ACC 2017 Video

Cardiologists J.P. Reilly, MD, and Larry S. Dean, MD, offer insight on the two-year results of the ABSORB III trial that evaluated Abbott’s Absorb bioresorbable vascular scaffold. They also talk about the March 18th FDA advisory letter alerting healthcare professionals of an increase in major adverse cardiac events with the Absorb compared with the Xience drug-eluting stent. As they note, physicians need to be careful about selecting the right patients who may benefit from bioresorbable stents, using them in right-sized vessels and making sure to properly deploy the devices.

Cardiovascular providers discuss their biggest challenges, including payers refusing to cover tests, procedures or medications that could benefit patients and providing costly and beneficial therapies and procedures while dealing with cost constraints. There are plenty more, listen in.

Cathie Biga, RN, MSN, discusses the importance of pre-planning for physician practices to avoid an audit. Having a full compliance plan for coding and documentation audits helps with appropriateness criteria, electronic medical record standards and making sure billing matches up with documentation. She also recommends that practices have at least one person who understands the MACRA legislation and shares the information with the entire group.  

ACC Vice President C. Michael Valentine, MD, sees teams of physicians and administrators as key to managing the changing healthcare industry. Partnerships help them tackle legislative, administrative and financial changes. And while some clinicians complain about MACRA, Valentine says, the legislation aligns government and physicians in switching from volume- to value-based care. ACC has created a MACRA task force and website to inform cardiologists and patients.

Cardiologists are facing rapid changes in reimbursement due to new payment models, but James C. Blankenship, MD, MHCM, says physicians should focus on providing the best quality of care for patients. He recommends physicians take care of everyone in their practice or group, as well. These days, physicians must also understand the balance between the traditional fee-for-service model and new payment models, such as the Merit-based Incentive Payment System.

Burnout among cardiologists is very real, with nearly half of cardiologists suffering from it, according to Charles Chambers, MD. Still, it is difficult to recognize even though it can lead to job dissatisfaction and severe issues such as alcoholism and suicide. Chambers suggests physicians take time off, exercise, stay in shape and maintain a work-life balance to help decrease the risk of burnout.  

Today, 1.5 million to 2 million adults in the United States have congenital heart disease, which is more than the number of children with the condition. Disty Pearson, PA-C, discusses new congenital heart disease guidelines and accreditation programs for appropriate care. Although there is a lack of adult congenital heart disease cardiologists, she says physician assistants and nurse practitioners can help care for these patients, many of whom have comorbidities and neurocognitive issues.

On March 10, the ACC and other medical societies updated the terminology used in the appropriate use criteria (AUC) for coronary revascularization in patients with stable ischemic heart disease. Gregory Dehmer, MD, notes the old methodology used “appropriate,” “uncertain” and “inappropriate,” whereas the new methodology uses “appropriate,” “may be appropriate” and “rarely appropriate.” Dehmer says the new terminology is a better fit for how cardiologists practice and discusses other changes in the updated AUC.

With the implementation of the MACRA legislation and the Merit-based Incentive Payment System (MIPS), Peter Tilkemeier, MD, says many physicians are dealing with the administrative burdens of medicine. He recommends cardiologists submit data to qualified clinical data registries to gain insight into how their practices are performing and meet a quality requirement for MACRA and MIPS. 

ACC President Mary Norine Walsh, MD, discusses the origins of “nocturnists,” a term used for internal medicine physicians who are hospitalists, work only at night and cover cardiology patients. Walsh’s practice employs nocturnists and believes they are well-trained and effectively serve patients while reducing the burden of night call on cardiologists.

Larry S. Dean, MD, provides insight on the randomized SURTAVI trial, which was presented in a late-breaking session at the ACC scientific session. At two years, intermediate-risk patients with severe symptomatic aortic stenosis had similar rates of all-cause mortality or disabling stroke whether they underwent TAVR or SAVR. Dean says the results confirm findings from the PARTNER IIA trial, which showed that TAVR can be effective in lower risk patients.

Teams benefit when providers work at the top of their license, according to Disty Pearson, PA-C. By doing so, it leads to mutual trust and respect. Instead of serving as the “quarterback” of the team, physicians may serve in more of a coaching role. 

Palliative care is a growing area in cardiovascular medicine, says ACC President Mary Norine Walsh, MD. Patients with heart failure and patients considering TAVR are among those who may benefit from working with the palliative care team. Listen in.

Surreal was the Merriam Webster word of the year in 2016. Cardiovascular Business asks physicians and others involved in cardiology for their “word of the year” for 2017 is. We’ll give you a hint – the word of the year suggestions start with change and concern and emerge from there.

During the past 10 years, there have been major advancements in cardiology, according to physicians and healthcare leaders. Listen in to hear what cardiology leaders define as the most important.