The availability of a specialty drug doesn’t guarantee its accessibility, as cardiologists who try to prescribe PCSK9 inhibitors to their patients are learning. Insurers’ requirements for prior authorizations can create formidable barriers, but some providers have found ways to surmount them.
The Centers for Medicare & Medicaid Services (CMS) delayed the launch of a new episode payment model affecting three types of cardiac care, pushing the July 1 start date to 2018. That doesn’t mean providers and hospitals should throttle back on bundles’ preparations.
For all the talk of the need to more closely tie physicians’ compensation to quality care and value, productivity continues to dominate payment schemes. Still, some cardiology groups are finding ways to shift from volume toward value using strategies built off their histories and cultures.
The need for permanent pacemakers in patients with severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVR) remains a complication, even as TAVR expands into lower-risk groups. That may prove to be a limitation, especially with younger patients who may have decades of life ahead of them.
Treating today’s cancer patient no longer means simply targeting the cancer. Given the known cardiotoxicities of some established chemotherapies and the possibility that newer approaches may damage the heart, oncologists, cardiologists and imaging specialists now work together to detect and minimize the risk of treatment-induced heart failure.
About one year ago, FIRE AND ICE trial investigators reported that cryoballoon ablation (cryo) performed as well as radiofrequency ablation (RF) as a treatment for patients with drug-refractory paroxysmal atrial fibrillation. But is “as good as” good enough to change practice? The answer may be emerging just now.
4D flow magnetic resonance imaging (MRI) offers striking visuals of blood flow in the heart and vessels but as yet has not found a foothold in clinical practice. Congenital heart disease, and in particular the bicuspid aortic valve, may provide its point of entry.