The stock markets are not the only entities that abhor uncertainty. The rational world of medicine also wrestles with unknowns, but unlike some investors, it doesn’t let fear drive its responses. Instead, in the clinical setting, physicians and administrators often step back and query: What do we know? What are the gaps? How can we fill those gaps? In the meantime, given these unknowns, how do we proceed?
Take, for example, the impending Medicare reimbursement cuts, which if implemented, could lower cath lab revenues significantly. The battle is still on but medical directors in various cardiac programs in the U.S. are not passively waiting. While they lament the potential limitations that cuts may bring, they are devising strategies to maintain quality care.
Other facilities are taking a more proactive stance by positioning themselves as leaders in new markets. Aspirus Heart & Vascular Institute in Wausau, Wis., for instance, developed a valve clinic to serve the growing valve disease population. Not only are they making a profit, but they also have honed their knowledge and expertise in disease states and techniques in subspecialties such as transcatheter aortic valve replacement (TAVR), which is awaiting FDA approval (as of press time).
TAVR also takes center stage in the ACC Corner and in our cover story (page 6), where six interventional cardiologists discuss landmark trials that most changed how they practice medicine. The FAME trial tops the list of studies that brought new knowledge into clinical practice, consequently improving care and reducing cost simultaneously. New antiplatelet drugs may be more of a mixed bag, the cardiologists contend, but TAVR may have the potential to transform interventional cardiology.
Thermal hypothermia also may be proving to be a transformative technology as it helps reduce the cardiac arrest mortality rate. Sometimes it is not novel findings but rather the promotion of existing evidence that provides physicians with the tools they need to better serve patients. Monitoring stroke patients, as recommended in the Brain Attack Coalition’s guidelines, allows neurologists to identify stroke risk factors such as atrial fibrillation and intervene before a second stroke occurs.
Still, uncertainties abound, as shown in the ARB-cancer debate. At times it may seem like a contentious exchange, perhaps. But it always is respectful and rational.