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This afternoon the Centers for Medicare & Medicaid Services (CMS) released the CY 2025 Medicare Physician Fee Schedule Proposed Rule. STS has compiled a summary of key provisions affecting thoracic surgery in the rule. 

Payment Cuts

CMS is again proposing significant cuts to cardiothoracic surgery reimbursement, this time by 2.8%. CMS estimates the CY 2025 conversion factor (CF) to be $32.36. Unlike hospital payments with a built-in yearly increase, physician payments do not have such adjustments. STS will continue lobbying Congress and CMS for systematic reforms and an inflationary update to Medicare payments.

Changes to physician reimbursement often stem from the budget neutrality requirement, which lacks a mechanism for inflationary adjustments. Disruptions occur when the value of specific services change, affecting the reimbursement of other services to maintain budget neutrality. STS and the physician community are advocating for Congress to legislate an inflationary update to the CF and adjust budget neutrality thresholds. For more details, see our recent response to the Senate Finance Committee’s request for information on physician payment. 

Quality Payment Program (QPP)

Thanks to advocacy efforts from STS and other stakeholders, Congress has stepped in to extend a 3.5% incentive payment for Advanced Alternative Payment Model (APM) participation in CY 2025 (based on CY 2023 participation). Additionally, starting in payment year 2026, APM participants will be eligible for a higher CF update than other clinicians: 0.75% compared to 0.25%. 

STS previously worked with CMS to provide specialty-specific, meaningful measures for our members who participate in the Bundled Payments for Care Improvement (BPCI) Advanced APM. Additionally, this will be relevant for CT surgeons performing CABG procedures under the new TEAM payment model proposed in the inpatient payment rule. CMS is considering, with STS support, allowing TEAM participation to count towards Advanced APM participation under the QPP.

Global Surgical Codes 

CMS is proposing to expand the use of transfer of care modifiers for global packages. They would require the use of modifiers (-54, -55, and -56) for all 90-day global surgical packages in cases where a practitioner (or another from the same group) expects to provide only the pre-operative (-56), procedure (-54), or post-operative (-55) portions. This applies to both formally documented and informally expected transfers of care. CMS aims to use the information collected to refine global surgical codes in the future.  

In the past, STS has actively promoted the benefits of maintaining the 90-day global code and has refuted flawed data used to advocate for their repeal. We will continue to promote the value of these bundled payments and urge policymakers to extend the increased reimbursement for E/M visits to those packaged in procedural global payments.  

Telehealth

CMS has extended telehealth flexibilities where possible, including adding new services to the telehealth list and permitting two-way and real-time audio-only communication technology for any telehealth service. Absent congressional intervention, the future of telemedicine hangs in the balance as the current telehealth flexibilities are scheduled to expire on December 31, 2024. STS urges Congress to permanently extend telehealth flexibilities established during the COVID-19 public health emergency. 

*Please note, this article was updated on September 5, 2024:

*After STS submitted letters to the Centers for Medicare & Medicaid Services  and the United States Preventive Services Task Force, the Centers for Medicare & Medicaid Services (CMS) responded, stating they cannot reconsider the National Coverage Determination (NCD) at this time. Following this, STS, the GO2 Foundation for Lung Cancer, and the American College of Radiology (ACR) met with CMS and had a productive conversation about the steps that need to occur, and the data needed to reconsider the NCD. USPSTF has also responded, indicating that this issue will be considered at their Topic Prioritization Workshop in the fall.

On June 21, 2024, The Society of Thoracic Surgeons, The American College of Radiology®, and the GO2 Foundation for Lung Cancer submitted joint letters to the Centers for Medicare & Medicaid Services and the US Preventive Services Taskforce that include recommendations to improve existing lung cancer screening eligibility requirements. 

The organizations formally requested reconsideration of the National Coverage Determination (NCD) for screening lung cancer with low-dose computed tomography and asked to eliminate the exclusion criteria of current smokers or people who have quit smoking within the last 15 years and the upper age limit. This would align the NCD with the updated American Cancer Society and the National Comprehensive Care Network evidence-based guidelines. 

Removing these criteria would significantly increase the number of high-risk individuals eligible for screening from 14.2 million to 19.2 million. Annual lung cancer screening with low-dose computed tomography in high-risk patients significantly reduces lung cancer deaths and may help identify cancers at an early, treatable, and curable stage.  

If you have questions about STS’s lung cancer screening advocacy efforts, contact Haley Brown, senior manager, political affairs and advocacy. 

On June 7-8, 2024, in Miami, more than 120 cardiothoracic surgeons and heart team members from around the world gathered for the third annual STS Coronary Conference. With a focus on the technical aspects of coronary surgery, attendees experienced case-based panel discussions, abstract sessions, practical tips and tricks, and interactive “How I Do It” video presentations featuring surgical techniques.

The two-day event covered a wide range of topics, including conduit selection and harvest, graft configuration, off- and on-pump CABG, and a stepwise approach to minimally invasive coronary surgery, from MIDCAB to advanced multivessel revascularization.

"Coronary surgery is a sub-specialty within cardiac surgery, so it’s important for future surgeons to be skilled in off-pump surgery, minimally invasive surgery, and traditional on-pump cross clamp surgical techniques,” said Chase Brown, MD, assistant professor of surgery at the University of Pennsylvania, and a course presenter.  “Attendees were able to learn from experts leading the way in the field.”

"The most exciting things I learned about were the technical aspects of coronary sequential grafting," said cardiac surgery resident Dr. Kevin An from the University of Toronto. “It’s an area I’m interested in implementing into my practice.” 

Here's what a few other attendees said about the Coronary Conference:

• "I enjoyed the panel discussions at the end of each session – I learned as much from them as I did from each of the presentations."
• "So many great presentations. I think the 'How to Prevent AKI After CABG' presentation by Dr. Daniel Engleman may have been my favorite."
• "After attending the sessions, we will add certain changes in the steps for endoscopic harvesting of the saphenous vein, as well as measures to reduce and prevent sternal wound complications."
• "In the future, I would like to see more perioperative content and learn how to implant an Impella 5.5."
• "I really enjoyed the conference.  It was worth coming to the US from Brazil to take the course."
• "As a result of attending the conference, I would tend to perform MAG-TAG more often to more patients, use the skeletonization technique to decrease sternal wound infections, and practice the Y-T graft."

View all conference abstracts. 

Check out our event photo gallery.

The STS Workshop on Robotic Cardiac Surgery held May 9-10 in Peachtree Corners, Ga., offered 80 surgeons from across the country two days of hands-on team training for mitral valve repair, coronary bypass, and other surgery procedures in a cardiac robotics simulation environment.

Here are the top five benefits that surgeon attendees received from the experience:

1. Innovation: Attendees trained in robotic mitral valve procedures and robotic coronary revascularization using the latest techniques and technology. Multiple operating bays fitted with surgical robots allowed participants to sit at the console to control the robots.  

2. Training: The program offered a variety of educational activities for surgeons, including real-world simulations, case videos, faculty discussions, emphasized patient selection, perioperative management and postoperative care, and operative techniques.

3. Collaboration: The workshop was designed for both beginner robotic surgical teams who are looking for fundamental information and guidance on how to build a program, as well as advanced robotic surgical teams already practicing cardiac surgery robotics and are looking to continually improve the efficiency and effectiveness of their program.  

4. Access to luminary experts in the field: The workshop was led by world-renowned robotic heart surgeons. The surgeons who served as faculty not only mastered the use of robotics in cardiac surgery, but they also helped define it. 

5. Networking: Robotic Cardiac Surgery Workshop attendees connected with surgeons from across the country who are on the cutting edge of robotic cardiac surgery. 

Feedback on the conference was overwhelmingly positive. Here are a few highlights:

• "The best presentation was the one on preoperative criteria and assessment for robotic mitral valve patients." 
• "The session content was helpful for those thinking about starting a robotic mitral valve program." 
• "The presentations given by early-stage faculty on difficult cases where they had to convert to open were very helpful." 
• "Dr. Joanna Chikwe's session on complications of mitral valve repairs was wonderful.  I loved this presentation."
• "The most valuable sessions were those that offered peer-to-peer interaction with the experienced surgeons, including the hands-on lab."
• "I think the courses being part lecture and part hands-on gave the background and data to support what we are doing in the lab.  Even more hands-on time would be great, as well."