Working relationships

Let’s talk policy. Policy is a whole lot more palatable than its cousin politics right now.

This week we looked at several research papers published in Health Affairs. The journal often offers insights on policy and practice that might glide under the radar of busy cardiologists and administrators, although the findings may prove relevant for them.

One such paper was published recently by a team from the University of Michigan in Ann Arbor. They analyzed Medicare data for 30-day readmission to the emergency department after surgical procedures. Leading the pack was CABG for emergency department use rates within 30 days of discharge, with PCI clocking in above the average as well. The rate for post-CABG was 22.4 percent compared with 17.9 percent for PCI and 17.3 percent overall.

CABG is likely to be in the limelight more and more as Medicare’s 30-day readmission penalties are expected to expand beyond acute MI, heart failure and pneumonia. Another recent study in the New England Journal of Medicine determined that the 30-day readmission rate for CABG was more than four percentage points above the average for six common surgical procedures.

The emergency department will be a valuable partner in efforts to identify and modify factors that contribute to these readmissions.

On a different subject, federal policy analysts took advantage of the addition of national provider numbers in Medicare claims to better assess trends in physician practice size. Their study also appeared in Health Affairs. It is no surprise that they found consolidation; survey-based research has pointed to the same trend. But their results revealed consolidation into groups of 50 or more was greater than previously reported, and growing. That trend could influence costs, quality and access to care.  

Unlike you-know-where, the parties who build the evidence that informs policy collaborate and value different perspectives. Multidisciplinary researchers, while not immune to politics, work together and healthcare is better as a result.

Cardiovascular Business, editor