Inside Cardiology's PCI Problem

Cheryl Clark, for HealthLeaders Media , August 18, 2011

Last week Peninsula Medical Center of Salisbury, MD, agreed to pay the federal government $1.8 million to settle claims that hospital officials knew about, but failed to act on, unnecessary cardiac stent procedures performed by a cardiologist.

Brindis acknowledged that the issue of inappropriate angioplasty "has gotten everyone's attention, particularly in Washington and particularly with payers, and the reason is a good one: 43% of Medicare expenses are in the cardiovascular arena."

Now the ACC, with its National Cardiovascular Data Registry CathPCI, is addressing the problem in a big way, with the first of many coming reports like this one, he said.

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Present in more than 80% of the nation's hospitals, the registry is giving cardiology experts a way to evaluate and measure these procedures, "not just in terms of clinical outcomes, safety and effectiveness and mortality, but now we're actually assessing the appropriateness" not just of the angioplasty itself, but of the imaging and other tests performed on patients who didn't need them, he explained.

"We're trying to avoid unnecessary tests on patients who didn't need them, to help physicians and payers use these technologies more judiciously," Brindis said.

"As Peter Drucker said, ‘if you don't measure it, you can't manage it,' " Brindis said.

Brindis, an invasive cardiologist with Kaiser Permanente in Northern California who also is on the faculty of the UCSF Philip R. Lee Institute for Health Policy Studies, says the success of this introspection could not have occurred without an auditing process to vet the veracity of the data hospitals supplied.

When that happened several years ago, he said, "all of a sudden payers, regulators and the U.S. Food and Drug Administration became very interested in using the registry."

This new auditing strategy will give feedback, based on benchmarks, data and quarterly reports, to each hospital where those procedures take place so each hospital will know how many PCIs under its roof were inappropriate, and why, in hope of eventually reducing that 38% "undetermined" to a much smaller number, Brindis said.

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1 comments on "Inside Cardiology's PCI Problem"

Will ElLaissi (8/19/2011 at 2:59 PM)
First, I must say that your article is great. It shed insight on the implications of over-stenting and the complications that can arise. Recently, it was reported, I believe in the NEJM, that PCIs could be performed in an out-patient setting due to the competence of invasive cardiologists (meaning that there is now little threat that an artery could burst producing a need for emergency open heart surgery). I work in the industry and I do feel torn by one issue that you raised. You mentioned that some hospitals hang their hat on their cardiology program and the margins that they receive from angioplasties, CABGs, or Valve replacements. We are certainly in this industry to help the patient, but a disconnect appears when we discuss ways to correctly incentivize physicians AND hospitals to cut down on the "inappropriate" PCI cases. It is a hard sell as a consultant or a policy maker to pitch quality when many hospitals suffer for higher quality (Of course we do, but you address the problems that arise). I guess this is the catch in our healthcare system. We are all in healthcare to improve it and to seek options that would improve the way healthcare is delivered to the patient, but practically speaking, we see the downside of doing the right thing. The hope I am sure is that ACOs and bundled payments will help correctly incentivize hospitals and physicians towards higher quality outcomes at lower costs. However, practically speaking, for hospitals that enjoy the lucrative nature of high margin procedures which allow them to stay "in the black" or not deep in the red, can they afford higher quality of care? Will shared savings correctly create the needed incentives? Because as I mentioned, there is no doubt that everyone has picked this industry to create the best care for the patient.




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