Cardiothoracic Surgical Advocacy in a Time of COVID-19.

The COVID-19 pandemic has resulted in substantial morbidity and mortality worldwide.1, 2, 3 It was only several months ago when the United States braced for the expected tsunami known as novel coronavirus 2019. The news media barraged our airways with disturbing and tragic stories of patients, nurses, physicians, and hospitals that were quickly overwhelmed outside our shores with what was rapidly recognized as a world-wide pandemic. The United States expeditiously converted our health care institutions to prepare for the onslaught of COVID-19 patients that we had seen arrive by the thousands in China, Italy, Spain, and the United Kingdom. Patients were rapidly discharged from our hospitals, elective surgical schedules were cancelled, and extra shifts of nurses and physicians were hastily scheduled while communities discussed the advantages of social distancing, school and business closures, and isolating in place. It was in this context that the advocacy arm of The Society of Thoracic Surgery (STS) began to focus their activities on both the clinical and legislative concerns of the impending pandemic.

It was obvious that the health care system in the countries first affected by COVID-19 were struggling with supply chain limitations that profoundly restricted their ability to treat patients and protect their medical staff and extended health care workers. Direct communication was initiated with the deputy secretary of Health and Human Services, administrative leadership of the Energy and Commerce Committee, the Centers for Disease Control, the Food and Drug Administration, and the National Institutes of Health. With each of these governmental organizations, our concerns regarding access to personal protective equipment, ventilators, medications (parenteral intravenous diuretics and anticoagulation agents), and blood product shortages were vociferously raised. Additional concerns regarding the availability of devices and supplies to initiate and apply extracorporeal membrane oxygenation to help treat refractory respiratory failure were voiced. A process to fast track approval of the MC3 Corporation Nautilus oxygenator for use with the extracorporeal membrane oxygenation devices, owing to the expected shortages of the other oxygenators, was urged and ultimately achieved. Although all these issues are quite commonplace now, the governmental prioritization of these concerns was fairly superficial only a few short weeks ago.

The STS strongly advocated with these governmental agencies by numerous conference calls, and our concerns were strongly raised in the halls of Congress as well. Discussions were held with members of congress and their administrative staff to consider current administrative impediments to health care delivery in the context of a national pandemic in the next emergency congressional legislation. These included, but were not limited to, ensuring physicians and health care workers have appropriate access to personal protective equipment, providing Good Samaritan protections to physicians who practice across state lines, relief of unnecessary prior authorizations for care, small business relief for physician practices including small business loans, requesting disability protections for physicians treating COVID-19 patients, protecting physicians in Medicare alternative payment models from losses due to canceled cases and poor outcomes, suspension of the annual 2% Medicare budget sequester, suspension of the Medicare Access and CHIP Reauthorization Act quality reporting requirements, and provision of additional financial support to hospitals and physician practices adversely affected by the COVID-19 crisis. Although many of these priorities were included in the Coronavirus Aid, Relief, and Economic Security Act, which was signed into law on March 27, 2020, other priorities will be included in upcoming additional congressional legislation expected to be drafted in the next several months in the attempt to protect patients and providers from the ravages of the novel COVID-19 pandemic.

It must also be remembered that the COVID-19 pandemic has occurred during the time when the Centers for Medicare and Medicaid Services (CMS) has plans to cut reimbursement for cardiothoracic surgeons by 8% in January 2021. , Such reductions to many cardiac and thoracic surgeons, in addition to the economic burden we have had to endure as a result of losses from cessation of elective surgery by directives of state governments, salary reductions to help compensate for hospital and health care institutional losses, and illness as a direct result of the COVID-19 virus, may leave many in our specialty with devastating economic losses to practices and surgeons. During STS advocacy in support of supply chain materials and legislative relief, additional advocacy has been conducted with the American College of Surgeons to address the CMS financial reductions to the specialty of cardiothoracic surgery. The STS is part of the steering committee for the Surgical Care Coalition, which will continue to formulate strategy and create a constructive appropriate response to the 2020 final payment rule by CMS during the summer and fall of 2020.

The COVID-19 pandemic has demonstrated regionalized patterns worldwide and in the United States. Although it appears to be coming under control in some areas of the United States, other urban environments are still confronting the effects of this virus on many patients and hospitals in their locale. It is for that reason, as well as the work that still needs to be done to resume health care delivery to many thousands of patients who have deferred such care to avoid being exposed to COVID-19 in the hospital, that significant governmental advocacy remains to be done by the STS. In parallel with these efforts, active participation by our specialty in the Surgical Care Coalition remains an equal priority. With the help and guidance of those in our specialty and of STS leadership, we will continue to persevere in our resolve to protect our patients and our membership.