The Changing Climate of Health Care: Impact on the Practice of Pediatric Cardiology

This post was authored by Robert Campbell, MD, FACC, Adult Congenital Pediatric Cardiology representative to the 2015 Cardiovascular Summit planning committee.

Change is everywhere. Nobody minds change, but everybody minds being changed. You can lead, follow, or get out of the way. We’ve all heard these sayings, and they have never been more pertinent in the field of medicine. From my perspective, adult cardiology benefits from many evidence-based physician performance guidelines; this data can be used to document quality. However, many adult cardiologists, previously in private practice, now find themselves in new alignments and employment arrangements with hospitals. Medicare issues are formidable. In contrast, pediatric cardiologists have less evidence-based physician performance data with which to prove outcomes, best practice standards, quality and value. Generally, pediatric cardiology programs are based at children’s hospitals and/or academic centers. Medicaid, while similar in some ways to Medicare, is state funded thus different center to center. Continue reading

Heart Valve Summit 2014 Recap

This post was authored by Xiushui (Mike) Ren, MD, affiliate member of the ACC.

A near equal proportion of cardiologists and cardiothoracic surgeons attended this year’s ACC/AATS 2014 Heart Valve Summit in Chicago, IL from September 18 – 20.

Conference Co-Director Robert O. Bonow, MD, MACC, kicked-off the meeting with an update of the 2014 ACC/American Heart Association guideline for the management of patients with valvular heart disease. For all valves, the guideline committee emphasized using stages to categorize valve disease, analogous to stages of heart failure. Stage A represents patients at risk for valve disease, such as bicuspid aortic valve or mitral valve prolapse; stage B represents patients with mild to moderate valve dysfunction; stage C represents patients with severe asymptomatic valve disease; stage D represents patients with severe symptomatic valve disease. Continue reading

ACC.15: Hot Science, More Learning, Less Lecturing

This post was authored by Athena Poppas, MD, FACC, chair of the ACC’s Annual Scientific Session.

The ACC’s 64th Annual Scientific Session will bring together the world’s leading cardiovascular professionals in an interactive and innovative learning environment. Taking place in San Diego, CA from March 14 – 16, 2015, the meeting will place a focus on more learning, less lecturing.

ACC.15 will feature 11 clinical learning pathways, including a new “Future of Cardiovascular Medicine” track, which will present ideas and concepts looking forward in time, imagining what the world of cardiovascular care will look like ten or twenty years down the road. Continue reading

Roundtable Continues Important Discussions Around Anticoagulation Therapy

This post was authored by Kim Williams, Sr., MD, FACC, president-elect of the ACC.

Over the years the use of anticoagulants have become a vital means of treating atrial fibrillation, atrial flutter, acute coronary syndromes, ischemic stroke, pulmonary embolism and venous thrombosis. Managing the layered facets of their use, however, can at times be quite daunting for the patients, physicians, nurses, pharmacists and any other stakeholders involved.

In an effort to continue much needed discussions about anticoagulation therapy, including key questions facing providers, patient barriers and evolving research and treatment options, the ACC brought together a number of stakeholders across the health care spectrum for its 2nd Anticoagulation Consortium Roundtable on Saturday, Sept. 27. Continue reading

Tackling CVD Around the Globe Through Heart-Healthy Environments

This post was authored by William A. Zoghbi, MD, MACC, past president of the ACC and co-chair of the Global Cardiovascular Disease Taskforce.

Today we celebrate World Heart Day, a global initiative created by the World Heart Federation to better educate citizens about the prevalence of cardiovascular disease and stroke.

As next year will see the selection of the United Nation’s Sustainable Development Goals – the successor to the organization’s Millennium Development Goals that will set the global health and development strategy for the next 15 years – it is vital that the College and the cardiovascular community do all they can to ensure that cardiovascular disease and other non-communicable diseases (NCDs) are included and prioritized on this agenda. Continue reading

Advocacy vs. Apathy

This post was authored by Mark Victor, MD, FACC, CEO of Cardiology Consultants of Philadelphia, as delivered during ACC’s 2014 Legislative Conference.

Over my 33 year career I have witnessed an unimaginable change in the practice of medicine. The certainty of where and how we practiced, relationships with the hospitals, the satisfaction in utilizing the skills which we learned as fellows, were all predictable. As I made the transition from fellow to attending from impatient and perpetual student to energetic teacher/practitioner, I became the second physician in our practice. My career seemed set. But as the next several years evolved and we grew to a four member practice, I began to feel that change was necessary for us, and change we did. The profession also began to change over the next decade as hospitals began their first foray into physician acquisition. Turf wars between competitive systems began as the artificiality of “certificates of need” gave way to competition from community hospitals against the historic monopolies of tertiary cardiac care by the academic medical centers. They in turn had to redesign their mission away from an emphasis on research and education to a more financially driven model, forcing academically inclined and research minded faculty to more closely resemble their community based clinical colleagues. Continue reading

The Electronic Health Record: 4 Years Later

This post was authored by Alfred A. Bove, MD, PhD, MACC, and was originally published in the August 2014 issue of CardioSource WorldNews.

Like many of you, I have been immersed in the world of the electronic health record (EHR) for the past four years. I am reminded daily to digitally close an encounter, to be sure electronic prescriptions are signed, to click on a box to swear that I reviewed a lab or imaging report, and to be sure to give the patient a summary of their visit before he or she leaves the office. I receive constant reminders of drug interactions, the need for flu shots, and whether I am at par with my peers in e-prescribing, closing encounters, etc.

Our EHR is available through a secure web browser, so I can access the information from home or when traveling to keep up with my patients and clear the never-ending new items from my inbox.  Continue reading

ACC Members Hit the Hill to Advocate for CV Professionals and Patients

Nearly 400 cardiovascular professionals stormed Capitol Hill this week to meet directly with their legislators. In their meetings, ACC members shared examples of how the College is leading the transformation of care and urged Congress to work with the ACC to develop a quality driven health care system, ensure practice stability and secure the future of cardiovascular care. With a plethora of challenges facing health care providers, ACC Members were able to provide first-hand perspectives of how decisions made in Washington impact practices and patients across the country. Hot topics on the Hill included Sustainable Growth Rate repeal, In-Office Ancillary Services Exception preservation, increased research and graduate medical education funding, incentivizing the use of clinical data registries, and improving access for Medicaid children with complex medical problems. Take a look at the full set of messages that members took to congressional offices. Continue reading

Provider Perspectives on EHR Benefits and Interoperability

Over the last few years, the percentage of practices using electronic health records (EHRs) and the number of cardiologists participating in the federal EHR Incentive Program has grown tremendously. With these developments, clinicians are recognizing some real benefits from their EHRs, however, according to a recent CardioSurve survey, much room for improvement still exists for this technology particularly in the areas of interoperability and closing gaps in treatment and care.

Nearly eight out of 10 cardiologists (78 percent) indicated they have been using EHRs for at least two years or more. More importantly, nine out of 10 cardiologists said they have a fully functioning EHR program or are in the process of implementing one. Popular CV practice EHRs continue to be Epic, Allscripts, NextGen, Cerner, GE Centricity, e-Clinical Works, Athena Clinicals, GEMMS, and Greenway. Continue reading

Reducing Radiation Risk For Our CHD Patients

This post was authored by Aimee K. Armstrong, MD, FACC, co-director of the ACC’s Reducing Radiation Risk Quality Improvement Initiative

The treatment of congenital heart disease (CHD) often includes multiple diagnostic and interventional cardiac catheterizations, which give repeated patient exposure to ionizing radiation. There is growing concern regarding the adverse effects of the cumulative radiation exposure, particularly in children, whose organs are still developing. Developing organs are more sensitive than mature organs to the induction of certain cancers from radiation exposure. In addition, children have a longer life span than adults, during which to manifest the possible detrimental effects of the exposure. The long-term effects (stochastic injuries) are not the only concern, as large skin doses can also lead to radiation burns (deterministic effects). In fact, the Joint Commission has deemed a peak skin dose of >1500 rads a sentinel event. With interventional catheterizations for CHD becoming more complex and lengthy, particularly with the introduction of transcatheter valve therapy, there is a need to pay particular attention to the cumulative radiation dose that our patients receive and we need to seek ways to decrease this dose whenever possible. Continue reading