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On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule final rule. Despite vocal opposition from The Society of Thoracic Surgeons (STS) and many others in the physician community, this rule finalizes a greater than 3% reduction to physician reimbursement beginning January 1, 2024.

When adjusted for inflation, Medicare physician payments have declined by 26% since 2001. This latest reduction is the most recent example of a trend that is unsustainable and impacts patient access to care. These cuts are due to the implementation of the flawed complexity add-on code G2211, combined with expiring temporary relief previously enacted by Congress. The final rule also contains a few positive developments. CMS agreed with STS’s concerns that raising the required threshold to avoid a penalty in the Merit-based Incentive Payment System (MIPS) from 75 to 82 points was inappropriate at this time because the MIPS program has been largely paused since 2019 due the COVID-19 pandemic. CMS also approved several new intraoperative cardiac ultrasound CPT codes (76987–76989) at higher levels than in the proposed rule, which will be available to cardiothoracic surgeons next year.

Fortunately, the Senate Finance Committee recently released a draft legislative proposal that seeks to extend relief payments for physicians that are slated to expire this year. If enacted, this would help counteract a portion of the cuts slated for 2023. STS will continue to urge Congress to halt this unsustainable cut and to enact policies such as H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would provide an annual automatic inflation update for physician payments going forward. Help us maintain adequate Medicare reimbursements by contacting your lawmakers now!

Learn more about STS’s advocacy efforts focused on the 2024 Medicare Physician Fee Schedule.

Overall survival rates of esophageal cancer have risen in the past 50-plus years, from 5% in 1970 to 22% in 2023. Yet, no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that incorporate input from surgeons, radiation oncologists, and medical oncologists have been available, until now. 

The Society of Thoracic Surgeons, American Society for Radiation Oncology, and American Society of Clinical Oncology have co-authored the first comprehensive guideline on the management of esophageal cancer. Published today in The Annals of Thoracic Surgery, the guideline addresses key clinical subject areas pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer. 

The guideline delivers recommendations for the use of induction chemotherapy, optimal radiation dose, value and timing of esophagectomy, use of chemotherapy vs. chemoradiotherapy before surgery, approach and extent of lymphadenectomy, and the value of adjuvant therapy after resection.

“These comprehensive guidelines address areas critical for standardizing and improving care and outcomes for esophageal cancer patients,” says study investigator Stephanie Worrell, MD, clinical associate professor and thoracic section chief at the University of Arizona in Tucson. “The recommendations are based on a comprehensive review of innovations and advancements in the most recent literature.”

The Society of Thoracic Surgeons presented the Legislator of the Year Award to Congressman Raul Ruiz, MD, (D-CA), during a ceremony at the 2023 STS Advocacy Conference on October 17 in Washington, DC. The congressman was honored for his leadership on numerous policies impacting cardiothoracic surgeons and the physician community at large.

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“As an emergency physician, Rep. Ruiz understands the issues facing physicians and their patients. He works tirelessly on behalf of the community to address these issues head-on,” said Thomas E. MacGillivray, MD, STS President. “He has championed improvements to stabilize Medicare physician payments through an annual inflationary update. He also has played a key role in reducing physician burnout and maintaining an appropriate balance of power during insurance negotiations over billing disputes. STS is incredibly proud to be represented in Congress by a physician leader like Dr. Ruiz.”

For the first time, The Society of Thoracic Surgeons joined the Korean Society for Thoracic and Cardiovascular Surgery (KSTCVS) in their presentation of the Heart Valve Disease Forum (HVDF), an annual conference that delivers the latest developments on the basis, cause, diagnosis, treatment, and future of valve disease.

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The forum, held September 15-16, 2023, in Dragon City, Yongsan, Seoul, was led by the President of the HVDF, Dr. Kyung Hwan Kim, and organized by co-program directors Dr. Joon Bum Kim of Asan Medical Center of Ulsan College of Medicine and Dr. S. Chris Malaisrie of Northwestern University, who commented “STS was thrilled to partner with the KSTCVS on this international event, highlighting transpacific expertise on valves.”

Dr. Kim remarked, “By co-hosting the forum with STS, we brought together the world’s top scholars in related fields for discussion and achieved the best conference experience.”

More than 300 surgeons, residents, and other medical students attending the conference heard from luminary surgeons and professors on today’s hottest topics impacting the specialty, including TAVI, innovative SAVR, and endocarditis, and trained on surgical techniques in wet labs. “The dynamic, case-based discussions and interactive wet labs with skilled faculty inspired the next generation of cardiac surgeons," said Dr. Malaisrie.

Dr. Thomas MacGillivray, president of STS, delivered several talks, including one on “Crisis Management in the Operating Room and Surgeon Leadership.”

At this year’s conference, particular emphasis was placed on connecting young surgeons responsible for the future of heart valve surgery with proven STS surgeon leaders through a mentor-mentee program. It was an exclusive opportunity for early career attendees to gain invaluable guidance on navigating their career paths and overcoming challenges from leaders.

“The heart valve symposium was a wonderful success and a historical event that stands out among the meeting’s 30-year history,” said Dr. Kim. “Our Korean colleagues agreed that collaborating with STS was the best thing in terms of excellence of lectures, one-to-one teaching in the wet lab, an exciting mentorship program, and beautiful times spent outside of the conference room.”

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Cardiothoracic surgeons provide tremendous value to the patients and institutions they serve. But understanding their value and translating it into fair compensation has always been challenging. While there are external resources that provide general guidance on surgeon compensation, there are no compensation surveys that capture the nuances of the specialty. Until now.

STS has commissioned Gallagher, a consulting firm with more than four decades of experience in physician compensation and valuation services, to conduct a first-of-its-kind compensation survey in early October to help CT surgeons practicing in the U.S. understand their value in the market specific to their specialty, practice, career stage, and geographic region. Data collected will be kept confidential and will not be shared with STS.

A compensation report, featuring only aggregated data consistent with federal guidelines to ensure data integrity and anonymity, will make it easier for CT surgeons to evaluate employment opportunities and negotiate salaries and benefits.

The compensation report—slated for release January 2024—will be available to STS surgeon members who participate in the survey at no cost, and to STS members and nonmembers who do not participate in the survey for a fee.

How To Participate in the STS Compensation Survey

Non-resident/trainee CT surgeons should have received an email with instructions on how to complete the survey from Gallagher or you can access the survey here. The survey should take about 15 minutes to complete.

Participants should have their 2022 W-2 (or equivalent income documentation), compensation plan, and associated annual compensation calculations and productivity (e.g., wRVUs, etc.) reports at hand before they begin. Participants should contact their practice administrator if they do not have access to the required documentation.

Deadline for completing the survey is October 27, 2023.

If you have questions or do not receive an email invitation but wish to participate, email jenna_lambrecht@ajg.com.