Inside Cardiology's PCI Problem
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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