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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.

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.

Cardiology fellow Haider Warraich, MD, hopes his book about death will change how we live.

After decades of steady progress pushing back the leading cause of death and disability, cardiologists are striving to achieve the Quadruple Aim as they prepare for a tidal wave of aging patients with multiple chronic conditions. Bellwether hospitals are rethinking old systems and carving out new pathways for managing “Chronic America.”

Ask cardiologists to name the big advances of the past decade, and many point to transcatheter aortic valve replacement (TAVR) and other breakthroughs that are allowing cardiologists to treat structural heart disease with minimally invasive procedures. Looking ahead, some believe that even bigger, broader changes are coming.

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.

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!

Questions have swirled around the value of percutaneous coronary intervention (PCI) for patients whose quality of life has suffered from chronic total occlusion (CTO). Inevitably, another issue has arisen: which cath labs and operators should be undertaking these difficult and costly procedures?

The availability of a specialty drug doesn’t guarantee its accessibility, as cardiologists who try to prescribe PCSK9 inhibitors to their patients are learning. Insurers’ requirements for prior authorizations can create formidable barriers, but some providers have found ways to surmount them.

Some hospital systems are considering offering integrated vein care centers. One of the challenges they face is uncertainty about reimbursement.

With the passage of MACRA and introduction of new reimbursement models, hospitals are analyzing the costs and benefits of sending patients to skilled nursing facilities (SNFs).

Pediatric cardiologists say they can use telemedicine to improve patient care and ease the burden on patients’ families. But with the costs of these programs stretching into the hundreds of thousands, and a patchwork of reimbursement and regulations to contend with, what does it take to find success with pediatric telecardiology?

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