and Professor of Surgery at Johns Hopkins University. “This may be the first example of a strategy that allows the clinical data in the STS National Database to facilitate precision medicine, where medical and surgical therapy is tailored to the unique genetic or biochemical profile of the individual patient. Indeed, this initiative represents an initial attempt to link clinical data from STS to data related to genomics, proteomics, lipidomics, and metabolomics, and therefore, this analysis explores an exciting new frontier with unlimited potential.” "This may be the first example of a strategy that allows the clinical data in the STS National Database to facilitate precision medicine." Jeffrey P. Jacobs, MD Early results were presented at the STS 52nd Annual Meeting this past January and are expected to be published in The Annals of Thoracic Surgery. Additional results will be submitted as abstracts for the STS 53rd Annual Meeting in January 2017 and as papers to The Annals. Ultimately, the researchers plan to create an online risk calculator that physicians can use to predict 30-day readmission or mortality in their cardiac surgery patients. “If we can improve our ability to identify high-risk patients for readmission or mortality before they leave the hospital, we may succeed in reducing 30-day readmission rates and 30-day mortality while improving transitions from the hospital,” Dr. Brown said. For more information about this study or the STS Research Center, contact Robert Habib, STS Research Center Director, at Robert Habib.

STS News, Summer 2016 -- STS members and subscribers to The Annals of Thoracic Surgery are loyal readers. A new survey found that 85% of respondents read The Annals at least once per month, and nearly all respondents (97%) said the journal keeps them up-to-date with the latest advances in the field. “There are many changes taking place for The Annals, and this survey was an important step in learning what the readership thinks is valuable,” said Editor G. Alexander Patterson, MD, FRCS(C). “I was impressed with the response rate, which indicates good engagement with the journal. These survey results will give us a baseline against which to evaluate our new initiatives.” Elsevier Inc., which has published The Annals since 1989, distributed a 36-question online survey to 6,750 members and subscribers last fall. The overall response rate was 17% (1,158), with 40% of respondents residing outside of the United States. “The results tell us that The Annals is successfully serving its readers and the medical communities. We assumed this to be true, but now we have the data to prove it,” said Andrew Berin, Publishing Director at Elsevier. “For example, fully 90% of those surveyed find the ‘How To Do It’ feature very useful or useful. This percentage rises to 96% when asked about original research published in The Annals. That’s powerful.” "The results tell us that The Annals is successfully serving its readers and the medical communities." Andrew Berin Digital Resources Expanding While the majority of subscribers (53%) primarily read the journal in print form, use of digital media is popular. Close to half (46%) of readers reported visiting the journal’s website (www.annalsthoracicsurgery.org) at least monthly, while more than one-third (35%) have accessed The Annals through its mobile app. Available on both iOS and Android platforms, the app allows users to create reading lists, add notes, and save articles for offline viewing. The app also includes interactive figures, tables, multimedia presentations, and supplementary content. The Annals recently added enhanced multimedia content, including video interviews with authors and editorial board members. That content will expand as more authors include supplemental content, specifically videos, with their submissions. The journal also started tracking how online communities engage with the content. “All of the discussions people are having about certain articles—whether in the popular press, blogs, or social media—are now tracked and measured on Annals article homepages. This is but one additional means of measuring the impact of research,” Berin said. New Submission Site Available In April, the journal launched a new manuscript submission site: www.editorialmanager.com/annals. Early feedback has been very positive. “Authors will experience a more intuitive submission process, and editors and reviewers will have a streamlined yet powerful system for peer review,” said Kavitha Reinhold, Managing Editor of The Annals. Users of the previous manuscript system do not need to create another account; login information was carried over to the new manuscript tracking system. For more information on submitting a manuscript to The Annals, visit www.annalsthoracicsurgery.org/content/authorinfo.

STS News, Summer 2016 -- Accurate coding of cardiothoracic surgery procedures is essential for receiving optimal reimbursement. Surgeons and coders must work together to correctly describe the work being performed. The following represent some of the common topics handled by the STS Coding Help Desk, a free resource offered to STS members and their staffs. To submit your questions or comments about Current Procedural Terminology*, billing, and/or reimbursement, go to www.sts.org/codinghelpdesk. Adult Cardiac Conduit Creation to Facilitate Cardiopulmonary Bypass The work of placing a patient on cardiopulmonary bypass to accomplish a cardiac procedure is included in the work of the primary procedure, unless otherwise indicated in the code (for example: 33300 – Repair of cardiac wound; without bypass). However, there are situations in which central cardiopulmonary bypass is contraindicated (such as ascending aortic atherosclerotic disease) and the ascending aorta cannot be cannulated, so peripheral cardiopulmonary bypass is required. For peripheral cardiopulmonary bypass in which the cannula(s) is placed directly into the artery (femoral, iliac, axillary, other), the placement of the cannula(s), initiation of bypass, cannula removal, and suture repair of the vessel(s) are included in the primary procedure. No additional codes may be reported. However, when direct cannulation of the peripheral artery is felt to be ill-advised, a graft conduit, anastomosed directly to the peripheral artery for purposes of accomplishing cardiopulmonary bypass, may be required. The work of creating the graft conduit for initiation of cardiopulmonary bypass, as well as the cutting or oversewing of the graft stump with sutures when cardiopulmonary bypass is no longer needed, may be reported separately. Example: The axillary artery is surgically exposed. After heparinization, a graft is sewn to the axillary artery. The graft is connected to an arterial cannula, a venous cannula is placed (centrally and/or peripherally), and cardiopulmonary bypass is established. The cardiac procedure is performed. After the cardiac procedure is accomplished, the patient is weaned from cardiopulmonary bypass. The axillary artery graft is clamped and cut as short as possible. The graft stump is closed with sutures. Currently, with the exception of the TAVR and ECMO codes, there is no code to report the creation of a graft conduit to facilitate arterial access. In order to report this service, the unlisted code 33999 – Unlisted procedure, cardiac surgery should be used. Creation of the graft conduit is included in the work of the TAVR procedures (33361–33369). To report this service in conjunction with ECMO, use add-on code 33987 - Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure) (Use 33987 in conjunction with 33953, 33954, 33955, 33956). General Thoracic Coverage of the Bronchial Stump Coverage of the bronchial stump typically is included in lung resection procedures when intrathoracic local tissue or structures are utilized. Examples of intrathoracic local tissues include pericardial fat pad, pericardium, pleura, and thymus. Using these local structures is considered part of the procedure and would not be separately reportable work. This is in contrast to the use of extrathoracic soft tissue—for example, muscle flaps. Coverage of the bronchial stump with intercostal, latissimus dorsi, serratus anterior, pectoralis, or other muscle flaps is reportable separately with code 15734 – Muscle, myocutaneous, or fasciocutaneous flap; trunk. Bronchoplasty Add-on code 32501 - Resection and repair of portion of bronchus (bronchoplasty) when performed at time of lobectomy or segmentectomy (List separately in addition to code for primary procedure) only may be reported in conjunction with codes 32480 - Removal of lung, other than pneumonectomy; single lobe (lobectomy), 32482 - Removal of lung, other than pneumonectomy; 2 lobes (bilobectomy), or 32484 - Removal of lung, other than pneumonectomy; single segment (segmentectomy). 32501 would be reported when a portion of the bronchus is removed or resected in a situation other than sleeve lobectomy (32486) or sleeve pneumonectomy (32442). Closure of the remaining bronchus most often involves complex suturing. An example would be reconstruction of the bronchus with a V-plasty technique by approximating the edges of the wedge. Code 32501 should not be used simply for suture closure of the proximal end of a resected bronchus. Congenital Cardiac ASDs and VSDs Several codes may be used to report atrial septal defect (ASD) repairs, ventricular septal defect (VSD) repairs, and combined ASD and VSD repairs. The code that most accurately describes the procedure performed should be reported. For example, if an ASD (or patent foramen ovale [PFO]) and VSD repair are performed in the same session, the combined code 33647 must be reported; you cannot separately report an ASD (33641) and VSD (33681) repair code. There is no code for repair of multiple ASDs, as there is for closure of multiple VSDs (33675, 33676, and 33677). In circumstances where multiple ASDs are repaired in the same session, code 33641 (or the appropriate ASD repair code) only may be reported once. There is a medically unlikely edit (MUE) of “1” for Medicaid and Medicare for the ASD and VSD codes. An MUE typically represents the maximum number of units reportable on the same date of service. If different types of ASDs are repaired, such as a secundum or PFO (33641) and an ostium primum ASD (33660), both codes may be reported. Check the bundling edits for the codes; some coding combinations are bundled and will require an appropriate unbundling modifier (e.g., 59) in addition to the multiple procedure modifier (51). It does not matter if the ASD or VSD is closed primarily (suture closure) or with a patch; the same code is used in either case. For the multiple VSD codes (33675, 33676, 33677), the code can be used only once per session—i.e., 33675 is used once for closing two, three, or more VSDs. Also, one cannot use the single VSD closure codes (33681, 33684, 33688) at the same time as the multiple VSD closure codes. The following codes may be reported for ASD, VSD, or combined ASD and VSD repairs. The tips under each code outline additional terms associated with the code, as well as highlight some of the work components that may or may not be specifically included in the code.  Atrial Septal Defect Repairs 33641 - Repair atrial septal defect, with cardiopulmonary bypass, with or without patch Secundum ASD Patent foramen ovale (PFO) closure Partial closure PFO (neonatal TOF repair) Includes suture closure 33645 - Direct or patch closure, sinus venosus ASD, with or without anomalous pulmonary venous drainage Includes Warden procedure Can't use with 33724 - partial anomalous pulmonary venous connection (scimitar syndrome) Can't use with 33726 - pulmonary venous stenosis 33660 - Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair Ostium Primum ASD Atrioventricular (AV) septal defect or endocardial cushion defect Report 33641 with 51 modifier and appropriate unbundling modifier for additional secundum ASD or PFO repairs Repair of common atrium or partition of common atrium—use 33641 or 33660 Can’t use with mitral valve repair or annuloplasty codes 33665 - Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair Has restrictive VSD component Ventricular Septal Defect Repairs 33681 - Closure of ventricular septal defect, with or without patch; (includes suture closure) 33684 -           with pulmonary valvotomy or infundibular resection (acyanotic)—double chambered right ventricle 33688 -           with removal of pulmonary artery band, with or without gusset 33675 - Closure of multiple ventricular septal defects; 33676 -           with pulmonary valvotomy or infundibular resection (acyanotic) 33677 -           with removal of pulmonary artery band, with or without gusset Combined ASD and VSD Repair 33647 - Repair of atrial septal defect and ventricular septal defect, with direct or patch closure Can’t use 63 modifier (Procedure Performed on Infants less than 4 kg) *Current Procedural Terminology (CPT®) copyright 2015 American Medical Association. All Rights Reserved. The material presented here is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement, however, and should not be construed as organizational policy. The Society of Thoracic Surgeons disclaims any responsibility for the consequences of actions taken based on the information presented in this article.