The American College of Cardiology (ACC) held its annual conference March 14-16 in San Diego. Here are some highlights and perspectives on the sessions.
Turning TAVR’s growth into hospital profits
Transcatheter aortic valve replacement (TAVR) programs are picking up steam in the U.S. And they can be fiscal as well as clinical successes, but it requires physicians and administrators working together to maximize efficiencies.
The U.S. and Europe account for 89 percent of TAVR cases worldwide, says Michael Mack, MD, of the Heart Hospital Baylor Plano in Texas. In 2013, the U.S. had 350 TAVR centers—more than half the total worldwide.
But are those centers a good business proposition? G. Michael Deeb, MD, director of the Multidisciplinary Aortic Clinic at the University of Michigan Health System in Ann Arbor, says hospitals need to weigh the upfront investment against the downstream benefit with an eye on the bottom line. The capital investment can be high, with multimillion-dollar hybrid operating setups and valves costing about $30,000.
His center saw a 17 percent increase in surgical aortic valve replacement (SAVR) procedures after the first full year of the TAVR program but that trajectory dwindled over time as patient volume shifted from SAVR to TAVR. “What you really want to do is make direct, not indirect, profits,” Deeb says. “How are you going to do this?”
Their solution involved an emphasis on efficiencies. For instance, make sure the hybrid room is in use, if not with TAVR, then with other hybrid procedures, and develop a flex team with multitasking cath and OR personnel. They analyzed the entire procedure to identify inefficiencies and determine how to stagger cases. As a result, they improved caseload from two procedures a day to five, with physicians done by 5 p.m.
The hospital will look at direct margins per inpatient day to determine if TAVR is worth the investment. In their case, they reported an increase for TAVR of about $300 between 2011 and 2014. SAVR also rose about $500.
Focusing big data on patients fosters better preventive care
“Big data” can change healthcare into a system that better focuses on early detection and prevention rather than acute care—if physicians make better use of it.
“Data is one of the big trends in health information technology,” says James Tcheng, MD, of the Duke Clinical Research Institute in Durham, N.C. “But I would suggest that we’re really falling short of meaningful use of health information technology. We’re focusing on the wrong place.”
Physicians use it as an administrative tool rather than figuring out how to apply the data that flows through their systems to better care for individual patients, he says. “Big data is squishy. It really is hard to put your hands around, but leveraging the appropriate data streams has the potential to change the paradigm of healthcare, by taking big data and focusing it down on the patient.”
Physicians need to take general information and apply it to individual patients to shift the healthcare paradigm, says Jeroen Tas, CEO of Philips Healthcare. In a country that spends $3 trillion on healthcare, 83 percent goes to chronic disease. Yet the system is organized around acute care. The information provided by big data can change that, allowing healthcare to be organized around a health continuum and the needs of each patient.
“I think if we do this, we cannot just marginally improve healthcare, we can truly exponentially improve healthcare,” Tas says.
Upcoming PCI AUC take into account past criticisms
Acknowledging there was room for improvement, the authors of PCI appropriate use criteria (AUC) have applied lessons from the last set of guidelines in a revision scheduled for publication this year, attendees learned at one session.
Writing committee member Gregory J. Dehmer, MD, of Scott & White Healthcare in Temple, Texas, says the AUC are a work in progress. “We are still learning how to apply them.”
The AUC were developed proactively by cardiologists to reduce variation and improve the quality of care. Publication of the AUC led to some unintended consequences, though. Specifications that the criteria should not be tied to reimbursement fell on deaf ears, and the misinterpretation of uncertain procedures and lumping them with inappropriate PCIs created a skewed public perception of overuse.
“You need to understand that uncertain means there was not enough clinical information available to make a firm determination or, even more