2018 STS Meeting Bulletin

Shifting Medicare Payment Program Emphasizes Quality Performance

Physician payments are undergoing a sea change as payers seek to reward quality over volume. In particular, the Medicare Access and CHIP Reauthorization Act (MACRA) made significant changes to the way physicians are paid under the Medicare program.

Health Policy Forum: The Changing Medicare Quality Reporting and Payment Landscape

Tuesday, January 30
7:30 a.m. – 8:30 a.m.
Rooms 220-221

As the Centers for Medicare & Medicaid Services implements MACRA’s various provisions, cardiothoracic surgeons will need to stay apprised of changes in reporting requirements and performance benchmarks.

Health Policy Forum attendees will learn how they can be successful under either aspect of the Medicare Quality Payment Program: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).

Speakers will describe the MIPS categories in which clinician performance will be evaluated, including quality, advancing care information, and improvement activities. They also will discuss the current options for participating in an APM and highlight the Society’s efforts in advocating for cardiothoracic surgeons who participate in these programs.


Late-Breaking Abstracts Session Today

Don’t miss a special late-breaking session added to the educational program this afternoon. This Just In: Late-Breaking Research Results and Novel Ideas will be held from 4:15 p.m. to 5:15 p.m. in Room 304 and will feature abstracts on fetal aortic valve development, minimally invasive esophagectomy, surgeon-specific performance monitoring, near-infrared fluorescence guided surgery, and total arterial revascularization. Three additional late-breaking abstracts have been added into scientific sessions today and tomorrow. Access a PDF of the late-breaking abstracts at sts.org/annualmeeting.

Learn How to Improve Accuracy in Your Manuscripts

The publication of research using national databases has risen exponentially over the past decade. Unfortunately, methodological mistakes are common when preparing manuscripts and interpreting results.

The Annals Academy: Preparation and Interpretation of National Database Research

Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 316

During The Annals Academy, experts will explain the differences between association and causality in observational research, as well as between statistical and clinical significance in large databases. They also will describe common performance metrics for multivariable modeling and discuss options for merging STS National Database data with other longitudinal databases to obtain long-term outcomes.

For additional information on improving your manuscripts, stop by the STS booth (#807) in the Exhibit Hall, where staff from The Annals of Thoracic Surgery will be available to answer your questions.


Novel Strategies Can Help Manage N2 Disease in NSCLC Patients

Immunotherapy using new PD-1 receptors and other markers may help prevent a systemic reoccurrence of N2 disease in patients with non-small cell lung cancer (NSCLC), according to Robert J. Cerfolio, MD, MBA, from NYU Langone’s Perlmutter Cancer Center.

STS/CATS/CSCS: Difficult Decisions in Thoracic Surgery—Advice From Canadian and American Experts

Monday, January 29
11:30 a.m. – 12:30 p.m.
Room 305

“This represents a paradigm shift for us as surgeons in the very diverse group of patients with N2 disease, which is controversial because we are now seeing patients who are 2 and 3 years out of chemotherapy for stage IIA N2 disease and only have local disease left that can be resected with lobectomy,” said Dr. Cerfolio. “Immunotherapy has changed our landscape a bit in these patients and may make the North American surgeon as aggressive as the European surgeon for N2 disease upfront, as the need for improved local therapy may increase, and the role of surgery may be revisited as the direct line of treatment.”

Difficult decisions regarding the treatment of N2 disease will be discussed today during a collaborative, case-based session organized by STS, the Canadian Association of Thoracic Surgeons, and the Canadian Society of Cardiac Surgeons.

“N2 disease must be identified prior to the start of thoracic oncologic therapy or procedures, as we increasingly focus on safe therapeutic treatment strategies,” Dr. Cerfolio said, adding that North American surgeons still prefer that patients with biopsy-proven N2 disease undergo neoadjuvant therapy prior to surgery.

In addition to the management of N2 disease in the NSCLC patient, session participants will discuss various approaches to managing airway injuries and fistulae following esophagectomy.


STS National Database Enables Extensive Research

The STS National Database is a valuable tool for quality improvement and research, and research utilizing the Database has grown exponentially in recent years. STS offers researchers various options for using these data, depending on the scale of the project and the questions posed by researchers.

Research Using the STS National Database

Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 305

The STS Access & Publications Research Program allows Database participants to submit novel, well-conceived, and hypothesis-driven proposals for research. Submissions are accepted two times a year for the Adult Cardiac Surgery Database, General Thoracic Surgery Database, and Congenital Heart Surgery Database. Soon, requests will be accepted for the new Intermacs Database component, which focuses on mechanical circulatory support devices.

Another option is the STS Participant User File (PUF) Research Program, which allows analysis of national-scale de-identified data from the Database at investigators’ institutions. The PUF Program was designed primarily as an affordable option for investigators to pose research questions, quickly obtain quality data, analyze these data themselves given appropriate biostatistics resources, receive feedback, and develop their efforts into abstracts and manuscripts.

At this afternoon’s Research Using the STS National Database session, speakers will explain the differences between the programs, cover the ins and outs of submitting data requests, and offer tips on developing a hypothesis, specific aims, and research plan.

This is a must-attend session for anyone wishing to fully utilize the research capabilities of the STS National Database.

Learn How to Advocate for the Specialty

STS Key Contacts are the lifeblood of the Society’s advocacy efforts. Key Contacts meet with their elected officials in Washington, provide facility tours at home, and do much more to advocate for legislative and regulatory issues that affect cardiothoracic surgeons and their patients.

STS Key Contacts: Advocates for Cardiothoracic Surgery

Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 220-221

But many surgeons may not know how to get started or may feel unprepared for these meetings. During this afternoon’s STS Key Contacts: Advocates for Cardiothoracic Surgery, attendees will gain the tools to become more involved. STS staff and surgeon leaders will explain how the program works, discuss the current health care debate, and describe how STS-PAC enhances these advocacy efforts. In addition, experienced Key Contacts will role-play a meeting with a member of Congress, the Key Contact of the Year and other awards will be announced, and attendees will be able to socialize and network.


Ethics Debate Explores Postoperative Coverage

More smaller or remote health care facilities are requesting assistance from cardiothoracic surgeons at major hospitals, leading to controversy over what happens when the cardiothoracic surgeon leaves. Oftentimes, patient care is transferred to a less experienced general surgeon. During the Ethics Debate, two cardiothoracic surgeons will explore the pros and cons of this practice.

Ethics Debate: Neighborly Help or Itinerant Surgery?

Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 315

James S. Allan, MD, of Massachusetts General Hospital, will argue that postoperative coverage by a general surgeon is an acceptable arrangement, while Alberto Ferreres, MD, PhD, of the University of Buenos Aires School of Medicine, will argue that a cardiothoracic surgeon must provide postoperative coverage.

“The debate is not going to provide an answer to this question,” said STS/AATS Cardiothoracic Ethics Forum Chair Robert M. Sade, MD, who will facilitate the discussion. “It is going to provide two different ways of thinking about it. Then, it will be up to whoever is in the audience to take that information and decide how they would handle it if it comes up.”

Symposium Highlights Techniques to Manage Heart Infections

Infectious heart disease, especially as a result of the current opioid epidemic, is on the rise among young adults. At the International Symposium, surgeons from around the world will explain their approaches to dealing with these infections, the central challenges they face, and the ethical disease management dilemmas related to infectious heart disease in young adults.

International Symposium: Confronting Infectious Diseases in Young Adults Undergoing Cardiac Surgery

Monday, January 29
1:30 p.m. – 3:30 p.m.
Room 304

Speakers will discuss the treatment of infected mitral valves, repairing the bicuspid aortic valve, endocarditis and neurological complications, transcatheter interventions for failing repairs, valve thrombosis, and infection of aortic prostheses.

“Many surgeons in developing countries don’t have the resources they need to treat these patients,” said session moderator Juan P. Umaña, MD, of Fundacion Cardoinfantil-Institute of Cardiology in Bogotá, Colombia. “Imaging techniques are not readily available, so discussing a simple algorithm in how to approach these patients will be a major focus.”

STS 2018 Begins

Richard L. Prager, MD

Welcome to the STS 54th Annual Meeting! I am thrilled to welcome you to Fort Lauderdale for this preeminent educational event in cardiothoracic surgery.

The STS Annual Meeting will be packed with interactive learning on hot topics. Over the next 5 days, you’ll experience thought-provoking lectures from renowned faculty and guests, exciting hands-on learning, an abundance of networking opportunities, and a chance to view the latest products and services in the specialty.

A number of sessions will feature perspectives from international experts. A Monday session from STS, the Canadian Association of Thoracic Surgeons, and the Canadian Society of Cardiac Surgeons will provide information on the management of airway injuries post-esophagectomy, management of N2 disease in non-small cell lung cancer, and much more. Also on Monday, surgeons at the International Symposium will explain their treatment approaches, challenges, and ethical dilemmas related to dealing with infectious heart diseases in young adults—especially in light of the current opioid epidemic.

On Tuesday, the Society will team up with the European Association for Cardio-Thoracic Surgery in a session on the treatment options available for bicuspid aortic valve disease associated with pure aortic valve insufficiency and root dilation. In the afternoon, STS will partner with the International Society for Heart and Lung Transplantation in a new session on contemporary experience with left ventricular assist device therapy around the globe. STS also will join with the European Society of Thoracic Surgeons to discuss controversial issues in general thoracic surgery, including surgical management of pulmonary metastases, management of malignant pleural mesothelioma, surgery in small cell lung cancer, and chest wall tumors.

In addition to collaborative sessions with international participants highlighted above, special presentations with the American Association for Thoracic Surgery, the American College of Chest Physicians, the Society of Cardiovascular Anesthesiology, and the Society for Vascular Surgery also are part of the program.

A new session on Monday will tackle the topic of diversity and inclusion in cardiothoracic surgery. Speakers will discuss how a diverse cardiothoracic surgery workforce can improve patient outcomes through increasing cultural competency and mitigating unconscious provider bias. Please make plans to attend this important session.

I also am very pleased about the three outstanding guest speakers at the General Session on Tuesday morning. Not one, but two speakers have been chosen for this year’s Thomas B. Ferguson Lecture. John Ayanian will deliver “Health Care Reform: Why It’s Still Needed and Where It’s Headed.” He is the Director of the Institute for Healthcare Policy and Innovation at the University of Michigan. Karen Joynt Maddox will present “The Future of Payment Reform in Medicare.” She is a practicing cardiologist at Washington University in St. Louis who has served as a health policy advisor for the Department of Health and Human Services. Following the two presentations, Keith Naunheim, Dave Shahian, Alan Speir, and I will participate in a panel discussion on health care reform.

The C. Walton Lillehei lecturer will be Laura J. Snyder, a historian, philosopher, and writer. Her talk, “The Philosophical Breakfast Club and the Invention of the Modern Scientist,” will describe how a group of thinkers at Cambridge University in the early 19th century introduced four major principles into scientific inquiry and, as a result, transformed medical science.

A full listing of presentations is available in your Program Guide, a publication that you will find invaluable for planning your schedule. New this year, the scientific abstract information is available in an e-only Abstract Book (sts.org/abstractbook) and in the STS Meetings app (sts.org/mobileapp).

On behalf of the Society’s leadership, thank you for joining us here in Fort Lauderdale. Welcome to the meeting!

Richard L. Prager, MD
STS President

Get the Most Out of the Annual Meeting

Kevin D. Accola, MD asks a question during the 2017 Annual Meeting.

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.

Download the App
“Planning your schedule at the meeting can be a challenge,” said Robbin G. Cohen, MD, MMM, Associate Professor of Cardiothoracic Surgery at the University of Southern California in Los Angeles. “It’s true that you have to juggle in order to see the things that interest you, and you can’t always attend everything you want to.”

If you haven’t already, download the STS Meetings app, available at sts.org/mobileapp, to help you stay on schedule. You can save sessions and presentations to your personal itinerary, then set alerts so that you’re reminded when they’re about to begin. You also can use the app to read scientific abstracts and take notes during presentations.

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. 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 are prepared to 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.

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, this issue of the STS Meeting Bulletin 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,” said Dr. Cohen. “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, STS-PAC, 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.”

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. The event allows attendees to connect with leaders in cardiothoracic surgery in a picturesque, informal setting. It’s not too late to purchase a ticket; you can do so at Registration on the first floor.

On the other evenings, industry-sponsored satellite activities feature expert talks and oftentimes a free meal.

“Many surgeons have been invited to industry dinners in advance by their local reps,” Dr. Cohen said. “These 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.