As a result, "there are heart failure patients and patients with acute myocardial infarction that are paying the price."
Take statins, the cholesterol-lowering medication that also reduces coronary artery occlusion, he says. "There's unequivocal, overwhelming evidence that (giving) statins to patients who have had heart attacks reduces all-cause mortality," he says.
"We've known this since 1994; it was reinforced in 2001. It was not until 2005 when it was made into any (pay for reporting) measure set, and still the Centers for Medicare & Medicaid Services does not have this as a measure. You can be classified as having received outstanding care by CMS measures without having been treated with this essential, life-saving medication."
Under VBP, hospitals count their heart attack patients given a fibrinolytic medication within 30 minutes of arrival, the number of patients receiving percutaneous coronary intervention within 90 minutes, and the percent of heart failure patients who are given discharge instructions. Those aren't bad measures, Fonarow says, but they should be supplemented with others that have solid scientific correlation to reduced mortality.
He adds that across the country, "all of these hospitals have spent millions of dollars collecting and reporting data [on the 33 Premier and 12 CMS-approved process measures. It's been mandated for heart care. The entire country was being told that these measures, if you do a good job with them, these are hospitals providing better care. But it has not translated to any clinical benefit in patients."