2012: Time for the Resourceful
Every resourceful 10-year-old knows to search beneath couch cushions and check the pockets of last season’s coats to find overlooked cash. In a period of shrinking reimbursements and cost-consciousness, some ingenious physicians also are poking into existing resources to extract nuggets that provide cost-free added value. They are looking to get more from what is available now, a smart strategy in what promises to be a tight-fisted upcoming year.

Financial discussions are beginning to permeate most aspects of cardiovascular practice, research and patient care. In this issue, and in upcoming issues in 2012, strategies to balance cost-cutting and cost-containment with quality of care are a theme or subtheme in many of the articles. When asked to discuss trends in 2012 for our cover story, four leaders from the worlds of business, practice, government and research independently remarked that spending less will be a driver of cardiovascular care.

In that kind of environment, we tend to re-evaluate what we have in search of opportunities to squeeze out more value. One source of this no- or low-cost gain is in already existing data.

A recent article in the Journal of the American College of Cardiology described a technique that applies computational fluid dynamics to datasets from noninvasive coronary computed tomographic angiography (CCTA) to quantify fractional flow reserve (FFR). The results showed good correlation with FFR, while proving more accurate than CCTA for detecting ischemia-causing coronary lesions. The authors pointed out that the method required no additional scans, medications or changes to protocols.

In another clever study in Science Translational Medicine, engineers paired up with cardiologists to design a method to extract useful information from electrocardiograms for estimating the risk of death for patients who experience acute coronary syndromes. They noted that the data are already being gathered but the sheer volume required computational techniques to find subtle, but important, signals.  

Another way to possibly cut costs and improve quality is to identify and eliminate wasteful and inefficient processes using lean and Six Sigma practices. The principles apply to both small or midsize practices and large hospital systems. Preventing avoidable adverse outcomes such as infections in cardiovascular implantable electronic devices offers another opportunity.

Spending less in 2012 need not equate with achieving less if we look creatively at the resources before us.