Musings from the Windy City

Kaitlyn Dmyterko, Associate Editor

After almost a week of covering the latest in cardiovascular news in the Windy City, it is time to reflect. At this year’s American College of Cardiovascular Administrators (ACCA) meeting, hospital thought leaders discussed what it takes to integrate the most innovative technologies and ways to incorporate the most cost-effective, quality-driven programs. This year’s American College of Cardiology (ACC) scientific session included clinical triumphs in anticoagulants and imaging techniques, among others, intertwined with the latest in research for a thought-provoking meeting. But both meetings left us asking one question, “Where is healthcare headed?”

From cardiovascular registries to ICD-10, the question on many administrators’ minds was physician-hospital integration. While the most forceful driver of these physician-hospital integrations continues to be reimbursement cuts, many wonder whether the trend will continue. At ACCA, Anthony Long, director of healthcare strategy at Navigant, urged that hospital administrators must understand the varying issues and values of physicians. In particular, he said, administrators must understand the increased expenses tied into hiring physicians.

At ACC.12, one of the clinical talkers was the ASCERT registry, in which Weintraub et al examined PCI vs. CABG. It was found that older patients with multivessel coronary artery disease (CAD) who did not require emergency treatment saw a long-term survival benefit from CABG compared with PCI. However, due to the fact that ASCERT included registry data, Weintraub speculated that the study would not have an immense impact on clinical decision making, and this still will weigh heavy on physician and patient preferences. Still, it attracted much meeting chatter.

Other clinical findings focused on adding cardiac CT angiography to practice and evaluated the advantage of newer, perhaps more cost-effective anticoagulants when compared to warfarin, among others.

While most of ACC.12 centered on finding innovative ways to pave the way toward value-based, cost-effective care, a large portion also focused on the elephant in the room—the Patient Protection and Affordable Care Act (PPACA), or more commonly known as the healthcare reform bill. In one session panelists, including ACC CEO Jack Lewin, MD, among others, discussed the possible implications of the controversial bill, which was vetted in the Supreme Court this week.

A major issue popping up was that it does not include, or attempt to improve, professional liability. “What’s missing in the bill in terms of professional liability? Everything,” said Richard E. Anderson, MD, chairman and CEO of The Doctors Company.  He went on to say that nearly 100 percent of care practiced in the U.S. today is defensive medicine.

He questioned healthcare reform, saying that there were only one to two mentions of professional liability reform within the 2,500-page bill. His main beef stemmed from the fact that if the bill provides all Americans with health insurance, supply will never be able to catch up with demand. Additionally, he noted that today health insurance covers nearly 80 percent of healthcare costs. If the bill is passed and more people are included, it will only cover 60 percent. “This is unsustainable,” he said.

While the meetings outlined room for improvement, strategies to enhance care and ways to cost-effectively practice care, the major question that remains is, “What will the future of healthcare look like?” Will accountable care organizations (ACOs) become the wave of the future? Will supply meet demand? Where is your hospital/practice headed and what are you doing in terms of reform? Let us know.

Kaitlyn Dmyterko
Cardiovascular Business, associate editor
Kdmyterko@cardiovascularbusiness.com