News & Media

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

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

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