Share ThisEditor's Update: This article was first published December 8, 2021. It was most recently reviewed and updated February 20, 2023.
Our vision is a world where everyone embraces health. In our Remarkable Leadership series, we talk with people who are making that vision a reality by leading the work to create a new system of health, empower our customers and communities, and better support every individual’s health journey.
Stephen Bailey, MD, knows he has big shoes to fill.
Allegheny Health Network’s renowned heart surgery program — headquartered at Pittsburgh’s Allegheny General Hospital (AGH) and developed over the last six decades by the Magovern family, Edward Kent, Don Fisher, and many other researchers and surgical pioneers — is under Dr. Bailey’s leadership.
In 2020, he was appointed chair of the AHN Cardiovascular Institute and system chair of the network’s Department of Thoracic and Cardiovascular Surgery.
Dr. Bailey cites three priorities for the institute:
Dr. Stephen Bailey, chair, AHN Cardiovascular Institute
“We’re fostering expertise and developing the future of cardiovascular care right here at AGH, and we’re deploying these new technologies in the community, for the benefit of our patients,” he says.
He is also excited about the future of his specialty — heart surgery. Minimally invasive procedures like the transcatheter aortic valve replacement (TAVR) — a heart procedure in which an artificial replacement valve is implanted into a diseased aortic valve through a catheter — have revolutionized heart surgery, and have also changed the role of the heart surgeon, whose field was dominated by open-heart procedures for decades.
But even as open surgeries have been surpassed in some ways by catheter-based procedures and intervention-based cardiology, the need for outstanding heart surgeons is greater than ever.
“Bypass surgery, for example, has stood the test of time,” Dr. Bailey says. “And while we think of coronary bypass surgery as relatively straightforward, the truth is, it requires a skilled surgeon. As our population ages, we’re going to see more and more of these cases, and there's going to be an increasing need for really competent surgeons in this country.”
Bill Toland: How has cardiovascular medicine and heart surgery changed over your career?
Dr. Stephen Bailey: The whole field of structural heart disease, and these less-invasive, transcatheter-based procedures, just didn't exist when I was in training. It’s been a real generational shift. As I was leaving Columbia University in 2006, the field was just emerging. And the trends and practices that emerged from that shift became the standard of care for many patients with aortic stenosis. Now, that type of minimally invasive intervention has extended to mitral valve procedures and other areas of the field. It’s totally changed heart care and heart surgery.
Bill Toland: And how has it changed the role of the heart surgeon?
Dr. Stephen Bailey: For a period of years, there was a sense that between catheters, stents, and statin drugs, there was going to be no need for bypass surgery. That led to a transient decrease in interest in cardiac surgery as a field. But clearly there is a large need for cardiac surgeons who are trained in minimally invasive and transcatheter procedures as well as the biggest, most complex open and re-do procedures.
Even with growth in transcatheter procedures, based on the demographics of the population and the incidence of heart disease, there's a huge need for cardiac surgeons who can take on the most challenging cases. And despite new stent technologies, coronary artery bypass grafting (CABG) surgery continues to emerge as the preferred therapy for most patients with multivessel coronary artery disease because of its associated survival benefit.
Bill Toland: Given that period of decreased interest, what does that mean for the current supply of heart surgeons?
Dr. Stephen Bailey: I would say the overall supply of competent cardiac surgeons is low, particularly when measured against the number of hospitals that want to offer these programs and perform these procedures. I think it's particularly difficult recruiting to lower-volume community hospitals, rural hospitals, and so on. That presents challenges for a number of hospitals in our region.
We are fortunate at AHN that we haven’t really experienced these recruiting issues. We obviously have a rich legacy of cardiovascular care and surgery dating back decades at AGH, and we complement that history by having a core of outstanding clinicians and support staff who care deeply about our patients.
That makes it easier to recruit the best and brightest, which allows us to drive the innovation and development of the next generation of modern therapies and procedures, right here at AGH. The collaboration between campuses also makes it easier to maintain the highest standard of care.
Bill Toland: Has the historical competition between cardiology and cardiac surgery ebbed at all?
Dr. Stephen Bailey: It has. In a previous era — and perhaps this persists in some locations — there was some competition over patients. Does the patient need to go to the cardiologist, for more of an interventional approach? Or do they need to go to the cardiothoracic surgeon? Those would have been two separate practices, and naturally both practices want to be busy. So there was a monetary driver to that competition, in addition to a philosophical one, since cardiac surgeons and cardiologists typically come from very different educational backgrounds.
A number of factors have led to the model changing. Some of them were reimbursement-driven — for example, in order to perform a TAVR, it was mandated that a patient had to be evaluated by both surgeons and interventional cardiologists. If you didn't do that, you'd be audited, and your reimbursement is in limbo. That sort of forced this interaction between cardiology and surgeons that has turned out to be incredibly productive for our field.
Beyond the mandate, though, it just became clear that to best serve the patient, we’d need more cross-specialty collaboration. When it comes to heart failure or structural heart disease, the patient is best served when cardiologists, surgeons, and a whole assortment of other team members work together to sort out the best course of treatment. For really complicated heart failure patients, you need every set of eyeballs, looking at all the options — more medications, intravenous medications, less invasive devices, on up to a heart transplant or a left ventricular assist device.
Bill Toland: That approach would seem to make sense across all disciplines — the Autoimmunity Institute at AHN is a great example — but particularly at the Cardiovascular Institute.
Dr. Stephen Bailey: Absolutely. It comes naturally to us here at AHN, since our specialties are organized by institute, rather than by hospital. The model really lends itself to this kind of multi-specialist collaboration. It gets everybody in the room at the same time, looking at images, sifting through the patient’s data, their anatomy and physiology, and coming up with the best option for a given patient. It’s not always a straightforward answer, which is why you need everyone around the table.
Bill Toland: Speaking of images, is it fair to say that the imaging team members are the unsung heroes of the institute?
Dr. Stephen Bailey: Whether you are talking about cardiac imaging, which is a subspecialty of cardiology, or radiology and the Imaging Institute more broadly, they are absolutely critical parts of our team. For so many procedures we do — transcatheter mitral valve repair, for example — you need precise cardiac imaging in real time. If you don’t have the images, the cardiac surgeon and interventional cardiologists categorically can't do their jobs.
It’s not an exaggeration to say that without best-in-class imagers, the cardiovascular program goes nowhere. Fortunately, we have a world-class cardiac imaging team at AHN.
Bill Toland: How do you maintain AGH as the seat of academic expertise, while also ensuring that AHN’s regional hospitals get the resources and talent they need to provide world-class care?
Dr. Stephen Bailey: First, you have to be thoughtful about what exactly you're moving to the community. And then you have to have a good system in place for sharing knowledge and skills that have been developed across the system. With TAVR, for example, we also launched programs at Jefferson and Forbes. Both facilities benefit from the expertise of 10 years of programmatic experience, and 2,000 TAVR procedures, here at AGH.
We view Jefferson and Forbes as key campuses within our institute, and extensions of our AGH program, as opposed to standalone programs that are figuring things out on their own, and going through all the learning curves and speed bumps that would typically accompany a new community program. And quite honestly, by working together, there is a great bi-directional flow of information. We have adopted practices at AGH that we picked up only because we were working together on the ground in our community hospitals.
Bill Toland: When programs were organized by hospital service area, there was more jockeying for volume, I imagine. But now it doesn’t matter as much that AGH might be losing volume to Jefferson or Forbes, right?
Dr. Stephen Bailey: That’s right. Reallocating programs and services in a thoughtful, careful, integrated way, is clearly better for the patients. It's better for many of the providers, who want to be able to provide this level of expert care closer to home. It’s good for the system, so long as the quality of care extends to all campuses. And from a blended health perspective, and a value perspective, there’s definitely a benefit to providing these services and surgeries in a lower-cost environment.
But the truth is, AGH stands to benefit, too. There’s only so much operating room space, and only so many operating room hours in a day, at AGH. By moving certain procedures out to other facilities, you also free up AGH operating rooms for more complicated, extensive heart procedures.
Bill Toland: That level of coordination wouldn’t have been possible when the hospitals were still operating as regional fiefdoms.
Dr. Stephen Bailey: That’s true. Dr. [George] Magovern, our long-time chair, did a great job of getting the institute to work as a more fully integrated system, as opposed to a collection of hospitals and practices that happen to be under the same umbrella. And during her years as AHN president and CEO, Cindy Hundorfean got us all pointed in the right direction by grouping our various specialties into institutes that cooperate with each other, rather than practices and facilities that compete with each other.
We’ve made a lot of progress over the last few years, and my goal is to build on that progress, making sure that whatever we do and wherever we do it, we do it best-in-class.
Bill Toland: And is that happening?
Dr. Stephen Bailey: Absolutely. Recently, we earned The Joint Commission’s Gold Seal of Approval© for Comprehensive Cardiac Center Certification for the second consecutive year — just one of 13 medical centers in the U.S. to receive that designation. AGH was also designated as a Target: BP Gold+ facility for its commitment to prioritizing hypertension and high cholesterol control — that’s the highest level a facility can earn. Back in 2021, we were recognized by the Society of Thoracic Surgeons with their highest rating across multiple programs. It’s one thing to say you offer best-in-class care, but it’s another to have concrete and objective examples and recognition from our field.
There are many other examples of our expertise. We were among the first hospitals in the country to use stereotactic arrhythmia radio-ablation to treat ventricular tachycardia, a heart rhythm disorder. We were one of the first in the country to use zero-radiation ablation to treat atrial fibrillation. We were the first hospital in the state, and one of 21 in the country, to receive an award from the American Heart Association and the Mitral Foundation for the quality of our mitral valve repair program. We have regularly ranked among the nation’s top medical centers for three-year survival rates in adult heart transplant patients, according to data from the Scientific Registry of Transplant Recipients (SRTR) — and in 2023, we completed our 500th heart transplantation.The list goes on and on. It’s a consistent track record of quality and innovation, and we’re all proud to be a part of it.
Bill Toland: How did COVID affect the Cardiovascular Institute?
Dr. Stephen Bailey: In a couple of ways. I should note that we didn’t see the mass postponement of surgeries that some other institutes might have seen. Most cardiovascular procedures are relatively urgent, so when we're scaling back elective cases, it's not typically impacting cardiovascular and thoracic surgery as much.
That said, it did affect our ability to accept transfers from other hospitals. That’s a big part of our mission — accepting complicated cases from other hospitals, even neighboring states. You never want to say no to a patient or a peer institution, because we really do believe in the objective benefits of receiving care through our Cardiovascular Institute.
While COVID itself has receded, it triggered events that have led to tremendous nursing shortages. We continue to struggle with this problem, and it continues to impact day-to-day operations and the ability to accept patients that need our care.
The biggest impact in the first several months of the COVID pandemic was a great fear of people coming to the hospital. Unfortunately, that fear affected people who truly needed to come to the hospital and led to delayed presentation for problems like heart issues or chest pain, which put patients at much higher risk for complications and death. It wasn’t as prominent as what they saw in New York City, which initially was the epicenter of the pandemic, but we saw it for sure.
Bill Toland: Did that experience change the way you thought about care access?
Dr. Stephen Bailey: Across the network, we were very proactive in terms of using video technology to continue to have contact with our patients. Following that initial surge, in spring 2020, telemedicine and virtual visits kind of ebbed and flowed, depending on the specialty, but with cardiovascular medicine and cardiology, virtual consultations are going to continue to be a major access portal for our patients.
In 2020, most of AHN’s telemedicine volume was in primary care or urgent care. But 6% was cardiology, which is great for our patients with chronic heart issues. They are still getting the care and advice they need, and in many cases they don’t need to leave their homes. This is a great advance, particularly for patients who live hours from Pittsburgh.
Bill Toland: You came to AGH in 2006, which was a challenging time for the hospital.
Dr. Stephen Bailey: Yes, and that certainly created challenges for our heart program.
You look at a graph of cardiac volume from the late 1990s through today, it’s like a roller coaster. At AGH specifically, we were doing more than 1,500 open-heart procedures annually in the 1990s. For reasons well documented, the number plummeted and hit a nadir in 2005 at around 450. We have steadily rebuilt over the last 15 years and do more than 1,300 major cardiovascular procedures a year.
Bill Toland: How did you bounce back?
Dr. Stephen Bailey: Ultimately, we had key individuals making important decisions and taking important actions at critical moments. Those contributions can’t be overstated — AHN would likely not exist without the leadership of Drs. Magovern, Demeo, Parda, and others.
From a Cardiovascular Institute perspective, we have benefitted from Dr. Magovern’s grace, purpose, and passion for the institution and its people. From a hospital perspective, and a network perspective, people may not appreciate what an incredible success story this is. To see the road we’ve traveled and the challenges we’ve overcome — that just doesn’t happen very often in health care. It’s a testament to the organization’s leadership, and to all of the amazing clinicians and team members who cared so deeply about this place.
Stephen H. Bailey, MD, ended up in Pittsburgh more or less by accident.
In 2006, his predecessor at AHN and AGH, George Magovern, Jr., MD, was looking for a new surgeon to help bolster AGH’s transplantation program. He called his friend and colleague at the University of Michigan, long-time heart surgeon Steven Bolling. Dr. Bolling, in turn, suggested a former Michigan student who was now serving as a fellow at New York-Presbyterian/Columbia Hospital.
That student took Dr. Magovern’s call, but he wasn’t interested in making the move to Pittsburgh. So he handed the phone to his co-fellow at Columbia — Dr. Bailey.
“Next thing I know, I’m coming out to Pittsburgh for an interview. The whole time, I’m thinking to myself, ‘This is crazy. What am I doing in Pittsburgh?’” Dr. Bailey says.
“I literally didn't know a soul here, nor did my wife. We didn't have any family here. We had three young kids at the time, and on top of it, I had a few other offers on the table.”
And yet the opportunity to work with Dr. Magovern and be part of AGH’s renowned heart surgery program appealed to him. Soon, he was packing for Pittsburgh.
A graduate of Williams College in Massachusetts, Dr. Bailey received his medical degree from Vanderbilt University, and completed residencies at New York-Presbyterian/Columbia hospital in cardiothoracic surgery and the University of Utah in general surgery.
Today, he chairs the AHN Cardiovascular Institute and is one of the nation’s leading heart surgeons. Throughout his career, he has specialized in heart transplantation, heart valve disease, mechanical heart assistance, and minimally invasive cardiothoracic surgery.
After more than 15 years at AGH and AHN, Dr. Bailey is now in a position to repay the mentorship and career opportunities that he received along the way.
“As chair, I hope to pay it forward by identifying surgeons and physicians with passion and purpose, giving them the resources and the space they need to develop their practices, for their own betterment and to the betterment of the system,” he says.
“I certainly didn’t start my career with a desire to be a chair one day. I wanted to provide expert, compassionate care,” he adds. “But when you spend 15 years in one place, leadership responsibilities often come calling. And when you’re very committed to the place and its people, it makes sense to answer the call.”
Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 42,000 people and serves millions of Americans across the country.
Entire contents © Highmark Health. All Rights Reserved.
Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.
Need to find info about providers, prescriptions, coverage, claims, ID cards, or health spending or savings accounts? If so, your Highmark member site is the place to go. (It’s separate from this blog.)