You are here

Practice Management


Six healthcare organizations are joining forces with the goal of streamlining preapproval for patients’ medical treatments. The collaboration, they said, will give patients access to timely, affordable care while reducing administrative burdens for healthcare professionals, hospitals and insurance providers.

A meta-analysis of 29 studies and more than 6 million patients has added to a pile of evidence supporting medicine’s “weekend effect,” according to a study published in Medical Care’s February issue.

Physician compensation has increased across the board over the last five years but cardiologists’ pay has grown less than other specialties, according to SullivanCotter’s 2017 Physician Compensation and Productivity Survey.

The newly revised Declaration of Geneva, released in October, contains wording tweaks throughout but also entirely new clauses focused on patient autonomy and physician health.

    Fewer than one in six American patients undergoes cardiac rehabilitation after MI, PCI or coronary artery bypass graft (CABG) surgery, and participation varies widely by state and region, a new study in Circulation found.


    Recent Headlines

    What’s one improvement that could further improve length and quality of life for children with congenital heart disease as they age?

    Due to advances in medical, surgical and transcatheter therapies, there are now more adults living with congenital heart disease (CHD) than children. Development of accessible integrated transition pathways from pediatric healthcare systems to specialized adult CHD centers will be essential to improve cardiac health, longevity and quality of life for children as they age. There are numerous potential barriers, such as inadequate self-understanding of the nature of their heart disease, separation from parental support, insurability concerns and lack of knowledge of available support resources, that can have a negative impact on the health of young adults living with CHD. Organized planning and access to centers with specialization in the management of adult CHD can prevent long periods of being lost to follow up and potentially irreversible decline in quality of life.

    How do you handle stress and protect yourself/your team from burnout?

    As president of a community hospital in suburban Boston, and a practicing vascular medicine specialist myself, I am terribly worried about the deterioration in the morale of my physician colleagues. They feel devalued, overwhelmed by administrative burden and are permanently tethered to computer screens. This is particularly evident among the primary care physician workforce. My hospital employs over 270 physicians representing many specialties. I am focused and committed to restore joy to the professional lives of my medical staff. I am looking at creative ways to make interacting with our electronic health record easier. I am investigating novel compensation plans that promote behaviors that align physicians and our health system. I am regularly interacting with my medical staff, listening to issues and evaluating solutions. Most important, I am discussing the challenges facing U.S. physicians on a regular basis with colleagues around the country, hopeful that successful pilots elsewhere would be applicable to my colleagues.

    Do you encourage today’s young people to pursue careers in healthcare? Why or why not?

    To my grandchildren, I would say…

    Are you insecure? Healthcare is recession proof and unlikely to be outsourced offshore.

    Are you financially worried? Healthcare jobs pay well, in some cases outrageously well.

    Are you adventurous? Healthcare is needed in exotic settings where few are bold enough to go.

    Are you innovative? Healthcare begs for innovation, from basic science research to global health policy.

    Are you good with your hands? The best place for skilled hands is on the handle of a scalpel.

    Are you intellectual? Daily your mind will be challenged by strange symptoms and insoluble problems.

    If you could have an immediate fix to one healthcare problem, which problem would you choose, and why? 

    It would have to be providing basic universal healthcare for all. There is no other way to address healthcare in the U.S. short of this, as evidenced by the political reality in Washington D.C. Even with a Republican majority in the Senate and House as well as a Republican president, the Affordable Care Act hasn’t been repealed—despite multiple attempts. People want access to adequate healthcare. We, as a country, should move forward to modernize our healthcare delivery system and fix the current patchwork of programs. Very little of the current system represents the modern reality. Providing adequate healthcare for citizens is the only way to move the country forward on this issue. Anything else is a political excuse.

    Physician Burnout: Going from Taboo to Treatable

    Physician burnout has been called a “silent epidemic” that not only overwhelms physicians but can impact the care they deliver to patients. A number of programs are starting to confront the problem head on—giving doctors hope that someone is listening.

    Game Brain: To Win at Healthcare, Think Like a Gamer

    The game has changed, the rules are evolving and winning has been redefined. Adopt a gaming mindset to get to the next level.

    What is the one pharmaceutical, device or other technology in the pipeline today that you are most eager for, and why?

    The recently reported CANTOS trial represents an enormously important development in cardiovascular medicine. For the first time, an anti-inflammatory drug (canakinumab) given by injection every three months has been shown to reduce morbidity and mortality. Trial entry criteria required a hsCRP level >2 mg/L and stable coronary heart disease. The 150-mg dose reduced the risk of nonfatal myocardial infarction, stroke and cardiovascular death by 15 percent with no effect on lipids. These benefits were observed in patients already treated with the best available therapies, including high-dose statins and antiplatelet drugs. The importance of these findings extends far beyond the CANTOS trial. Now that we know that treating inflammation can reduce cardiovascular morbidity and mortality, the search for other anti-inflammatory regimens can proceed with the high likelihood of successful clinical trials.

    What has been the biggest transformative change in cardiology since 2007, and why?

    This has been such an exciting time in cardiology—although the lens we use is often cloudy. Why? Because the pace of change is truly unparalleled. From massive changes in the physician fee schedule resulting in a rapid migration to employment to a total transformation in cardiovascular care delivery models, our practices are not what they were a decade ago. Cardiovascular service lines, dyad leadership and payment for quality and patient outcomes were unheard of in 2007. Yet I find our world invigorating and inspiring. We have successfully reduced mortality related to cardiac events!

    Education, screening program nearly eradicates inappropriate catheterization

    A one-month education and screening program at a rural tertiary medical center reduced inappropriate cardiac catheterization referrals by primary care physicians (PCPs) from 17 percent to zero percent.

    Early discharge for low-risk pulmonary embolism patients linked to fewer complications, lower costs

    Patients with low-risk pulmonary embolism (LRPE) who were discharged from the hospital within two days had better clinical outcomes and resulted in cost savings when compared to those with longer stays, according to a study in PLOS One.