Public Reporting of CABG-Valve Data

Thanks to all for responses to the notice that the CCORP will begin reporting CABG-valve cases sometime in the near future (the earliest would be the end of 2014). Of about 20 surgeons who responded, most agreed with Fred Grover’s parting recommendation that no further cardiac surgery reporting be undertaken without reporting of PCI. While this is not surprising, some also pointed out that we surgeons have been in the forefront of public reporting and should continue to support it. Unfortunately the law (SB 680) that established CABG reporting included ALL CABG, not just isolated CABG. Further, from a statistical point of view, the greater number of outcomes (deaths) provides improved significance to the reports. Clearly the law needs to be updated and this time around the CASTS must play a more active role in the legislative process.

A few quotes from the responses:

“Reporting needs to happen now, with cardiology and cath lab stats–there needs to be “skin in the game” and take advantage of their stronger lobbying power.”

“…until cardiologists agree to report their interventions, cardiac surgeons should simply tell their hospital administrations, that they will no longer act as back up for interventions that are undertaken without accountability.”

“I also agree with Dr. Grover’s wise remark not to participate in any State sponsored reporting until the Cardiologists are forced being accountable of their work. I see too many PCIs with poor intermediate and long term outcomes. The standing recommendation to refer a patient for CABG with 3 vessel disease and significant LV dysfunction is violated on a daily basis.”

“We need to develop a strategy to get a law to get PCI publicly reported. This will also require funding. Perhaps the CA ACC could step up. We can fight the extended CABG reporting, I predict without success. Instead, I recommend making the case for PCI reporting. The concerns that lead to the original law to report CABG is totally applicable to lead the quest to report PCI.”

“……if the ultimate intent of the reporting is to elevate the level of cardiovascular health care delivery then it must include defining what has appeared by some observers (myself included) to be an egregious inappropriate excess…reporting pci results is essential …. if mechanisms to force the issue are necessary then they should be used…double standards are hard to defend.”

“I disagree with Fred Grover. Cardiac surgery public reporting for cabg has reduced operative mortality since introduction. Expanding to valves and cabg valves would undoubtedly have a similar influence. Our specialty has had unusual strength of character and integrity making our leadership by example more powerful than debate.”

“The caveat for me is that this next level has to be more than just a linear extension of the mechanics of studying CABG to valve/CABG. There is more that we need from the data management since we have learned how it drives surgical, post surgical and nonsurgical behavior. Although I agree with Dr. Grover’s wish to have PCI also reported, I disagree that we should wait for that to happen before we move further forward. CABG data has dramatically improved outcomes even though the public does not know how to interpret these numbers. They none the less have been beneficiaries.”

“Historically, cardiac surgeons were initially dragged into a position of accountability insofar as risk-adjusted outcomes data for CABG surgery. Now, after three decades, the profession is admired by its peers and by the public for its foresight and clarity of purpose . The accurate reportage of our results has had beneficial effects in terms of better outcomes and has served as a useful guidepost for our patients in selecting whom they want as a surgeon. I can only see benefits in extending this accountability to the practice of valve/cabg surgery and possibly eventually robotic surgery.”

“We need to use this energy to point out the value of CASTS. I will certainly work on my state senator and assemblyman to get some legislation going. Also CMA can help push it once it gets going. The Consumers Union would be hypocritical if they didn’t support it also.”

Resignation of Ed Fonner

It is with a deep sense of gratitude as well as some sadness that I announce the resignation of Ed Fonner as Executive Director of CASTS. As many of you know, Ed has had some health issues as of late that have precluded him from continuing in this position. His organizational skills, innovative leadership, and friendship will be greatly missed. During several years of limited participation by surgeons in the organization, Ed was able to expand the organization by forming a solid alliance among the data managers in our group. His monthly conference calls, which were very popular, provided a focus for many of our activities, and achieved a national voice which brought the respectful attention of the National STS leadership. It is our sincere hope that we can find a way to foster the continued active participation among the data base managers as we push forward. I know I speak for all of us as we wish Ed Fonner warmest best wishes as he meets the challenges that lie ahead. He is indeed a remarkable individual.

The California STS has recognized the need to refocus on our goals and objectives as we continue into the future. It is a good time to select new, reinvigorated leadership for the organization, including the selection of a new President and Board of Directors. Dr. Joe Carey, founder of our organization, has graciously agreed to serve as Interim Executive Director as we begin to reshape our future. In the coming weeks, through a series of conference calls we intend to reformat the Board and to elect a new President. It has been an honor to serve the organization, but it is indeed a good time for a change. Please stay tuned as we begin this transformation into a more inclusive, functional organization that best represents the interests of thoracic surgery in California.