ACC: Cards need to prepare for changing payment model

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NEW ORLEANS—American College of Cardiology (ACC) CEO Jack Lewin advised the cardiology community to begin preparing for a move away from the current fee-for-service model of the U.S. healthcare system during a presentation April 2 at the 60th annual ACC conference.

The average income family in the U.S. will be spending 45 percent of their total income to the cost of their healthcare by 2016, explained Lewin, who added that this is “completely unsustainable” for individuals, small businesses, mid-sized businesses and government—both state and federal.

“Therefore, it is a national imperative to figure out better ways to organize healthcare with an improved payment model and delivery approach that also enhances quality, health status with lower costs,” he said. As a successful example of a new method, the door-to-balloon campaign, which doesn’t require funding, has successfully reduced the average length of stay for patients with ST-elevation MI (STEMI) from five days to three days in the U.S. Since the launch of the campaign, the average cost of care for STEMI patients has been reduced by about 30 percent for the hospital. In addition, these patients have reduced morbidity with less delay in treatments.

“Payment reform is really essential in this evolution because if the incentives are not aligned correctly, then we will not get to a better endpoint in terms of ferreting out efficiencies,” Lewin said.

As a result, physicians now need to consider the cost of care, which is not traditionally part of the medical education process. “We are called to think that way now, and it has to be part of our stewardship to improve quality and efficiencies without stifling innovation or rationing care,” he said.

Over the next five years, there will be many more changes to the healthcare payment model with or without the federal healthcare reform process, Lewin predicted. “For many specialties, including cardiology, the fee-for-service model is a comfortable process, but we are going to have to prepare for a change to this current method,” he added.

Some providers are already moving toward various bundling payment models, such as integrated systems with global budgets. For cardiovascular caregivers, he recommended focusing on getting evidence at the point of care in a more effective manner with the use of registries and engaging the patient in the decision-making process.

Lewin concluded by pointing toward the effect of the Medicare reimbursement cuts on the migration of private practices moving to become hospital employees. “A few simple payment rule changes in Medicare caused this massive migration,” he said. “The impact that payors can have on how doctors practice can be profound. The most auspicious part of the formation of accountable care organizations will be the partnering of providers and payors.”