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The Society of Thoracic Surgeons General Thoracic Surgery Database

2007; Elsevier BV; Volume: 83; Issue: 3 Linguagem: Inglês

10.1016/j.athoracsur.2006.09.078

1552-6259

Cameron D. Wright, Fred H. Edwards,

Cardiac Valve Diseases and Treatments

The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database has been a major success story for The STS, the participating surgeons, and our patients. This is now a robust database that is risk-adjusted and nationally renowned. As a result, the STS database is acknowledged by other specialties, government and consumer groups, and third party payors as the gold standard clinical data analysis registry. Data from the Adult Cardiac Database has allowed the joint STS/American Association for Thoracic Surgery (AATS) Workforce on Nomenclature and Coding to present actual data to the Relative Value Unit Update Committee (RUC) on cardiac operations to allow accurate valuation of previously undervalued Current Procedural Terminology (CPT) codes. Previous RUC methodology involved a small survey in which solicited physicians estimated the work involved in a specific CPT code by educated guessing. The new methodology, based on real data from the STS database included information such as preoperative risk factors, operating room time, intensive care unit stay, and days in hospital. Because of this improved data, the RUC recommended substantial increases in the relative value units of adult cardiac codes, which should lead to reimbursement that more accurately represents the intensity and complexity of the work that we do on behalf of our patients. The much smaller community of general thoracic surgeons needs to garner the same advantages that the Adult Cardiac Database provides. Momentum has been building in the General Thoracic Database; there were about 11,000 patients in 2003; 23,000 in 2004; and 30,000 in 2005. Currently 57 participant sites are enrolled in the General Thoracic Database. There are many reasons to participate in the General Thoracic Database: quality improvements in patient care, maintenance of certification by the American Board of Thoracic Surgery, support of contracting and payor negotiations, and differentiation from surgeons who are less qualified to perform thoracic surgery. The most important reason to participate in the STS General Thoracic Database is for the ongoing quality improvement efforts to improve patient outcomes. This is important for assessing areas of quality improvement locally and nationally. Surgeons are increasingly measured by a variety of administrative and payor-based databases, and participating in a high-quality clinical database allows thoracic surgeons to be proactive in addressing issues of quality, cost, and pay for performance. If you do not know the rate of atrial fibrillation or pneumonia after pulmonary resection, how can you monitor your effort to improve it and document it? How are you (or your group) doing among your peers? How does your mortality for pneumonectomy compare with other surgeons in your community? We need nationwide data from a spectrum of sources (ie, both private and academic) to allow us to benchmark the current results of our surgery. We are just beginning to gather enough data to begin risk modeling for our common larger operations. These efforts are now underway in conjunction with biostatisticians at the Duke Clinical Research Institute. This will allow risk adjustment similar to what is reported to the cardiac surgeons now. In addition, clinical research using the database will allow us to answer questions that previously could not be asked due to small sample sizes. Participation in a clinical database enormously helps to document your practice for your hospital reappointment or for the upcoming maintenance of certification for the American Board of Thoracic Surgery. Future recertification by the Board of Thoracic Surgery will require documentation of your practice along with clinical outcomes. Participation in the database will allow you to provide the necessary data to prove that you provide competent care for your patients. Pay for Performance (P4P) is currently being tested by the Centers for Medicare & Medicaid Services (CMS) for several medical diagnoses, and surgery is not far behind. Private insurance companies are starting to have contracts that require documentation of quality of care for reimbursement. Thoracic surgeons should lead the way with a database that collects pertinent structure, process, and risk-adjusted outcome information that was designed by the specialty rather than by the government or the insurers. Future contracts with insurance companies will likely include performance measures that must be met to capture an at-risk withhold. Database participation with collection of quality measures will likely convince insurance executives that you are serious about patient safety and good results when you negotiate insurance contracts. There are two fees associated with participating in the database. There is a participation fee paid to the STS for the cost of collecting the data, storing it in the Duke Clinical Research Institute (DCRI), analyzing the data and reporting it back to the participants. Recently this annual fee has been adjusted by the STS Board of Directors (now $400 per each STS surgeon and $500 for nonmembers) to increase its affordability for surgeons in solo practice or in a small group practice. There is also a fee for the software (and software support) used for data collection and transmittal to the DCRI. There are currently nine STS licensed software vendors with a variety of prices; most of these vendors also produce software for the Adult Cardiac Database. Data entry for some surgeons is done by data managers, some of which may be paid by the hospital, whereas others are employed by the surgeon and thus can represent another potential cost of participation in the database. Alternatively, many surgeons fill in the data forms themselves and do not use a data manager to save money (it takes from 5 to 15 minutes per patient). It should be especially easy for surgeons who already participate in the Adult Cardiac Database to also contribute to the General Thoracic Database. These surgeons already have a ready mechanism to provide their cardiac data such that adding their general thoracic cases would be an easy next step. With more cardiothoracic surgeons increasing their volume of general thoracic surgery this should be a ready source of patients for the database to grow. A robust database will have important reimbursement implications for all surgeons who do general thoracic surgery when we have solid clinical data to present to government and private payors. The STS and its members need greater participation in the General Thoracic Surgery Database. We are working to minimize the administrative burden and cost, while maximizing the value to you and your patients. To find out more information or enroll in the STS General Thoracic Surgery Database you can go to the STS website at www.sts.org, look on the left hand side, and click on the section titled “STS National Database.” You can also contact one of the members of the STS General Thoracic Surgery Database Task Force (see members names as follows). Also, you can always contact the STS National Database Operations Administrator, Gerard Tarafa, at the STS headquarters by phone at (312) 202-5833 or by e-mail at [email protected] for more information. Mark Allen Andrea Carpenter Frank Detterbeck Malcom DeCamp Cameron Wright, Chair