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STS News, Spring 2019 — More than 4,300 people, including 2,317 cardiothoracic surgeons and allied health care professionals, gathered in San Diego, January 27-29, for the STS 55th Annual Meeting. To view meeting photos, program content, and daily editions of the STS Meeting Bulletin, visit sts.org/annual-meeting-archive. Naunheim Points to Resilience as Key to Survival Cardiothoracic surgery has faced adversity for several decades. The specialty has been hit by reduced reimbursement, lower patient volume, and a shrinking workforce. Instead of getting angry, cardiothoracic surgeons became resilient. They worked to influence federal policy, used data to change practice patterns, improved medical guidelines, and began to change the face of the specialty, said Keith S. Naunheim, MD during his Presidential Address at the STS 55th Annual Meeting. He described how the change began in the mid-1990s when Robert Replogle, MD was STS President and CMS proposed a 45% reimbursement cut to move nurse practitioners, physician assistants, and surgical assistants out of surgical practices and into hospitals. “He resolved to address this in a strong but constructive fashion,” Dr. Naunheim said. “He restrained his anger, reassessed the situation, and responded to the threat. These days, the word for that kind of reaction is resilience—the capacity to recover quickly from difficulties with the ability to spring back or rebound. Resilience means you bend but you do not break. And STS does just that.” Dr. Naunheim’s address was titled “Anger Management 101: Why Am I Angry? Let Me Count the Ways.” In retrospect, he said, it should have been called “Resilience 101: How Can We Fight Back Against Those SOBs?” For Dr. Replogle, fighting back meant a $1,000 special assessment from each STS member. The Society put together an aggressive, $6 million lobbying campaign in Washington, DC. The campaign resulted in a $1.6 billion reimbursement increase over 10 years for cardiothoracic surgeons compared to the original proposals, a 26:1 return on investment. Another hit to the specialty came in the 1990s when balloon dilation and coronary stent implantation were introduced, and interventional cardiologists began to insert stents broadly. Percutaneous coronary intervention became the go-to therapy for coronary circulation issues. PCI rates soared; CABG numbers fell. “The wide application to PCI in the absence of evidence appeared inappropriate, and it fell to us, the cardiothoracic surgery community, to affirmatively address this misguided practice,” Dr. Naunheim said. STS and the American College of Cardiology (ACC) used data from both organization’s databases to compare long-term outcomes of CABG and PCI. The ASCERT Trial, published in 2012, demonstrated long-term survival benefits for CABG in multiple subgroups. "I am convinced that we can and will meet those future challenges and prevail." Keith S. Naunheim, MD The Society also led the creation of appropriate use guidelines for PCI in cooperation with ACC, the Society of Cardiovascular Angiography and Interventions, the American Association for Thoracic Surgery, and the American Heart Association. By 2015, the chance of PCI being appropriately used rose from 30% to nearly 50%, while the inappropriate use of PCI fell by half and CABG volume increased. “The good guys are winning,” Dr. Naunheim said. Good women are winning, too, as more women become cardiothoracic surgeons. To help spur this growth of women cardiothoracic surgeons, STS leaders again collaborated with others to promote and strengthen the specialty. This time it was with a focus on the development of transcatheter aortic valve replacement, minimally invasive surgery, and robotics, all attractive, cutting-edge procedures for young surgeons. And the Society worked with Women in Thoracic Surgery to develop and present role models for female medical students and residents. “We’ve come a long way, but there is still much improvement possible,” Dr. Naunheim said. “Our specialty has been and continues to be under assault from multiple directions, and we have to respond on every front. I am convinced that we can and will meet those future challenges and prevail.” This article was adapted from the Tuesday edition of the 2019 STS Meeting Bulletin. The entire Presidential Address is available as a video at sts.org/naunheimaddress. (left to right) Robert S.D. Higgins, MD, MSHA, Dr. Rusch, Dr. Naunheim, and A. Pieter Kappetein, MD, PhD Award Winners Honored The recent STS Annual Meeting offered the opportunity to recognize those who are making an impact on the organization and the specialty. The following were honored by the Society in San Diego: Distinguished Service Awards Distinguished Service Awards recognize those who have made significant and far-reaching contributions to the Society. The 2019 recipients were James M. Levett, MD and Douglas E. Wood, MD. Earl Bakken Scientific Achievement Award The Earl Bakken Scientific Achievement Award was presented to Valerie W. Rusch, MD, who is one of the world’s top experts on the management of lung cancer and mesothelioma. The Bakken Award honors individuals who have made outstanding scientific contributions that have enhanced the practice of cardiothoracic surgery and patients’ quality of life. President's Award The President’s Award was presented to Tara Semenkovich, MD, MPHS from Washington University School of Medicine in St. Louis for her paper, “Adjuvant Treatment for Node-Positive Esophageal Cancer After Induction Therapy and Surgery Improves Survival: A Multisite Study.” Selected by the STS President, this award recognizes an outstanding scientific abstract by a lead author who is either a resident or a surgeon 5 years or less in practice. Poster Awards Adult Cardiac Surgery: STS Overall Composite Scores: A Better Measure of High-Quality Cardiac Surgery (Julia Coughlin, MD) Congenital Heart Surgery: More Than 25 Years of Experience With the Ross Procedure in Children: A Single-Center Experience (Elisabeth Martin, MD, MPH, FRCSC) Critical Care: Platelet Nadir Following Cardiopulmonary Bypass Is Independently Associated With Postoperative Mortality, Infection, Acute Kidney Injury, and Prolonged Intensive Care Unit Stay (Benjamin Griffin, MD) General Thoracic Surgery: A Tumor-Specific Staging System for Neuroendocrine Tumors of the Lung Needs to Incorporate Histological Grade: An Analysis of the National Cancer Database (Anee Sophia Jackson, MD) Quality Improvement: Outcomes of Nonelective Coronary Artery Bypass Grafting Performed on Weekends (Jared P. Beller, MD) Access STS 55th Annual Meeting Online STS Annual Meeting Online provides access to more than 100 hours of recorded sessions. Access to Annual Meeting Online was included with Annual Meeting registration. Non-attendees can purchase the online product at sts.org/AMonline. Annual Meeting by the Numbers 2,317 Professional Registrants 130+ Oral Scientific Abstracts 90+ Educational Sessions 150 Exhibiting Companies and Organizations 58 Countries Represented by Registrants  

STS Receives Esteemed Eisenberg Award The Joint Commission and the National Quality Forum (NQF) have awarded STS the prestigious John M. Eisenberg Patient Safety and Quality Award, which recognizes individuals and organizations who undertake groundbreaking initiatives that support “better care, healthy people and communities, and smarter spending.” The Society was honored for its quality programs, including the STS National Database, NQF-endorsed composite performance measures, and the STS Public Reporting initiative. The award was presented on March 25 during the NQF Annual Conference in Washington, DC. From left: The Joint Commission EVP David W. Baker, MD, MPH, STS President Robert S.D. Higgins, MD, MSHA, STS National Database Founder and Task Force on Quality Measurement Chair David M. Shahian, MD, STS National Database Founder and Past President Frederick L. Grover, MD, and Shantanu Agrawal, MD, MPhil, NQF President and CEO. Grover Receives Prestigious Award STS Past President Frederick L. Grover, MD was awarded the 2019 John P. McGovern Compleat Physician Award from the Houston Academy of Medicine and Harris County Medical Society (HCMS). This award recognizes multi-accomplished physicians who have enriched the field of medicine with excellence and humaneness. Dr. Grover served as Chair of the University of Colorado’s Department of Surgery from 2002 to 2012 and has been a leader in clinical outcomes measurement, clinical research, and heart and lung transplantation. He has been an STS member since 1974 and served as the Society’s President from 2006 to 2007. From left: HCMS Past President Russell W.H. Kridel, MD, HCMS President Bernard M. Gerber, MD, STS Past President Frederick L. Grover, MD, HCMS Past President and STS Member Kenneth L. Mattox, MD, and STS Director-at-Large Ara A. Vaporciyan, MD Shortened Grace Period for Dues Payments The due date for annual membership dues payment is January 1 of the current year. In the past, a grace period of up to 1 year was provided; however, STS membership recently approved a Bylaws change that reduces the grace period from 1 year to 6 months. This means that in order to avoid the termination of your membership, you must pay your dues by June 30, 2019. If you have an outstanding balance, you can make your payment today at sts.org/dues (you will need your STS username and password to log in). If you have any questions regarding dues payments or have trouble logging in, contact membership@sts.org or call 312-202-5800. Watch or Listen to STS Roundtable Discussions Visit the Society’s YouTube channel at youtube.com/thoracicsurgeons to view several roundtable discussions filmed at the STS 55th Annual Meeting. Leading experts discuss a wide range of topics, including advances in lung cancer early detection and therapy, pain management in cardiothoracic surgery, and how artificial intelligence can benefit cardiothoracic surgery. You also can listen to the audio at sts.org/podcast or subscribe to Surgical Hot Topics podcast on iTunes, Google Play, or where ever you access your favorite podcasts. Colleagues Network at GTSC Meeting The recent General Thoracic Surgical Club Meeting (GTSC) in Naples, Florida, provided surgeons with an opportunity to hear about new research and health policy information, as well as time to network with colleagues and friends. The 2020 GTSC Meeting will be March 12-15 in Tucson. STS President Robert S.D. Higgins, MD, MSHA (right) and Malcolm V. Brock, MD, from Johns Hopkins Medicine STS Has Presence at International Meetings In February, STS Secretary Joseph F. Sabik III, MD and Director-at-Large Shanda H. Blackmon, MD, MPH (center) represented the Society at the 27th International Conference of the Asian Society for Cardiovascular and Thoracic Surgery and the 65th Indian Association of Cardiovascular – Thoracic Surgeons Congress in Chennai, India. Also pictured are STS members Byung C. Moon, MD (left) and Marc R. Moon, MD (right). In March, STS Immediate Past President Keith S. Naunheim, MD (right) attended the Society for Cardiothoracic Surgery in Great Britain & Ireland Gala Dinner at the Globe Theater in London, along with SCTS President Richard Page.

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.