News & Media

STS News, Fall 2019 — A great majority of cardiothoracic surgeons have formal financial ties with health systems. Be it through a professional service agreement or a fully employed arrangement, the surgeon-administrator relationship is more crucial to the delivery of health care now than it was in the past. STS Workforce on Practice Management member Heather Smith examines this relationship. Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Heather Smith, RN, MJ Business Director, Divisions of Cardiovascular, Thoracic, Vascular, and Transplant Surgery University of Pennsylvania, Philadelphia Just as a good physician-patient relationship can improve patient outcomes, a good physician-administrator relationship can improve the work environment and ease employee burnout. As a result, the importance of cardiothoracic surgeons and their administrators working as part of a team cannot be underscored enough.  A high-performing team comprises people who share a common goal, a pathway to achieve that goal, and trust among team members. That trust is built in part by understanding each other—knowing what matters and why, as well as being able to openly communicate, particularly at times of disagreement. The relationship between cardiothoracic surgeons and administrators has evolved over time. In the past, particularly in the traditional, non-academic private practice setting, there was no formal relationship. Surgeons practiced at the hospital, and administrators primarily were responsible for the smooth functioning of the physical plant and the employees. Surgeons may have practiced at multiple hospitals; in fact, hospitals often competed for a surgeon’s “business.” In order to survive and thrive in today’s employment environment, surgeons and administrators must learn about the other’s world and help educate each other. With the advent of surgeon employment by hospitals and health systems, the relationship has progressed to one where there is much more interaction, which the surgeon may perceive as an intrusion. If the relationship has not been developed into one with the components of a high-performing team, it can contribute to surgeon and administrator dissatisfaction and burnout. Continuous conflicts can threaten the surgeon-administrator relationship and a healthy working environment. Surgeons may find themselves facing myriad questions about their practice, which they are unaccustomed to answering. Sometimes, these questions are asked by someone who seems to have no knowledge of a surgeon’s world and makes a surgeon feel as if he or she is being measured only in terms of work relative value units (wRVUs) or case numbers. This can lead to frustration and may make the surgeon feel ill-prepared to function as a business leader. On the other hand, administrators may be frustrated if they can’t get answers or may feel intimidated by a lack of clinical knowledge that hinders their ability to communicate with surgeons. Education Helps Improve the Relationship In order to survive and thrive in today’s employment environment, surgeons and administrators must learn about the other’s world and help educate each other. Understanding the language, as well as the thought and decision-making processes the other uses, should inform how questions are asked and answered. More surgeons are obtaining MBAs and many administrators have clinical backgrounds, but formal education will not be the norm in most cases. The ability to explain the finance of health care in a way that is meaningful to a surgeon must be in every administrator’s repertoire. Administrators must make time to learn about the surgeon’s clinical practice, and the surgeon must help. A deep understanding of what patients, families, hospitals, and practice plans demand of surgeons is necessary. As the surgeon and administrator develop a stronger and more respectful relationship where both parties complement each other’s strengths and weaknesses, the benefits will become more apparent and include an enhanced surgical practice, achievement of organizational goals, and a healthy work environment, which will lead to better outcomes for our patients and our health care systems.

CABG, Opioid Studies Make Headlines The Society issued three press releases this past quarter highlighting important research on the benefits of coronary artery bypass grafting surgery (CABG) over percutaneous coronary intervention (PCI), how the opioid epidemic has led to an increase in donor hearts, and the institutions generating the most research through grants from The Thoracic Surgery Foundation (TSF). See pages 8-9 for more information on TSF grants. A study published online in The Annals of Thoracic Surgery in May showed that CABG surgery had a significant mortality benefit over PCI in patients with multivessel disease. The research, by Suresh R. Mulukutla, MD, and colleagues from the University of Pittsburgh Medical Center in Pennsylvania, suggested that CABG should be considered in broader patient populations, not just in cases of patients with diabetes and left ventricular dysfunction, as is commonly practiced. Media outlets such as MedPage Today, Cardiovascular Business, and the Cardiovascular Surgery Show on SiriusXM Doctor Radio covered the story. An Annals study released in June highlighted the increase in hearts available for transplantation as a result of the opioid epidemic—and that these organs may be as suitable as any other hearts. The researchers, including senior author Nader Moazami, MD, from NYU Langone Health in New York, concluded that overdose status alone is not a valid reason to discard an otherwise viable donor heart. The study generated interest from Physician’s Weekly, TCTMD, Yahoo News, and the Interventional Cardiology Show on SiriusXM Doctor Radio. For more information on the Society’s media relations efforts, visit sts.org/media or contact STS Media Relations. Contribute to Latin America Conference and STS Annual Meeting Share your research with an international community of cardiothoracic surgery professionals. Scientific abstract submissions and proposals are now being accepted for the STS/EACTS Latin America Cardiovascular Surgery Conference, November 22–24 in Cancun, Mexico, and the STS 56th Annual Meeting and Tech-Con, January 25–28, 2020, in New Orleans, Louisiana. Latin America Conference Abstracts may be submitted in any of the following categories: adult congenital heart disease, aorta and aortic disease, aortic root, aortic valve, atrial fibrillation, coronary artery disease, heart failure/ventricular assist devices, mitral valve, pediatric congenital heart disease, quality and outcomes initiatives, or tricuspid valve. Visit cardiovascularsurgeryconference.org/abstracts and submit your abstract by Friday, August 2. Annual Meeting Abstracts and surgical videos may be submitted in the areas of adult cardiac surgery, congenital heart surgery, general thoracic surgery, basic science research, critical care, quality improvement, geriatrics, and cardiothoracic surgery education. Visit sts.org/abstracts and submit your abstract by Tuesday, August 13. Tech-Con Submit proposals for short presentations on new cardiothoracic surgical technologies or innovative, off-label, or outside-the-box techniques that address complex problems. Accepted proposals will be presented during the Shark Tank session to a panel of experts and the audience. Visit sts.org/tech-con and submit your proposal by Tuesday, August 13. TEVAR Symposium Draws Praise for Interactive Discussion Format More than 100 people attended the Society’s recent symposium on thoracic endovascular aortic repair (TEVAR) in Chicago. The conference was entirely case-based, allowing for robust discussions. “[It was] by far one of the most useful and educational conferences I’ve been to,” according to one participant. Another said, “I particularly enjoyed how [the faculty] rotated amongst the different tables, allowing me to have constant personal interactions and ask them questions.” Participants also heard from industry representatives at a special breakfast that focused on the latest TEVAR research and technology developments. Reminder: Elect to Receive Surgeon-Specific Feedback If you participate in the STS Adult Cardiac Surgery Database (ACSD), don’t forget to take advantage of a new opportunity for self-assessment and quality improvement in cardiothoracic surgery—surgeon-specific outcomes reports. For those who affirmatively opt in, these feedback reports will be available beginning this fall and will include data on coronary artery bypass grafting (CABG), aortic valve replacement (AVR), CABG+AVR, mitral valve repair and replacement (MVRR), and CABG+MVRR for January 2016 through December 2018. If you would like to receive your surgeon-specific reports, visit sts.org/surgeonspecific to get started. Express Your Interest in STS Leadership Positions All members are invited to participate in the Society’s self-nomination process for standing committee and workforce appointments. Submissions will be accepted September 1–30; you will receive an email with further information on how to self-nominate. A full list of the Society’s standing committees and workforces can be found at sts.org/leadershipstructure. Leadership appointments are approved by the STS Executive Committee each year, usually during its December meeting. Positions for 2020–2021 will take effect immediately after the STS 56th Annual Meeting in New Orleans, January 25–28, 2020. The majority of open slots are for 3-year terms, renewable on a one-time basis. If you have questions about the STS leadership structure or the self-nomination process, contact Adam Doty, MPP, Senior Manager, Governance and Membership. STS Has Presence in China, Brazil, Ireland Society leaders recently networked with colleagues during cardiothoracic surgery events in Asia, South America, and Europe. Director-at-Large Shanda H. Blackmon, MD, MPH (second from left), represented the Society at the First Intercontinental Multisociety Symposium on Lung Cancer in Belo Horizonte, Brazil, as part of the XXI Congress of the Brazilian Society of Thoracic Surgery. Past President Joseph E. Bavaria, MD (right), shown with Gilles Dreyfus, MD, an STS member from Paris, spoke at the Asian Academy of Heart Valve Diseases meeting in Jinan, China. Dr. Bavaria described important new insights and perspectives on transcatheter valve procedures from data in the STS/ACC TVT Registry™. Chair of the STS Workforce on General Thoracic Surgery Michael J. Weyant, MD (right), and European Society of Thoracic Surgeons (ESTS) President Gilbert Massard, MD, led a joint ESTS/STS session at the 27th European Conference on General Thoracic Surgery in Dublin, Ireland. The session included presentations on video-assisted thoracoscopic surgery, robotic surgery, and simulation training. The Annals Impact Factor Reaches a Record High For a third consecutive year, the impact factor has increased for The Annals of Thoracic Surgery and is the highest in Annals history. The impact factor, an important metric indicating a journal’s influence, measures the frequency with which the average article has been cited in a particular year. For 2018, The Annals impact factor was 3.919, as reported by Clarivate Analytics in its Journal Citation Reports. Article topics that received the most citations last year include clinical practice guidelines on arterial conduits for coronary artery bypass grafting and surgical treatment of atrial fibrillation, as well as a risk adjustment model from the STS General Thoracic Surgery Database for predictors of major morbidity or mortality after resection for esophageal cancer. A subscription to The Annals is a benefit of STS membership. To read the journal online, visit annalsthoracicsurgery.org. Scholarships Foster the Next Generation of Cardiothoracic Surgeons Help support the future of the specialty by encouraging general surgery residents and medical students interested in cardiothoracic surgery to apply for a 2020 STS Looking to the Future (LTTF) Scholarship. Scholarships include complimentary registration for the STS 56th Annual Meeting and Tech-Con 2020 in New Orleans, a 3-night stay at an STS-designated hotel, participation in exclusive events, an assigned mentor to help plan a schedule of educational programming and facilitate introductions, and reimbursement of up to $500 in related travel expenses. Previous LTTF scholarship recipients report that participating in the program influenced their decision to train in cardiothoracic surgery.  "The opportunity to meet attendings from around the country and learn of their career paths and respective programs was invaluable," said 2019 scholarship recipient Dana McCloskey, MD, a general surgery resident at Cooper University Hospital in Camden, New Jersey. "All were very supportive, welcoming, and willing to answer questions and offer guidance." If you know of a general surgery resident or medical student who may qualify for an LTTF scholarship, encourage him or her to apply. You also can offer to write a letter of recommendation on the applicant’s behalf. Application details will be available at sts.org/lttf in mid-August. For more information, contact Rachel Pebworth, Affiliate Manager, Awards and Operations. Society Promotes Cardiothoracic Surgery at AMA Specialty Showcase For medical students who are still determining their career paths, speaking with a cardiothoracic surgeon could be the spark they need to pursue training in the field. To connect with these students and help spur interest in cardiothoracic surgery, David D. Odell, MD, MMSc, from Northwestern University in Chicago, represented STS at the American Medical Association Specialty Showcase and Clinical Skills Workshop in Chicago this June. He answered questions about the procedures cardiothoracic surgeons perform, how the specialty differs from general surgery and cardiology, options for training pathways, and more. It was his fourth year participating in the Showcase.  Dr. Odell said that these types of events are especially important for students who do not have local access to cardiothoracic surgery mentors. “I have seen several folks that I talked to at the Showcase come back as Looking to the Future Scholarship recipients and integrated residency applicants,” he said. “It’s wonderful to think that these conversations may have helped catalyze these students’ interest in a career in cardiothoracic surgery.”

STS News, Summer 2019 — Patient access to transcatheter aortic valve replacement (TAVR) will be expanded while patient safety requirements are maintained with the recent publication of a new national coverage determination (NCD) for TAVR. The Centers for Medicare & Medicaid Services (CMS) has made several important changes to existing Medicare coverage terms for this procedure. Over the past year, STS worked in collaboration with the American College of Cardiology (ACC), the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions to actively petition CMS for high-quality standards that would ensure TAVR is performed safely and in the right patient populations.  The new NCD changes minimum procedure volume requirements to open and maintain a TAVR program. Although the volume requirements have presented concerns to some centers currently performing TAVR, as access to TAVR is expanded in low-risk populations, volume goals should become more easily attainable. As access to TAVR is expanded in low-risk populations, volume goals should become more easily attainable. Details on specific volume requirements can be seen in the chart below. While the societies would have preferred CMS replace volume requirements with quality assessment measures from the STS/ACC TVT Registry™, the timing of the NCD made it difficult to codify that change. However, CMS agreed that "validated outcome measures may be an appropriate alternative to procedural volume requirements when establishing quality standards for TAVR programs" and will consider updating the NCD in the future. For information on how STS and ACC are working with CMS to develop quality metrics, see page 6. Another way the new NCD addresses concerns about access to care is by modifying the previous requirement that two surgeons independently evaluate patients to determine whether they are candidates for TAVR. CMS now requires that a cardiothoracic surgeon and an interventional cardiologist each examine patients face-to-face and evaluate their suitability for surgical aortic valve replacement (SAVR). CMS made this change to recognize "the accumulated experience of the TAVR surgeons and interventionalists, the wide acceptance of the heart team approach, and concern for improving access while maintaining quality of care." Finally, the NCD specifically requires continued monitoring of TAVR outcomes using a prospective, national, audited registry. Data from the TVT Registry will be used to answer several research questions associated with the NCD and shape the future of treatment for patients with aortic stenosis. Although there is still progress to be made in Medicare coverage and reimbursement, keeping careful controls on TAVR while focusing on patient access is a win for cardiothoracic surgeons and their patients. Requirements to Begin a TAVR Program for Hospitals without TAVR Experience ≥ 50 open heart surgeries in the previous year prior to TAVR program initiation ≥ 20 aortic valve related procedures in the 2 years prior to TAVR program initiation ≥ 2 physicians with cardiac surgery privileges ≥ 1 physician with interventional cardiology privileges ≥ 300 percutaneous coronary interventions per year Requirements to Begin a TAVR Program for Heart Teams without TAVR Experience The heart team must include: Cardiovascular surgeon with ≥ 100 career open heart surgeries, of which ≥ 25 are aortic valve related Interventional cardiologist with:  Professional experience of ≥ 100 career structural heart disease procedures or ≥ 30 left-sided structural procedures per year Device-specific training as required by the manufacturer Requirements to Maintain an Existing TAVR Program ≥ 50 AVRs (TAVR or SAVR) per year, including ≥ 20 TAVR procedures in the prior year, or ≥ 100 AVRs (TAVR or SAVR) every 2 years, including ≥ 40 TAVR procedures in the prior 2 years  ≥ 2 physicians with cardiac surgery privileges ≥ 1 physician with interventional cardiology privileges  ≥ 300 percutaneous coronary interventions per year

STS News, Summer 2019 — Practice arrangements are changing and professional challenges are becoming more intense for many STS members, according to the most recent member needs-assessment survey. Approximately 800 members (12%) responded to the online survey, conducted in November and December 2018. Questions asked were similar to those from a 2012 member needs assessment and in a 2015 strategic planning survey. Compared to 2012, a higher percentage of members now work in universities and hospitals (78% versus 66%), although this practice shift was more likely to occur among members within the United States. Practice changes may be connected to an increasing percentage of members who identified “managing work-related pressures” such as workload and work-life balance as their top professional challenge. In 2018, 38% of members selected this challenge, compared to 33% in 2015. Other high-scoring concerns included staying up to date on clinical advances (29%), career progression (28%), and managing regulatory/administrative burdens (28%). Differences among the disciplines included adult cardiac surgeons expressing greater uneasiness than colleagues about competition from other specialties and congenital heart surgeons displaying more worry about conducting and applying research. “The results of this survey are important, and we are grateful to those members who participated,” said STS President Robert S.D. Higgins, MD, MSHA. “As a membership organization, we are developing a series of strategic planning sessions, and members’ concerns will be addressed during those meetings.” Satisfaction with Membership, Benefits More than three-quarters of members said that they were satisfied or extremely satisfied with their membership (78%), which is similar to the results in 2015 (79%). The membership benefits valued by the majority were The Annals of Thoracic Surgery (89%), followed by live educational courses such as the STS Annual Meeting (73%), and the STS National Database (61%). A majority of survey respondents (64%) said that they prefer to receive communications from STS by email. Among the types of information offered by the Society, a plurality chose clinical practice guidelines (38%) and clinical research (23%) as being most important. The Society’s two general communications, STS News and STS Weekly, have been of increasing value to members. A majority of respondents (81% and 69%, respectively) listed these communications as useful or very useful in 2018, compared to 63% and 50%, respectively, in 2012. Among targeted communications, those that were perceived by the majority as being useful and very useful were STS National Database News (76%), the Surgical Hot Topics podcast (75%), and the roundtable video series (73%). Quinquennial Practice Survey Later this year, the Society will open its important cardiothoracic surgery practice survey. The survey has been conducted approximately every 5 years since 1974 in order to obtain a better understanding of cardiothoracic surgery practice trends in the United States. Although surveys offer a great opportunity for members to provide feedback to the Society, members should feel free to contact STS at any time during the year. If you have comments or concerns, contact Dr. Higgins via his STS email box.

STS News, Summer 2019 — For cardiothoracic surgeons establishing their research programs or pursuing advanced surgical training, grants from The Thoracic Surgery Foundation (TSF) can serve as stepping stones to bigger endeavors. As the Society’s charitable arm, TSF provides funding for research, education, leadership courses, and surgical outreach missions and awarded $951,500 in grants for 2019. Applications for 2020 grants open soon (see sidebar for more details).  Two previous grant recipients have found that the support provided by TSF has had a significant impact on their careers. TSF Research Grant awardee Bryan A. Whitson, MD, PhD, received an R01 grant for his work with ex-vivo lung perfusion. Lung Transplant Research Grant Paves Way for R01 Study Bryan A. Whitson, MD, PhD, was awarded a $3.4 million, 5-year R01 grant from the National Heart, Lung, and Blood Institute last year—thanks in part to data generated from the TSF Research Grant he received in 2015. Dr. Whitson is the director of the Section of Thoracic Transplantation and Mechanical Circulatory Support at The Ohio State University Wexner Medical Center in Columbus. His research focuses on utilizing ex-vivo lung perfusion (EVLP) to improve the quality of donor lungs and lower the risk of primary graft dysfunction (PGD) after transplant surgery. While patients are continually added to the lung transplant waiting list, the number of available donor organs can’t keep up with demand. And once patients receive new lungs, severe PGD can occur in up to a third. PGD is thought to be caused by ischemia/reperfusion injury; Dr. Whitson and his colleagues theorized that using the protein MG53 during EVLP could help mitigate this injury by reversing damage to cell membranes. With the funding from the TSF grant, the researchers identified the ideal dose of MG53 to be used during EVLP and tested its regenerative and protective functions in rat models. "Not only did the TSF grant provide the financial resources to develop the preliminary data needed for my R01 application, but it also provided external validation to the National Institutes of Health that the research question and methods had merit," he said. "This financial support [from TSF] set the stage for my future research endeavors, allowed me to be promoted, and was absolutely critical to getting the R01 funding." Bryan A. Whitson, MD, PhD Over the course of the R01 grant, the researchers will use EVLP with MG53 to conduct lung transplants in porcine models, setting the stage for future clinical trials. They also will work to solidify an assessment signature that would identify lung injury more precisely than arterial blood gases. Dr. Whitson said his ultimate goal is for more patients to receive lung transplants and have better outcomes. As TSF prepares to open submissions for its 2020 award cycle, Dr. Whitson advised applicants to be persistent and seek strong collaborations. "TSF grants provide resources to advance the research and also bring recognition to the institution," he explained. "This financial support set the stage for my future research endeavors, allowed me to be promoted, and was absolutely critical to getting the R01 funding." Moritz C. Wyler von Ballmoos, MD, PhD, MPH, received the TSF Michael J. Davidson Fellowship to improve his skills in transcatheter therapies. Davidson Fellowship Expands Skills in Minimally Invasive Cardiac Procedures In addition to research awards, TSF currently offers five educational fellowships, including the Michael J. Davidson Fellowship, created in honor of the cardiothoracic surgeon who was killed in January 2015 at Brigham and Women’s Hospital in Boston. Dr. Davidson was a strong advocate for a future that would meld the cardiac catheterization lab with the operating theater, and the fellowship is awarded to early career cardiothoracic surgeons who share his passion for less invasive heart surgeries. 2018 Davidson Fellowship awardee Moritz C. Wyler von Ballmoos, MD, PhD, MPH, has a deep interest in this area, having previously completed fellowships in robotics and minimally invasive cardiothoracic surgery. "This is currently the most exciting and innovative domain of cardiac surgery in which to work," he said. "I have a passion for treating valvular heart disease, and I find the science and technology that we can leverage to improve patient outcomes in this field stimulating." During his yearlong Davidson Fellowship at Houston Methodist DeBakey Heart & Vascular Center in Texas, Dr. Wyler von Ballmoos implanted more than 350 transcatheter heart valves and performed more than 100 minimally invasive surgeries. He spent substantial time in the cath lab and hybrid OR, improving his skills in utilizing transcatheter technology to treat various conditions, including valve disease, paravalvular leak closure, and aortic pathologies. Dr. Wyler von Ballmoos also focused on minimally invasive cardiac surgery cases consisting mostly of mitral valve repair surgery, aortic valve replacement, and coronary artery bypass grafting surgery. He developed expertise in imaging for structural heart interventions, including advanced imaging technology (such as 3D image fusion) that also is useful for minimally invasive cardiac surgery. "Surgeons who are not experts in transcatheter treatments of these disease processes miss out on the opportunity to be the one unbiased advocate offering the full therapeutic spectrum to patients." Moritz C. Wyler von Ballmoos, MD, PhD, MPH "The time spent with thought leaders in the field has given me more breadth and depth in terms of my skillset and knowledge, allowing me to take better care of simple and complex cases alike," Dr. Wyler von Ballmoos said. He encouraged other cardiothoracic surgeons to apply for the Davidson Fellowship and advance their knowledge in transcatheter techniques. "As the Roman philosopher Seneca once said, 'Fate leads the willing and drags along the reluctant.' That is no different for the treatment of structural heart and aortic disease in the 21st century," Dr. Wyler von Ballmoos said. "Surgeons who are not experts in transcatheter treatments of these disease processes miss out on the opportunity to be the one unbiased advocate offering the full therapeutic spectrum to patients." Apply Today for TSF Grants Applications will open on July 15 for a number of awards, fellowships, and scholarships from TSF. Learn more at thoracicsurgeryfoundation.org/awards and submit your application by September 15, 2019. Contact TSF Executive Director Priscilla Kennedy via email or 312-202-5868 with any questions.

Elaine Weiss, JD CEO/Executive Director STS News, Summer 2019 — For most people, April 15 means IRS (tax day). For me, April 15 meant STS (first day on the job as Executive Director). Paying my taxes can be painful; joining STS has been joyful. For more than 25 years, I’ve worked on health care issues and/or been in the professional association management world. Combining my passion for both into one STS executive director position has been energizing, exhilarating, and only occasionally exhausting. Today more than ever, navigating the changing health care landscape while simultaneously ensuring that STS membership value remains strong, represents a significant challenge. Luckily, I savor a good challenge. And, as it turns out, STS produces a wealth of products, programs, and services that constitute a strong arsenal of tools to tackle the multiple issues that cardiothoracic surgeons face such as: A daunting array of regulatory and reimbursement complexities Rapidly emerging techniques and technologies Evolving workplace and employment arrangements Persistent legal liability pressures and increased media scrutiny Greater emphasis on patient safety and quality improvement Increases in both physician burnout and retirements Maintaining a robust pipeline of diverse and talented young physicians The professional challenges are clear. But in times of great challenge, the big question is whether STS is up to the task of facing these challenges and delivering for its members. No surprise; I believe my response is that STS is perfectly poised to tackle the challenges of today and take on the issues of tomorrow. First, STS physician leaders represent the titans of the specialty. The quality of our education through live programs, webinars, and podcasts involves cutting-edge issues and top-line experts. The clinical practice guidelines we develop, position statements we articulate, and mentoring we provide to the newest members of the specialty are powerful initiatives led by impressive professionals. Our visibility in Washington continues to grow as we solidify relationships and interactions with key policy leaders on the Hill, CMS, and the FDA. And when it comes to the RUC—where the entire House of Medicine gathers and establishes the relative value of medical procedures to inform payment decisions—one of our own, cardiothoracic surgeon Peter Smith, leads the entire group. (If this were the musical Hamilton, RUC meetings would definitely represent “the room where it happens.”) STS is perfectly poised to tackle the challenges of today and take on the issues of tomorrow. Nowhere is the STS arsenal more effective in bolstering the profession and its individual members than through the STS National Database. But even a gold standard program can become tarnished if not adequately polished. So, a rigorous process to deliver the next generation database is under way. This will not be “your father’s database” but our “STS National Database 2.0.” (See page 1.) Here at STS, we’re fine-tuning our operations, enhancing technology, and reaching out via social media to meet the changing needs of our members. But at the end of the day, the value of an association for its members still remains the personal interaction with colleagues, mentors, leaders, and future leaders. In today’s world when virtually everything is virtual, I truly believe that the joy of coming together to interact with professional colleagues who share a passion and pursuit of excellence cannot be replaced. Artificial intelligence may be the wave of the future for the practice of medicine, but associations and the role they play on behalf of their members remains based in the traditional yet powerful personal connections one makes throughout his or her career. From finding that first job to fine-tuning your skills to mentoring the next big name in the specialty, STS is “the room where it happens.” So, on April 15 I began my new journey. I’m thrilled to embark on this adventure and help bolster the Society as it serves a specialty that I quickly have come to respect and now proudly represent. I stand ready to do my part in partnership with our terrific surgeon leaders, led by STS President Robert Higgins. I am excited to work together with my impressive new STS colleagues. The good news is that April 15 no longer reminds me of the dreaded tax day. It now represents my anniversary with STS. The bad news is that I was so excited to begin my new role that I ended up filing for a tax extension.

STS News, Summer 2019 — The concept of “fair market value” is a centerpiece in physician employment compensation agreements as mandated by federal law. In this edition of STS News, Dr. G. Randall Green explores the challenges associated with the real-world application of this construct. Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management G. Randall Green, MD, JD, MBA Division Chief of Cardiac Surgery, Upstate Medical University, Syracuse, NY If physicians used clinical research the way that the health care industry uses physician compensation surveys, patient outcomes would be as unpredictable as practice valuations. Most market participants believe that compensation surveys establish a fair market value of physician compensation. Defining ranges of fair market value of physician compensation using these surveys, however, reveals a systemic misunderstanding of the data and leads to an indefensible valuation practice. Compensation market research lacks the rigor of the STS National Database to be used with the same confidence for valuation purposes. Survey data are drawn from voluntary samples, and specialty sample sizes reported can be comparatively small. Many commercial studies also are biased toward large, multispecialty groups providing data. By using a single questionnaire for every specialty, current surveys fail to capture specialty-specific and even subspecialty-specific drivers of value in each of these very different businesses. In our own specialty, consider the significant differences between adult cardiac, pediatric cardiac, and general thoracic surgery. Such incomplete data collection ultimately limits comparability. To use market research for physician compensation valuation, comparability of the survey data to the subject transaction is a threshold issue. Market participants routinely turn to physician productivity as the sole measure of comparability. Here, measures of productivity such as the much-derided wRVU percentile are used to identify a corresponding percentile of compensation. This practice assumes a relatedness between survey data tables and a linear correlation between productivity and compensation. Tim Smith of TS Healthcare Consulting, however, has shown using Medical Group Management Association data that productivity fails to account for as much as 60%-70% of physician compensation. Physician compensation follows a multifactor economic model, and survey instruments that fail to collect a comprehensive dataset limit comparability. The lack of scholarship on the physician compensation data itself limits our understanding and, therefore, the utility of the surveys. The importance of these studies should be clear to anyone in clinical practice. Although a few holdouts remain, the majority of STS members are now employed, leased, or in management positions and, therefore, have financial relationships with hospitals. The requirement that such relationships be at fair market value means that existing physician productivity and compensation market research will be used to establish levels of compensation. What may not be so clear to high-earning physicians is how survey data are used in regulatory compliance cases where hospitals and health systems are alleged to have paid above fair market value for physician services. In two notable cases, Tuomey and Halifax, the compensation valuation expert for the Department of Justice took the position that fair market value should be based exclusively on physician compensation survey data. Due to the nature of participation in voluntary surveys, it is possible that high-earning physicians compose a very small proportion of the sample used to construct currently available compensation data. As such, those same physicians fail to establish the true market for their professional services with resulting increased compliance risk. Although physicians cannot control how the data are used, the power to create a truly representative database of physician productivity and compensation lies with each one of us. As one of the first societies to collect our clinical data to improve clinical outcomes, perhaps it is time to lead once again by using our own practice data to serve our profession. Note: STS will conduct its quinquennial practice survey this fall. More information about this important survey will be provided in the coming months.