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The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule today. STS has compiled a summary of key provisions affecting cardiothoracic surgery in the rule.  

Payment Cuts

CMS is proposing severe cuts to cardiothoracic surgery reimbursement. According to CMS, cardiothoracic surgeons will see a 3% cut in 2024. CMS estimates the CY 2024 conversion factor (CF) to be $32.7476. STS will continue to fight these cuts by lobbying Congress and CMS to provide an inflationary update to Medicare payments. While physicians have been subjected to across-the-board cuts for the last several years, Medicare continues to increase payments to hospitals, most recently proposing a 2.8% increase for inpatient hospital payments. Physicians deserve similar treatment.  

Changes to physician reimbursement are often driven by Medicare’s budget neutrality requirement combined with no built-in mechanism for inflationary or other increases in resources for the Medicare fee schedule. Disruptions to reimbursement occur when there are changes to the value of specific services, which negatively affects how other services are reimbursed to maintain budget neutrality. An inflationary update would be the first step toward resolving the constant downward pressures created by this dynamic. Urge your lawmakers to support H.R. 2474, a bipartisan bill that would create an automatic inflation update for physician payments for the first time. 

Global Surgical Codes

Once again, CMS has failed to apply the increased value of evaluation and management (E/M) codes services packaged in global surgical payments. STS has repeatedly recommended that CMS follow its own precedent and apply commensurate values for the office/outpatient E/Ms, inpatient E/Ms, and discharge day management visits packaged in the procedural global payments. This has been CMS’s policy every time E/M services have undergone a significant overhaul.  

Previously Delayed Complexity Code

CMS is once again proposing to implement payment of the flawed G2211 add-on code for E/M office visits, which was previously delayed by Congress through legislation. These visits are defined as a “visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.” STS successfully advocated for the congressional delay to this code in 2020 and continues to have significant concerns with its proposed implementation, which will impact the Physician Fee Schedule by redistributing billions of dollars between specialties. STS has and will continue to vehemently advocate against this proposal in its current flawed form.  

Telehealth

CMS is retaining Category 3 codes on the Medicare telehealth list through CY 2024. STS is supportive of this proposal as data collected during COVID-19 demonstrates the positive impact telehealth has had on both patient clinical outcomes and patient experiences.  

Additionally, CMS proposes to provide coverage and payment of certain audio-only telehealth services until December 31, 2024. STS supports the provision of continued payment for audio-only visits in appropriate circumstances to help address health disparities and individuals without strong internet access, although we do not believe audio-only is adequate for more complex visits. 

Quality Payment Program

CMS will discontinue the Alternative Payment Model (APM) incentive payment as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in CY 2024. Instead, for performance year 2024, CMS is proposing APM participants receive a higher payment rate using a specific qualifying APM conversion factor. If CMS’s goal is to encourage providers to prioritize value-based care by participating in APMs instead of the traditional MIPS program, then CMS should work with Congress to reauthorize the 5% APM incentive payment. Additionally, the Centers for Medicare and Medicaid Innovation (CMMI) will need to test APMs that directly recognize the role of specialists. 

CMS also proposes to expand the inventory of MIPS Value Pathways (MVPs), which is a new voluntary participation option aimed at providing clinicians with a more focused and cohesive MIPS experience. While MVPs offer a slight reduction in reporting burden, STS continues to believe that it fails to address fundamental flaws that have hampered meaningful participation by cardiac and thoracic surgeons.  

On June 3, 2023, in Miami Beach, Florida, cardiothoracic surgeons from around the world convened for the second annual STS Coronary Conference. Distinguished speakers and luminary surgeons painted a modern, ever-changing landscape of coronary surgery with new technologies, such as medical robotics, increasingly integrated into the specialty daily. Attendees experienced game-changing ideas, back-to-the-basics techniques, and ground-breaking science in diagnostic and therapeutic approaches to heart disease.

“The meeting brought together international leaders in the treatment of coronary artery disease and focused on the fundamentals and advanced therapies for coronary artery disease, including medical management, arterial conduits, and minimally invasive surgical revascularization,” said Joseph F. Sabik III, MD, surgeon-in-chief and vice president for surgical operations at University Hospitals Cleveland Medical Center, and a course director of the conference. “The conversations were engaging and the atmosphere was electric.”

Sessions covered a wide range of topics, including heart team patient selection and approaches; conduit selection and harvest; non-invasive and invasive preoperative workups; and postoperative medical therapy.

Here’s a look at a few key presentations:

Two Decades of Coronary Artery Bypass Grafting in Females: Has Anything Changed? ​

Elizabeth Norton, MD, Emory University School of Medicine, and a team of surgeons representing the division of cardiothoracic surgery and the division of cardiology at the institution, examined trends in females undergoing isolated coronary artery bypass grafting during the past two decades. What they found is that female CABG mortality at their institution was higher than the male cohort and the overall national average and did not improve over time.​ Females undergoing isolated CABG were increasingly diverse, experienced more preoperative comorbidities, were more likely to undergo urgent CABG, and had greater IMA utilization.

External Stenting for Saphenous Vein Grafts in Coronary Surgery

Saphenous vein grafts have high failure rates with 3% to 12% occluding before hospital discharge, 8% to 25% failing at 1 year, and only 50% to 60% remaining patent after a decade.​ As a research fellow with the department of cardiothoracic surgery at Weill Cornell Medicine, Giovanni Jr. Soletti, MD, wanted to know - can neointima formation be prevented?​

By conducting a study-level meta-analysis of randomized clinical trials and other research methods, Dr. Soletti found that VEST reduces intimal hyperplasia and thickness of SVGs after CABG. This reduction does not translate into fewer graft occlusion events or repeat revascularization compared to non-VEST SVGs at a follow-up of 1.5 years. SVGs harvested with no-touch technique or arterial conduits, when clinically adequate, may be safely used to improve long-term patency. Further long-term data and larger studies are needed.

Intraoperative Extubation After Isolated CABG and Post-Operative Outcomes

There is a well-known association between post-op ventilator time and morbidity in CABG surgery. Les James, MD, a resident cardiothoracic surgeon at NYU Langone Health, explored the impact of routine OR extubation on postoperative outcomes. She studied risk factors and outcomes based on a patient’s age, BMI, EF% STS risk score, STS prolonged vent score, CPB, and XC and concluded that routine OR extubation after isolated CABG is safe and that expanded use of planned OR extubation may be warranted.

All three highlighted abstract presentations were conducted by cardiothoracic fellows. STS encourages residents and fellows to submit original research to an international expert faculty for future presentations.

Review all conference abstracts.

Find the latest updates on STS member job changes, promotions, and accomplishments.

de Souza Will Advance Robotics in Tampa

Rodrigo de Souza, MD, has joined the University of South Florida’s Morsani College of Medicine as an associate professor of cardiothoracic surgery. Dr. de Souza, who previously taught at the University of California, San Francisco (UCSF), is employed to develop minimally invasive and robotic cardiac surgery at Morsani and the Heart and Vascular Institute at Tampa General Hospital. He has been an STS Member since 2022.

Dubeau Named First TSF Resident Director

Carolyn Dubeau, MD, has been appointed to serve a two-year term on the board of The Thoracic Surgery Foundation, STS’s charitable arm, as its very first resident director. Dr. Dubeau, currently in her third year of training at UT Health San Antonio, plans to pursue a path in congenital cardiac surgery. She became a Resident/Fellow Member of STS last year.

Cohen Directs Cedars-Sinai Cardiac Surgery Program

Robbin Cohen, MD, MMM, now serves as director of the Cedars-Sinai Cardiac Surgery Program at Huntington Health in Pasadena, CA, an affiliate of the Smidt Heart Institute in Los Angeles. An STS Member and volunteer since 1993, Dr. Cohen serves as chair of STS’s Workforce on Media Relations and Communications, vice-chair of the Standards and Ethics Committee, and is a member of the Workforce for Patient Safety.

Yang Is Frankel Research Professor at University of Michigan

Bo Yang, MD, PhD, has been named the inaugural Frankel Research Professor in Aortic Surgery at the University of Michigan. Dr. Yang joined the university’s Department of Cardiac Surgery in 2011 after a fellowship at Stanford University. A 2015 Thoracic Surgery Foundation Research Grant recipient and an STS member since 2010, Dr. Yang specializes in complex aortic repair.

Bhora Appointed as Hackensack Regional Chair

Faiz Y. Bhora, MD, FACS, was recently onboarded at Hackensack Meridian Health as the inaugural Regional Chair of Surgery for the New Jersey central region. Dr. Bhora previously was system chief of thoracic surgery and director of thoracic oncology at Nuvance Health and chief of thoracic and robotic surgery in the Mount Sinai Health System. He has been an STS Member since 2005.

Toker Takes Helm at West Virginia University

Alper Toker, MD, has been named professor and chief of thoracic surgery at the West Virginia University (WVU) Heart and Vascular Institute and the Department of Cardiovascular and Thoracic Surgery in the WVU School of Medicine. Dr. Toker joined WVU in 2019 and has served as interim chief of Thoracic Surgery for the last several months. An STS Member since 2021, he leads the tracheal surgery program and the thoracic surgical oncology program.

Fiedler, Scrimgeour Make History on All-Female Transplant Team

STS Members Amy Fiedler, MD, and Laura Scrimgeour, MD, were part of a historic heart transplant team at the University of California, San Francisco, in which the surgeon, anesthesiologist, surgical fellow, perfusionist, nurses, and patient were all women.

"I go to work every day because I love cardiac surgery," Dr. Fiedler told the TODAY show, who picked up their story. "To be able to be a part of something bigger that can hopefully inspire the next generation of individuals—be it boys, girls, people of color—for anyone to look at us and say, 'There's no barriers and I can do this,' that's really what makes it worth it."