Accelerating Comanagement in Cardiac Care

Joe Cantlupe, for HealthLeaders Media , September 15, 2010
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Joe Cantlupe is senior editor for physicians and service lines for HealthLeaders Media.
He may be contacted at

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Controversy Over Cardiac Procedures

Are many procedures for treating cardiovascular disease unnecessary?

Angioplasty, for instance, costs about $16,000 per patient to clear up clogged arteries in the heart. Elliot S. Fisher, MD, MPH, director of the Dartmouth Center for Health Research Policy, has stated that too many elective angioplasty procedures are unnecessary.

President Obama also has opined on the subject, telling CBS News: "If you are getting paid more for the angioplasty, then that subconsciously even might make you think the angioplasty is the better route to take."
There has been research that angioplasty benefits patients who are having a heart attack or have a high risk for one, but medical therapy may be just as helpful at reducing major risks.

In a Maryland courtroom, questions about potentially unnecessary stents used in angioplasty may be tested. Attorneys have filed a lawsuit against St. Joseph Medical Center in Towson, MD, after 369 patients received notifications they may have received unwarranted cardiac stents. The Office of Inspector General asked the 354-bed facility to turn over patient records linked to its contract with a cardiology group who performed the stenting.

Researchers at the Center for Outcomes Research and Evaluation at the Maine Medical Center in Portland say physician behaviors and attitudes may influence variation in utilization for potentially unnecessary catherizations.

"Although nearly all physicians denied ordering a potentially unnecessary cardiac catherization for financial reasons, some physicians acknowledged ordering the test for other reasons," according to the center's study, "Variation in Cardiologists' Propensity to Test and Treat," published in the April 2010 issue of Circulation. The reasons include: meeting patient, referring physician, and peer expectations, as well as malpractice concerns.
More than 27% of the respondents in the study reported ordering a cardiac catherization if a colleague would do so in the same situation. In addition, nearly 24% reported doing so out of fear of malpractice.

"Variability in cardiologists' propensity to test and treat partly underlies regional variation in utilization of general health and cardiology services," the study says. "The fact most closely associated with this propensity was fear of malpractice suits."

—Joe Cantlupe

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Cool It

The Minneapolis Heart Institute has implemented a system in which ED physicians and rescue squads apply ice to lower a patient's body temperature, resulting in effective cardiac arrest-related outcomes. Michael R. Mooney, MD, FACC, director of the MHI cath lab, designed the therapeutic hypothermia program, dubbed Cool It. The program was designed to treat cardiac arrest patients who have not attained consciousness. Through the icing procedure, patients are sedated and cooled to 33 degrees for 24 hours.

The hospital has treated more than 200 therapeutic hypothermia cardiac arrest patients from February 2006 through August 2010, with favorable neurological recovery rates—as much as 70%. Initial findings compare favorably to other treatment plans, and the hospital is evaluating the figures before releasing a paper on the subject on quality and outcomes, says Barbara Tate Unger, RN, development director for systems of CV emergency care at MHI. In carrying out the program, education and practice were key elements "to decrease chaos and increase organized efficiency," according to Unger.

—Joe Cantlupe

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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1 comments on "Accelerating Comanagement in Cardiac Care"

Linda Ollis (9/27/2010 at 12:11 PM)
Thanks for a very informative update on the comanagement model as one model for increasing physician engagement. Many facilities should find this to be a more palatable step in moving toward an ACO as it's far less disruptive to current relationships yet builds the stronger engagement that we're all seeking.




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