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| The Monthly Pulse |
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| TAVR outperforms SAVR when treating women, historic all-female trial confirms
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| The Story |
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| According to findings from the RHEIA trial, an all-women trial with 443 participants, transcatheter aortic valve replacement (TAVR) is associated with better one-year outcomes compared to surgical aortic valve replacement (SAVR). Primary endpoints, including death, stroke, or rehospitalization within one year, were seen in 8.9% of TAVR patients, compared to 15.6% of SAVR patients. The average age of patients was 73 years old. |
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| What You Should Know |
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| The study’s principal investigator notes that women are an underrepresented group in the treatment of severe aortic stenosis (AS). This historic study offers valuable insights for providers and patients for treatment options. This study also serves as another example of TAVR’s ongoing momentum as a viable treatment option for severe AS, and other research shows that TAVR complications have experienced a significant downturn in recent years.
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| Depression predicts delayed return to daily activities in patients post-cardiac surgery: a prospective observational study
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| The Story |
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| A recent observational study published in the Journal of Cardiothoracic Surgery shows that depression has a profound effect on patients’ recovery and return to daily activities following cardiac surgery. Patients with higher Center for Epidemiologic Studies Depression Scale (CES-D) scores see delayed return to independence, social participation, and work. Further, post-operative depression is an independent risk factor for hospital readmission.
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| What You Should Know |
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| According to the research, while depression can affect recovery, a delayed recovery can likewise induce depressive symptoms in patients who previously were not depressed. The study’s findings therefore underscore the importance of assessing patients’ mental health both before and after surgery, and potentially giving special attention to at-risk patients. With a deeper understanding of patients’ mental wellness, the goal of improving quality of life through cardiac surgery can be fully realized.
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| New Mandatory Payment Model for CABG Coming in 2026 |
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| The Story |
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| In August 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a mandatory episode-based alternative payment arrangement. Known as the Transforming Episode Accountability Model (TEAM), the new arrangement is a five-year model that will take effect in 2026. In impacted facilities, hospitals will be responsible for the cost and quality of care for surgeries and the first 30 days following discharge. |
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| What You Should Know |
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| TEAM will be mandatory in more than 760 hospitals in select regions. During the care period, hospitals will submit their usual fee-for-service claims. While CMS originally proposed a 3% discount for CABG episodes, the Society of Thoracic Surgeons recommended a 1.5% discount to prevent a decrease in quality of care, which was honored by CMS. Pricing includes a broad range of services, and affected hospitals are encouraged to review CMS requirements now to prepare.
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| Leadership Reflections |
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Vendor Relationships
Over the past year, I have evaluated several key vendor relationships. These evaluations served as a valuable reminder of the importance of periodically reviewing factors such as pricing, customer service, and expertise. I highly value strong relationships, and therefore, do not advocate for changing vendors frequently. However, a review cycle every three to five years is a prudent approach. Below, I outline the three primary factors that influence my vendor review process.
Pricing is important to all of our organizations. When you have a strong relationship with a vendor, pricing can gradually become less competitive, often due to a lack of regular review. Without periodic evaluations, pricing may drift away from market standards. Red flags include a lack of visibility into competitive quotes and reviews that consistently result in retaining the same vendor without adequate consideration of alternatives. In general, unless there are other pressing concerns, my rule of thumb is that pricing needs to be at least 5-10% more favorable to justify switching vendors.
Customer service is another area that can be overlooked, especially in long-standing relationships. It’s crucial to define and hold vendors accountable through Service Level Agreements (SLAs), which clarify roles, responsibilities, and response times. Changes in vendor personnel can sometimes negatively impact these service commitments, so regular monitoring is essential.
Lastly, expertise is what sets key vendors apart as trusted advisors. It's important to evaluate their knowledge and industry involvement. Are they active in professional organizations? Do they stay updated on current trends and industry developments? Are they able to respond to questions quickly and professionally?
Periodic evaluations based on these factors help ensure that vendor relationships remain beneficial and aligned with the organization's needs.
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| 2024 STS Perioperative & Critical Care Conference |
| Fri., Oct. 25 - Sat., Oct. 26 |
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TCT 2024 |
| Sun., Oct. 27 - Wed., Oct. 30 |
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| 35th Annual Cardiovascular Interventions |
| Tues., Nov. 12 - Fri., Nov. 15 |
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| Coronary Artery Disease: Case-Based Learning |
| Fri., Nov. 22 - Sun., Nov. 24 |
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| STS 2025 - 61st STS Annual Meeting |
| Fri., Jan. 24 - Sun., Jan. 26 |
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