Leadership Forum: Looking into the 2011 Crystal Ball

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 - Looking to the future

Reimbursement changes, healthcare reform, comparative-effectiveness research, conflicts of interest, accountable care organizations and a workforce shortage—these are some of the topics that our Leadership Forum participants put forth as challenges—with perhaps some hidden opportunities—for the coming year.

The Participants are:
Larry S. Dean, MD, President of the Society for Cardiovascular Angiography and Interventions (SCAI) and Director of the University of Washington Regional Heart Center in Seattle, Wash. Clyde W. Yancy, MD, Immediate Past President of the American Heart Association (AHA) and Medical Director and Chief of Cardiothoracic Transplantation at Baylor Heart and Vascular Institute in Dallas Douglas L. Packer, MD, President of the Heart Rhythm Society (HRS) and Director of the Heart Rhythm Services at Mayo Clinic in Rochester, Minn. Jack Lewin, MD, CEO of the American College of Cardiology (ACC)

Q. What are at least two major challenges in cardiovascular medicine going forward in 2011?

Lewin: One of the big issues for cardiovascular medicine is how the delivery system will change and whether or not there will be a continued movement toward employment of cardiologists by hospitals. A second challenge—which may be ancillary to the first—is whether or not private practice for cardiology will remain viable.

Another challenge will be designing accountable care organizations [ACOs], which can be analogous to Bigfoot: We think we know what they are, but nobody has really ever seen one. Congress points to existing integrated systems such as Geisinger Health System, Kaiser Permanente and Intermountain Healthcare. ACOs that work well tend to have physician governance structures, like the Mayo Clinic, Cleveland Clinic and Geisinger. We will have to ensure that the federal definition of ACOs will help move the non-integrated majority of U.S. caregivers into a better delivery system.

Dean: The biggest challenge is trying to anticipate what will happen with healthcare reform. There has already been a considerable impact over the last couple years from the rationing down of payments—both for imaging and basic cardiology services. And these changes occurred before healthcare reform. In 2011, we have to position ourselves so we can respond to changes coming from healthcare legislation. It’s a difficult challenge because of the uncertainty. ACOs and medical homes appear to be the future for primary care physicians, for example, but we don’t know the impact of those on cardiology.

Packer: The biggest challenge for practitioners and societies is to stay on track regarding the mission of putting patients first. We have to continue to promote research, education and optimal health policies. There has been a shift where we are increasingly dealing with the process of medicine—reimbursement and regulatory issues, for example—rather than patient care. We have to continue to highlight our core mission and values.

Yancy: Cardiovascular medicine will indeed be challenged in 2011, but there will be major opportunities as well. The first challenge will be managing the dynamics of payment reform—notice, I didn’t say healthcare reform; and second, understanding issues of manpower. The real opportunity for us is to embrace and pursue a very new direction in cardiovascular medicine—and that is prevention. The burden of disease is so major that unless we all work collaboratively, no healthcare reform system will work; we must  capture the specialized arena of prevention.

Q. What manpower issues will impact 2011?

Packer: Cardiology fellows are worried about the increasing workload, which may worsen before it improves, if 40 million previously uninsured Americans enter into the healthcare arena. Fellows need to see our efforts to improve efficiency, quality and performance, as well as how we can continue to deliver quality care with limited resources.

There needs to be a continued understanding that quality is more than effectiveness outcomes—more than the ablation success rate or the sudden death rate, for example. Quality is about safety, process, structure and efficiency. With potential workforce challenges, we need to focus more on defining quality metrics in a measurable way, thereby, using those data to improve overall performance and patient care.   

Lewin: New research, technologies and scientific breakthroughs will continue to make cardiology one of the most exciting fields. However, the length of time it takes to train