Good evening. Before I begin, I want to make it clear that I’m speaking tonight as an individual cardiac surgeon. The views I’m sharing are my own views and do not necessarily represent those of my employer or any organization with which I’m affiliated.

Tonight, I wish to speak to my fellow cardiac surgeons and give you important updates. If you’re a cardiac surgeon, there are some important things happening in Washington, D.C. right now that I think we should all be paying attention to.

Perhaps the most immediate issue is that of TAVR. As you may know, CMS is reconsidering the National Coverage Determination for TAVR, or NCD, and the final decision is expected very shortly in September. In this NCD, there are some important questions involving the heart team, the roles of cardiac surgeons and interventional cardiologists, operator and institutional requirements, registry participation, and the continued expansion of TAVR into different patient populations.

And why should cardiac surgeons care? Because this isn’t just about TAVR. The decisions being made today could establish the framework for how future structural heart technologies involving the mitral valve, tricuspid valve, aorta, and other areas of cardiovascular medicine and surgery are introduced and then regulated.

I strongly believe that the heart team needs to remain a real heart team, not simply a phrase.

Cardiac surgeons and cardiologists bring different perspectives to patient selection, procedural planning, management of complications, and perhaps most importantly, helping patients understand all of their treatment options.

But TAVR isn’t the only issue that we need to be watching these days. Medicare physician reimbursement continues to be a major concern, and it’s only getting worse. Changes involving physician payment, work RVUs, and the valuation of 10- and 90-day global surgical periods may sound like Washington policy details, but collectively they can have significant consequences for surgeons, hospitals, and our ability to maintain complex cardiovascular programs.

Another important issue is site of service. As CMS continues to consider where different procedures can be performed, we need to make sure that decisions involving complex cardiovascular care remain driven by patient safety, appropriate resources, outcomes, and clinical judgment, not simply economics.

And then there is something even bigger: the future of our specialty.

We need an adequate cardiothoracic surgical workforce, and this has been strained lately. We need to train the next generation of cardiac surgeons. Another important issue is the need for meaningful prior authorization reform. And lastly, as cardiovascular technology continues to evolve, cardiac surgeons need to remain actively involved in developing the standards that determine how these therapies are evaluated and used.

I’ve been really fortunate to participate in advocacy work through the Society of Thoracic Surgeons for many years, and that experience has reinforced something that I think is incredibly important for cardiac surgeons to understand.

If physicians aren’t part of these conversations, decisions affecting our patients and our profession will still be made. They will simply be made without our input.

You don’t necessarily have to go to Washington, D.C. to make a difference, although I think it’s a wonderful idea and I’ve done it many times. The important thing is to learn about the issue, participate in our professional societies, respond when there is a call for public comments, and yes, communicate with your elected representatives and support the physicians and organizations advocating for our patients and our specialty.

As cardiac surgeons, we spend our careers advocating for individual patients in the operating room. Sometimes we need to advocate for them outside of it as well.

Because the future of cardiac surgery isn’t being shaped only in our operating rooms, clinics, and cardiac catheterization laboratories. Some of it is being shaped right now in Washington, D.C.

And I think it’s important that cardiac surgeons have a voice in that conversation.

I’m Dr. Raymond Singer. I hope this update was helpful, and I’ll see you next time.

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(𝘛𝘩𝘦 𝘷𝘪𝘦𝘸𝘴 𝘦𝘹𝘱𝘳𝘦𝘴𝘴𝘦𝘥 𝘪𝘯 𝘮𝘺 𝘱𝘰𝘴𝘵𝘴 𝘢𝘳𝘦 𝘮𝘺 𝘰𝘸𝘯 𝘢𝘯𝘥 𝘥𝘰 𝘯𝘰𝘵 𝘳𝘦𝘱𝘳𝘦𝘴𝘦𝘯𝘵 𝘵𝘩𝘦 𝘷𝘪𝘦𝘸𝘴 𝘰𝘧 𝘮𝘺 𝘦𝘮𝘱𝘭𝘰𝘺𝘦𝘳 𝘰𝘳 𝘢𝘯𝘺 𝘰𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯.)