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It was not so long ago that membership in a professional organization required a review of credentials, a recommendation from a member or two, and the promise to pay dues and show up from time to time at the annual scientific meeting. The meetings were strategically located in pleasant locations that permitted an attached vacation while hearing the latest and greatest to emerge from clinical trials and/or scientific research. As such affairs have considerable expense, the associated industry trade show was always a major attraction – new toys, new ideas, new connections. However, the face of American medicine is rapidly changing. The former technological imperative that equated new with better, and innovation with necessity has gradually yielded to a more sober analysis of actual risks and benefits, along with a more realistic assessment of costs. Simply put, the system is going broke. Healthcare expense continues to grow faster than gross national product – beyond swallowing all potential advances in wages, it is threatening the competitiveness of the American economy while raising the specter of an overwhelming burden of debt. The new reality: financially, we simply cannot afford to do everything, and, medically, we sometimes do more harm than good by trying to do everything.
 
Fortunately in this new paradigm of “value-based care”, in which value=quality/price, the professional societies have increasingly tried to refine our understanding of quality. In 1989, the Society of Thoracic Surgeons (STS) initiated a database, at first incorporating only coronary artery bypass surgery, to try to better understand the outcomes of surgical practice. The construct was relatively simple: heart surgery is a high risk, high volume, and high price affair with very measureable endpoints. The patient either did or did not have surgery on a given date; he survived or he died; he did or did not have a stroke; he did or did not have this or that complication, etc. From what were initially somewhat primitive beginnings (by current standards) has emerged a database which currently captures close to 90% of the heart surgery performed in the country, which encompasses all forms of adult and pediatric heart surgery, as well as thoracic surgery, and provides extensive reports replete with well-conceived statistical analysis of risks and outcomes. Armed with meaningful data, the Society has become an active participant in the National Quality Forum and a frequent visitor in the halls of government. In short, the profession has a responsibility to understand and constantly refine what constitutes quality and to share that information with the public and the professional societies are the forum to develop that agenda. The STS now shares its data with payers – health plans and insurance providers, and has an active program promoting voluntary public reporting. Moreover, the database is designed to ultimately link to CMS so that data on long-term outcomes can be obtained. More recently, the STS and the American College of Cardiology (ACC) have joined together in multiple collaborative ventures, one of which is linking their databases to try to determine the optimal therapy for different groups of patients. The traditional “siloed” approach to medicine, in which cardiologists and surgeons competed for patients is gradually but definitively giving way to collaborative ventures to try to determine the optimal therapeutic approach to patients with coronary artery disease, valvular heart disease, congestive heart failure, atrial fibrillation, etc. Increasingly one finds joint society statements and guidelines, as well as a jointly sponsored FDA mandated database which tracks the results of the newly introduced percutaneous valve replacement technology (TAVR).
 
Yes we physicians still go to our annual meetings, but increasingly we find that many of the featured speakers are our colleagues from other professional societies (such as the recent lectureship at the STS by the president of the ACC). When CMS recently released their payment guidelines for TAVR, they based the institutional and professional requirements on the guidelines previously released as a joint statement of the STS, the ACC, the American Association of Thoracic Surgery, and the Society of Cardiovascular Angiography. The age of interprofessional collaboration in an effort to provide leadership and improve quality in healthcare has arrived – and it is a welcome and refreshing response to rapid changes of our time.