News & Media

STS News, Winter 2018 -- The old adage that "if you don’t have a seat at the table, you could wind up on the menu" perhaps could not be more relevant than when considering physician reimbursement. Determining appropriate payment for cardiothoracic surgical services is a complicated process, and STS has worked tirelessly to help ensure that the procedures performed by its members are fairly quantified and valued. Two important ways in which the Society has had a seat at the table have been through its work with the American Medical Association’s CPT® Editorial Panel and with the AMA/Specialty Society Relative Value Scale Update Committee (RUC). Accurate Codes are Essential The CPT Editorial Panel is where all the codes for the procedures performed by cardiothoracic surgeons originate. CPT terminology is the most widely accepted medical nomenclature for reporting medical procedures and services to both governmental and commercial health insurance programs. The CPT Advisory Committee supports the Editorial Panel by suggesting revisions to the CPT code set, providing documentation regarding the medical appropriateness of various medical and surgical procedures under consideration for inclusion, and coming up with definitions for different procedures. “Getting the terminology right and collaborating with other medical and surgical specialties are the first steps toward appropriate reimbursement and recognition by various external bodies of the work that we do,” said Francis C. Nichols III, MD, who serves as the STS representative on the CPT Advisory Committee. Dr. Nichols also chairs the STS Workforce on Coding and Reimbursement. "Getting the terminology right and collaborating with other medical and surgical specialties are the first steps toward appropriate reimbursement." Francis C. Nichols III, MD Recently, the Society worked with vascular surgeons to develop new “conduit creation” codes that capture the extra work that is sometimes necessary in order to safely establish cardiopulmonary bypass. In addition, STS took the lead in creating new laparoscopic/thoracoscopic esophagectomy codes, commonly called minimally invasive esophagectomy codes. “We all know there is nothing minimally invasive about esophagectomy, no matter what the approach, and we didn’t want the magnitude of these procedures misconstrued,” Dr. Nichols said. “We’ve been able to achieve so much because the Society has earned respect and credibility, which benefits all cardiothoracic surgeons. This credibility didn’t come overnight, but rather through detailed, honest, and realistic proposals.” Valuing Physician Work The RUC is the physician community’s primary vehicle for communicating with the Centers for Medicare & Medicaid Services about payment policy. The RUC works to quantify the resources required to provide physician services and then proposes value recommendations to CMS. STS representatives regularly have provided evidence to the RUC on behalf of the specialty regarding CPT codes that have been identified as potentially misvalued, new codes being valued, or codes that require revaluation per RUC rules. For example, the Society’s proposed values for revised esophageal codes and artificial heart codes recently were accepted by the RUC, and ultimately CMS, subsequent to STS presentation. In addition to presenting data that will help with the valuation of certain codes, STS has a representative on the RUC—currently Verdi J. DiSesa, MD, supported by alternate Joseph C. Cleveland Jr., MD—who votes on codes and values brought up for review and participates in subcommittees and workgroups, including those which address practice expense and professional liability issues that impact physician work valuation. Dr. DiSesa was appointed to the role after STS Member Peter K. Smith, MD was named RUC Chair in 2015. Dr. Smith had spent a decade representing cardiothoracic surgery on the RUC, prior to his appointment as Chair. “The value of having a seat on the RUC can only be realized by developing critical relationships with AMA staff and other RUC members. In so doing, we have become experts on the entire RUC process, which has allowed us to achieve a significant measure of success in physician reimbursement,” said Stephen J. Lahey, MD, Chair of the STS/AATS Workforce on Health Policy, Reform, and Advocacy. “A certain trust is built over the years, and this indirectly helps our cause with any codes that STS brings forward.” Drs. Nichols and Lahey both stressed the importance of the next generation learning the ins and outs of the CPT and RUC world. “Quite simply: It behooves us to become actively involved in this critical financial process,” Dr. Lahey said. If you’d like to learn more about ways in which you can serve the specialty through these and other activities, contact the STS Government Relations office via email or at 202-787-1230. STS Members Urge Support for Training Slots, Smoking Bans, Research About two dozen cardiothoracic surgeons converged on Washington, DC, in November for the Society’s latest Legislative Fly-In. Raymond Strobel, MD met with Rep. Debbie Dingell (D-MI). During their meetings on Capitol Hill, STS members urged support for the Resident Physician Shortage Reduction Act, which would expand the current cap on the number of Medicare-supported training slots for doctors and increase opportunities for physician training programs—a move essential to ensuring patient access to care. Research has shown that by 2035, cardiothoracic surgeons would have to increase their caseload by 121% in order to meet demand. STS members also asked lawmakers to pass a bill that would immediately ban smoking inside Veteran Health Administration (VHA) facilities and would ban smoking outside VHA facilities within 5 years. Currently, VHA facilities have 971 outdoor spaces affirmatively designated for smoking and 15 indoor spaces designated for smoking, despite the fact that many veterans suffer from chronic obstructive pulmonary disease, hypertension, and coronary artery disease, all of which are exacerbated by secondhand smoke. In addition, Fly-In participants urged restoration of funding for the Agency for Healthcare Research and Quality and requested more time to meet certain provisions in the Medicare Access and CHIP Reauthorization Act. (From left) STS Political Affairs and Advocacy Manager Nicholas Beek, Omar M. Lattouf, MD, PhD, Kevin W. Lobdell, MD, Rep. David Rouzer (R-NC), and Peter N. Kane, MD discussed issues affecting the specialty.

STS News, Winter 2018 -- Whether it’s your first time attending the STS Annual Meeting or your 20th, making the most of your time in Fort Lauderdale will require planning and a good dose of flexibility. Three veteran meeting attendees share their best advice to help you maximize your experience. Plan Your Schedule “I first check out the weekend sessions, such as Tech-Con, followed by the specialty symposia. That’s how I plan my flights for arriving and departing,” said Robbin G. Cohen, MD, MMM, Associate Professor of Cardiothoracic Surgery at the University of Southern California in Los Angeles. The Abstract Book, available at sts.org/annualmeeting, offers detailed descriptions and agendas for the entire meeting. The STS Meetings app, available at sts.org/mobileapp, also can help you plan ahead. You can save sessions and presentations to your personal itinerary, then set alerts so that you’re reminded when they’re about to begin. Get a Well-Rounded Experience While many Annual Meeting sessions offer in-depth science, technology, and hands-on learning, others address the practice management side of cardiothoracic surgery. For the 2018 Annual Meeting, these sessions include the Practice Management Summit (Sunday), Diversity and Inclusion in Cardiothoracic Surgery: What’s In It for Me? (Monday), and The Importance of Physician Documentation in Reimbursement (Monday). Kevin D. Accola, MD, a cardiothoracic surgeon at Cardiovascular Surgeons PA in Orlando, encourages his colleagues to attend the STS Key Contacts session on Monday and the Health Policy Forum on Tuesday so that they can advocate for the specialty. “It’s essential that cardiothoracic surgeons and others in our field become knowledgeable about changes in our health care system, as they impact our daily practice,” he said. Kevin D. Accola, MD asks a question during the 2017 Annual Meeting. Dr. Accola also strongly encourages attendees to participate during sessions, whether it’s during the Q&A portion of a session or via polling software available in select sessions. “The discussion opportunities are very informal and provide ample opportunity for further interaction and exchange of new ideas,” he said. Visit the Exhibit Hall In addition to offering insightful information about Annual Meeting sessions, the STS Meeting Bulletin, which is available in bins throughout the convention center, offers a map of the Exhibit Hall and descriptions about what companies are offering at their booths. “I frequently find a new instrument or idea that I hadn’t thought of,” Dr. Cohen said. “Visiting the Exhibit Hall also helps you establish relationships with salespeople and their managers who might be good resources in the future.” The Society has a booth in the Exhibit Hall (#807) where attendees can learn about everything STS, such as membership, The Annals of Thoracic Surgery, and the STS National Database. Data managers and surgeons participating in the STS National Database should take time to visit the STS Regional Data Managers booth (#1112). “It’s a great way to find out what’s going on around the country and how to become more involved with local efforts,” said Syma Prince, RN, BSN, AACC, Director of Cardiovascular Outcomes at HCA North Texas in Dallas. “These regional initiatives are where some of the strongest networks are built.” Build Your Network Networking is an essential component of the Annual Meeting experience. “People I’ve met at the Annual Meeting have remained mentors throughout my career and become close friends,” Dr. Accola said. Dr. Cohen agreed. “I would advise new and young members to not be shy about attending social events and approaching even the most famous members in our field,” he said. “I think STS is a really inclusive organization that is welcoming of young talent.” "The discussion opportunities are very informal and provide ample opportunity for further interaction and exchange of new ideas." Kevin D. Accola, MD One of the highlights of the meeting is the President’s Reception, which will be held on Sunday evening at the Fort Lauderdale Marriott Harbor Beach Resort & Spa. On the other evenings, industry-sponsored satellite activities feature expert talks and oftentimes a free meal (find a list in the Program Guide or STS Meeting Bulletin). “Many surgeons have been invited to industry dinners in advance by their local reps,” Dr. Cohen said. “These are not part of the STS educational program, but can be another good way to learn about new technology in development.” Recharge Your Batteries Relaxing in your hotel room with room service can be a refreshing option after days filled with learning and socializing. “The meeting can be a lot to take in. There’s nothing wrong with getting in some downtime so that you’re ready to go tomorrow,” Prince advised.

Patient Safety E-Learning Program Available for Purchase STS is offering an e-learning program on the science and practice of patient safety. “Fundamentals of Patient Safety for the Cardiothoracic Surgery Team” is a series of online modules covering topics such as the epidemiology of error, systems thinking, human factors, the culture of safety, fundamentals of quality improvement, communication, and methods and tools for evaluating safety events. By completing the entire program, learners can earn 4.5 AMA PRA Category 1 Credits™, as well as self-assessment credits toward Part II of the American Board of Surgery Maintenance of Certification Program.  Visit sts.org/patientsafetymodules to purchase the program, and contact Education with any questions. Educational Courses Span All Aspects of CT Surgery Fall is always a busy time at STS, with planning well under way for the Annual Meeting in January. But the last quarter of 2017 particularly was eventful, with five educational courses taking place October through December. Things kicked off with the 14th Annual Multidisciplinary Cardiovascular and Thoracic Critical Care Conference, held October 5-7 in Washington, DC. The conference brought together health care teams to explore the complex nature of cardiovascular and thoracic critical care cases, including their unique physiology, array of procedures, and potential complications. Later that month, data managers and surgeons participating in the STS National Database gathered in Chicago for Advances in Quality and Outcomes: A Data Managers Meeting, October 18-20. Speakers addressed all aspects of data collection, including spec upgrades for the Adult Cardiac Surgery Database and the General Thoracic Surgery Database. STS also partnered with the American College of Surgeons on CT Surgery in the Future, a hands-on course designed specifically for general surgery residents and medical students held during the ACS Clinical Congress in San Diego on October 23. Participants were able to interact with leading cardiothoracic surgeons and practice specific CT surgery procedures. On November 16-18, the Coding Workshop in Hollywood, California, provided surgeons, cardiothoracic surgery coders, and other billing professionals with information on new and revised codes for 2018, as well as other changes that will affect reimbursement. And, on December 1-2 in Chicago, Masters in Structural Heart and Valve Therapy: A Case-Based and Hands-On Symposium highlighted the latest innovations in aortic, mitral, and tricuspid valve therapies for structural heart disease, including traditional, minimally invasive, and catheter-based therapies. To get the latest information on STS educational courses in 2018, visit sts.org/meetings. New Guideline on Anticoagulation During Cardiopulmonary Bypass Available Soon STS, the Society of Cardiovascular Anesthesiologists, and the American Society of ExtraCorporeal Technology will soon release a new clinical practice guideline on anticoagulation during cardiopulmonary bypass (CPB). Despite more than a half century of “safe” CPB, the evidence base surrounding the conduct of anticoagulation therapy for CPB had not been organized into a succinct guideline, leading to enormous practice variability. The new guideline offers practice recommendations, including heparin dosing and monitoring for initiation and maintenance of CPB, heparin contraindications and heparin alternatives, and reversal of anticoagulation during cardiac operations. The guideline will be posted on The Annals of Thoracic Surgery website, annalsthoracicsurgery.org, on Friday, January 19, at 5:00 p.m. EST. It also will be available at sts.org/guidelines and via the STS Clinical Practice Guidelines mobile app. Scholarships Encourage CT Surgery Careers The Society’s Looking to the Future Scholarship Program will welcome 60 medical students and general surgery residents to the upcoming STS 54th Annual Meeting in Fort Lauderdale. Initiated in 2006, the program was developed to identify and encourage general surgery residents who are considering, but not yet committed to, a career in cardiothoracic surgery. In 2011, medical students became eligible. Since its inception, the program has awarded 490 scholarships. Nearly 150 medical students and residents applied for the 2018 scholarship. “The LTTF applicants seem to be an interesting reflection of the cardiothoracic surgery field,” said Elizabeth A. David, MD, Chair of the Looking to the Future Scholarship Task Force. “The quality of the applicants continues to improve year after year, likely reflecting improvements in the job market and young people being encouraged and inspired to pursue careers in cardiothoracic surgery.” During the meeting, programs for medical students and residents provide targeted information about cardiothoracic surgery as a profession, life as a cardiothoracic surgeon, and the application processes for training programs. In addition, each scholarship recipient is assigned a surgeon mentor to provide one-on-one insights. "One of the particular strengths of our program is the ability to identify talented applicants who may not be training at traditional 'powerhouse' programs and provide them with access to mentorship." Elizabeth A. David, MD “The scholarship recipients have direct access to leaders and mentors in cardiothoracic surgery throughout the Annual Meeting, and for recipients who do not have access to local mentorship, this is absolutely key,” Dr. David said. “One of the particular strengths of our program is the ability to identify talented applicants who may not be training at traditional ‘powerhouse’ programs and provide them with access to mentorship.” The recipients aren’t the only ones who benefit from the LTTF program. “I have been inspired by my own mentees and their enthusiasm for cardiothoracic surgery,” Dr. David said. “The experience of being a mentor is very rewarding, as you get to share the uniqueness and challenges of our specialty and know that you are influencing the next generation of cardiothoracic surgeons.” To view a list of the 2018 scholarship recipients, visit sts.org/lttf. For information regarding the LTTF program, contact Rachel Pebworth, Senior Coordinator, Affiliate Organizations, via email or at 312-202-5835. STS Leaders Join European and Chinese Colleagues at CSTCVS Meeting Several STS surgeon leaders, along with their counterparts from the European Association for Cardio-Thoracic Surgery, attended the Chinese Society for Thoracic and Cardiovascular Surgery’s Annual Meeting in Hangzhou, China, this past November. One of the Society’s strategic plan goals is to foster collaboration and connection worldwide. Participating in international cardiothoracic surgery meetings is an important part of this initiative. Members of the STS and EACTS delegations visit the largest children’s hospital in the region. From left: Shuben Li, PhD (First Affiliated Hospital of Guangzhou Medical University), Pala Babu Rajesh, FRCS (EACTS Council), Thomas E. MacGillivray, MD (STS Treasurer), Hon Chi Suen, MD (STS Workforce on International Meetings), Qiang Shu, MD (President, The Children’s Hospital of Zhejiang University School of Medicine), Joseph E. Bavaria, MD (STS Immediate Past President), Douglas J. Mathisen, MD (STS Historian and Past President), Peter B. Licht, MD, PhD (EACTS Council), and XiangMing Feng, MD, PhD (Zhejiang University School of Medicine).