Reducing overuse from many angles
Candace Stuart - FOR LEAD ONLY - 157.40 Kb
Candace Stuart, Editor, Cardiovascular Business
The revelation that the hospital chain HCA is being scrutinized by the U.S. Attorney’s Office in Miami after allegations of overstenting in some hospitals in Florida may be prompting some medical directors and administrators to look into their oversight procedures. The tools may already be in place.

As reported previously, HCA was asked in July to turn over any reviews assessing the necessity of cardiac services at its facilities. HCA officials said they so far have identified 10 hospitals, mostly in Florida, that qualify. It is unclear what methods are in place at HCA to capture data that support decisions to stent patients, but processes, equipment, protocols and IT support exist for this purpose.

Resources such as the Accreditation for Cardiovascular Excellence (ACE) program may provide one framework. Excela Health in Greenburg, Pa., sought out ACE accreditation after an independent audit questioned the appropriateness of stenting in some patients. As part of the accreditation process, Excela reviewed its EMR and found that it had critical information to assess appropriateness but that it was buried. A reworking of the EMR made the information readily available.

EMRs are proving to be a useful on many fronts. For instance, researchers recently reported on a stealth alert system they designed and tested that informs a team whose job is to monitor patients on warfarin when a physician prescribes medication that may interfere with warfarin’s anticoagulation effect. The goal is to reduce alarm fatigue for physicians and improve patient care. The stealth alert process increased monitoring rates.

PCI is not alone when it comes to concerns about inappropriate use and overuse. Imaging also has been placed under the magnifying glass to ensure costs are contained and patients are not unnecessarily exposed to radiation.

While cardiac CT angiography is a useful tool for defining the presence and severity of luminal stenosis in patients with suspected coronary artery disease, physicians worried about misdiagnoses may turn to it too often. One statewide quality initiative, with participation of a payer, took aim at overuse by launching an educational program that included data monitoring and feedback. Researchers reported achieving a 60.3 percent decrease in inappropriate use among participants in the initiative.

There may be more than one way to eliminate inappropriate use proactively. Perhaps it is a combination of overarching principles endorsed through accreditation and targeted approaches such as the stealth alerts and collaborative quality initiatives. What has worked for you?

Candace Stuart
Cardiovascular Business, editor