Advocacy

STS News, Fall 2022 — More than 50 cardiothoracic surgeons, residents, and medical students participated in the Society’s first in-person Advocacy Conference since 2019. STS members met with lawmakers to discuss several key issues of critical importance to STS members and their patients. “The Advocacy Conference is really important for each and every one of us in STS—to get together with colleagues and discuss what is really important in our specialty and, more importantly, for our patients, so that we can make health care better,” said Patrick T. Roughneen, MD, from UT Health Houston McGovern Medical School. “We are here together to talk with members of Congress, and they are very receptive to our voice.” Participants connected with several legislative decision makers during the conference. In addition, STS President John H. Calhoon, MD, presented Rep. Kim Schrier, MD (D-WA), with the STS Legislator of the Year Award. Rep. Schrier discussed the physician workforce shortage and her continued efforts to help stall physician Medicare payment cuts. “What we need is a permanent solution to Medicare reimbursement cuts,” she said. “Every year, the payment cuts come up, and it always is a crisis at the end of the year. I happen to think this is a good time for doctors to make their case, as we are losing physicians to retirement and resignation. This is a moment to make a play for that permanent solution, and I'm working with my committee to help.” STS members also heard from Rep. Larry Bucshon, MD (R-IN), a cardiothoracic surgeon, and Rep. Mariannette Miller-Meeks, MD (R-IA), an ophthalmologist, who provided perspective about the current Congress and its focus for the remainder of 2022. Reps. Bucshon and Miller-Meeks emphasized the importance of surgeon participation in advocacy and answered questions from participants. They explained their roles in temporarily halting Medicare reimbursement cuts for surgeons this year and their hopes to work with health care providers on a more permanent solution. Rep. Bucshon also discussed the bill he cosponsored with Rep. Schrier that would help registries like the STS National Database to facilitate innovation and quality improvement. Dr. Joseph Cleveland Jr. sits down with Rep. Jason Crow (D-CO) during the STS Advocacy Conference. During the conference, STS members met with House and Senate representatives in Congress and their staff, urging them to take action on three issues that are especially important to the specialty. “It’s a great experience to be in the city of Washington, DC, and connecting face to face with members of Congress and legislative assistants, talking about issues that help our specialty and our patients. There’s nothing like it—a lot of energy,” said Karen M. Kim, MD, from the University of Michigan in Ann Arbor. Ask #1: Stop Medicare Reimbursement Cuts The Centers for Medicare & Medicaid Services (CMS) has proposed to cut the Medicare conversion factor—the multiplier used to calculate the amount of Medicare payment using the relative value unit of a procedure or service—by 4.42%. Even worse, additional budget-related cuts will be layered on top starting in 2023. In addition, some estimates show the cost of running a medical practice has increased by 37% between 2001 and 2020. The startling reality is that, when adjusted for inflation in practice costs, Medicare physician pay actually declined 22% from 2001 to 2020. Unless Congress steps in again, cardiothoracic surgeons could see Medicare payment cuts of up to 8.5% in 2023. Reductions of this magnitude represent a very real threat to the financial viability of clinical practices and could limit patient access to care. Ask #2: Support Access to Claims Data Medicare claims data, when linked with clinical outcomes data in registries such as the STS National Database, allow researchers to conduct longitudinal analyses to measure quality improvement and improve patient safety. Currently, regulatory barriers prevent registries from linking claims data with clinical outcomes data. In order to help improve quality of care and perform important research, registries need timely, cost-effective, and continuous access to these data. Ask #3: Support the Resident Physician Shortage Reduction Act A key factor impacting the shortage of physicians is the artificial cap placed on Medicare-supported graduate medical education (GME) positions. This bill would help mitigate the physician shortage by creating 14,000 new GME slots over 7 years.  In December 2020, Congress provided 1,000 new Medicare-supported GME positions—the first increase of its kind in nearly 25 years. While this is progress, more support is needed. The Resident Physician Shortage Reduction Act of 2021 is a step in the right direction. Dr. John Calhoon and other STS members met with Rep. Larry Bucshon (R-IN) and other members of Congress. Miss the STS Advocacy Conference? You Still Can Be Involved! If you could not attend the STS Advocacy Conference, you still have a chance to meet with your federal representatives. STS members are the most effective advocates for the specialty and patients; contact the STS Government Relations office at advocacy@sts.org or 202-787-1230 for help with setting up a meeting or site visit. 

STS News, Summer 2022 — Grassroots advocacy is action that grows organically from the heart of a constituency—its members. And, one of the most powerful types of this grassroots work is patient advocacy. Meet two STS members who have taken patient advocacy to the next level.  The 2019 STS Key Contact of the Year, Rob Headrick, MD, MBA, from CHI Memorial Chest and Lung Cancer Center in Chattanooga, Tennessee, traveled to the White House in late spring to advise the Administration on the mobile lung cancer screening program that he started. The program, known as “Breathe Easy,” features a built-from-scratch bus with a portable computed tomography scanner and brings opportunities for early detection of lung cancer directly into the community. Learn more about the program and Dr. Headrick’s grassroots efforts in the Q&A below. Former STS President Douglas E. Wood, MD, from the University of Washington in Seattle, has taken his patient advocacy to a global level, demonstrating that early detection of lung cancer can have a significant impact in reducing overall cancer mortality. Dr. Wood chaired the Lung Cancer Screening Panel of the National Comprehensive Cancer Network (NCCN) when it was created in 2009. The panel was in the process of creating the first lung cancer screening guidelines when the National Lung Screening Trial (NLST) was published in 2010 (the trial was launched in 2002, and the initial findings were released in November 2010). The NLST demonstrated that a lung cancer screening program could reduce lung cancer mortality by 20%. As Dr. Wood explained, until that point, lung cancer screening hadn’t been accepted as a screening modality and the NLST results “changed the conversation.” However, there was still considerable work to do to get patients access to low-dose CT (LDCT) lung cancer screening. In December 2013, the United States Preventive Services Task Force (USPSTF) granted a B rating for lung cancer screening in adults aged 55 to 80 years who had a 30 pack-year smoking history and were currently smoking or had quit within the past 15 years. The B rating required that private insurance companies cover LDCT scans, but did not extend to Medicare beneficiaries. A Medicare advisory panel advised against screening for Medicare beneficiaries, withholding early detection from those at highest risk for lung cancer. Dr. Wood helped lead a coalition of health professionals to work with Medicare administrators on the safe implementation of screening. In February 2015, Medicare issued a National Coverage Decision providing lung cancer screening as a covered benefit for Medicare beneficiaries. The USPSTF updated its LDCT lung cancer screening recommendations in March 2021 to include adults aged 50 to 80 years who have a 20 pack-year smoking history, and Medicare followed a year later. Unfortunately, they both maintain an upper age limit and the requirement that eligible patients must currently smoke or have quit within the past 15 years. Dr. Wood more recently worked with the President’s Cancer Panel on a report issued in early 2022 that highlighted lung cancer as one of the top four cancers of focus. He also is the vice chair of the National Lung Cancer Roundtable from the American Cancer Society, a consortium of public, private, and voluntary organizations that work together to fight lung cancer by engaging in research and projects that no one organization can take on alone. In addition, Dr. Wood participates in the Lung Cancer Collaboration—a partnership between the World Economic Forum and the Lung Ambition Alliance. This coalition of patient organizations, scientific and medical societies, and industry—which shares the urgent ambition to double 5-year survival in lung cancer by 2030—developed a report that examined lung cancer as global public health issue. The report was presented to the World Health Assembly in May 2022. More information, including important lung cancer references and documents, is available below.   References and Documents from Dr. Doug Wood A report from the President’s Cancer Panel—Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access A report from the President’s Cancer Panel—Lung Cancer Companion Brief Lung Cancer Companion Brief  About the American Cancer Society National Lung Cancer Roundtable World Economic Forum: Urgent, Coordinated Global Action on Lung Cancer Q&A with Dr. Rob Headrick How did you get invited to the White House? We lobbied Washington, DC, and the Tennessee state government for funding to expand the mobile lunger cancer screening concept, but the pandemic put those efforts on hold. In 2021, we announced a partnership with the GO2 Foundation for Lung Cancer, AstraZeneca, Merck & Co., Inc., Bristol Myers Squibb, and a nonprofit foundation to expand the program. This collaboration caught the attention of the Biden Administration and the Cancer Moonshot initiative, and we received an invitation to the White House to help highlight important public-private partnerships that are critical to achieving the Cancer Moonshot goal of decreasing overall cancer mortality by 50% over the next 25 years. It was the highlight of my career to have our many years of work recognized by the White House and used as an example for the type of partnership they are looking for. What did you learn about the Administration’s work to advance lung cancer screening? It was clear to all involved that the quickest way to make progress toward the goal of reducing cancer mortality by 50% is through screening. Lung screening is the biggest first step that will start improving overall cancer mortality rates—which is why the White House was highlighting our mobile program and its effort to reach at-risk rural and underserved populations. The Moonshot leadership recognizes the importance of supporting continued improvements in screening policy. What is the latest on the mobile lung cancer screening bus initiative? The next mobile lung cancer screening bus is currently in the build stage and will hopefully be on the road by January 2023. In order to provide further value to these high-risk patients, the bus will include continued advancements in screening technology such as artificial intelligence (AI), calcium scoring, and possibly bone density assessment. Reliability, remote connectivity, and throughput also will remain priorities in the design. What innovations are there in the lung cancer screening space that STS members and patients should know? Low dose lung screening is much more than just finding lung cancer early. This population also is at high risk for ischemic cardiac mortality. We already use non-gated calcium scores with each lung screening to help protocolize patient risk and make sure appropriate medications are being prescribed. Smoking cessation also is encouraged. There is an opportunity to reduce the cardiac mortality in this population by 30%—similar to the lung screening benefit. In addition, so much data from these scans are not being used. For example, AI will play a role in our future by helping the radiologists read these scans and make better use of the data on the scans to improve the overall health of this population. We will become more efficient at predicting future risk for disease and focusing efforts to help mitigate that risk—all while staying within the low dose parameters and with a short single breath CT scan. How can STS members get involved in supporting the mobile lung cancer screening initiative? The Lung Ambition Alliance—with our help—currently is organizing an international mobile lung screening meeting that will feature all current mobile programs in the US (3) and United Kingdom (1). This meeting will allow those who are interested in developing such a program to learn from the existing programs and ask questions. We are hoping to have the meeting by the fall of 2022. It will likely be held in conjunction with one of the international lung meetings and will include a virtual option for those who cannot attend in person. Mobile lung screening isn’t for everyone, but for many, it is a great way to find lung cancer at an early stage and educate patients in areas where geographic or economic barriers prevent patient engagement. We are always willing to talk with STS members about the business model, discuss how we set up our program, and organize site visits to see the bus.