First Word: Taking Control Amid Ambiguity

Heart Rhythm Society (HRS) Chair of Health Policy Richard I. Fogel, MD, echoed the thoughts of many during the 32nd annual HRS meeting: "This is a very dynamic healthcare environment with a lot of unknowns. While I am not sure what the picture will look like in the next five years, one thing is for certain, healthcare in the U.S. will be forever different."

As a result of these inevitable changes—of which no one can clearly define—certain providers and medical societies have decided to pre-empt government mandates and third-party payor cutbacks through novel initiatives within their practices.

For instance, the echocardiography community has continued to update its appropriate use criteria (AUC) in an effort to ensure those practitioners ordering and conducting echo images are equipped with the most up-to-date data.

However, proper utilization of AUC and other guidelines cannot stop at their issuance, especially if they hope to experience widespread adoption across U.S. clinical practice (page 4). As Pamela S. Douglas, MD, of Duke University explains: "Forward-thinking practices take the guidelines and use them to create education materials and web-based decision tools."

To assist these practices, the "ASE Recommendations for Quality Echocardiography Laboratory Operations," also were released with the goal of clarifying some benchmarks and boundaries to establish a foundation for minimal standards for echocardiography quality in the practical setting of the echo lab.

The recommendations' lead author Michael H. Picard, MD, director of clinical echocardiography at Massachusetts General Hospital in Boston, suggests, "It's always preferred that physicians set the standards of care and utilization, rather than an external body, which won't be as familiar with our processes and the needs of our patients."

In addition to the national focus on over-imaging, high rates of readmission for heart failure and acute MI patients also have undergone scrutiny. Currently, CMS is publicly reporting readmission rates, and there is some talk about penalties for 30-day readmissions for heart failure in the future. The final CMS determination is again uncertain.

However, this month's ACC Corner (page 24) focuses on the H2H (Hospital to Home) initiative, which was formed from a partnership between the American College of Cardiology and the Institute for Healthcare Improvement, and seeks to connect hospitals, practices and physicians on data collection, identifying vulnerable patients, gaining administrative and physician buy-in, as well as coordinating inpatient and outpatient care.

While partaking in such initiatives will not stave off the impending changes within U.S. healthcare, these types of efforts, among others, can begin to equip providers with internal policies and a unified administrator/physician point of view on how better to approach these transformations.