10/27/2010 7:27:54 AM #

What is the data on the use of 75mg in patients with renal impairment? This was not studied in re-ly.

Todd

10/28/2010 7:10:13 AM #

I was certainly expecting to see both the 110 mg and 150 mg doses approved. With the 75 mg pill size, we can use 1 and 1/2 tabs BID to match the 110 mg dose. This will be a viable option for our patients at higher risk of bleeding or falling unless the cost of three tablets daily is prohibitive.

Fendley Stewart MD

10/28/2010 8:17:17 AM #

I suspect many will prescribe 1.5 of the 75 mg tablets (112.5mg) BID for patients at increased risk of hemorrhage-- if the tablets can be divided effectively.

Denny Bales MD

10/28/2010 2:32:10 PM #

Greetings:

I read a recent article published in an ACC flyer that claimed '50% of private cardiologists have sold their practices to hospitals'.

Hospitals typically don't buy physician practices because they are not good deals. Once you buy a physician practice, the physician tends to 'hit the brakes, take a lot of vacations, etc.'

What part of the country has hospitals buying cardiology practices? The West, East, Midwest, South?

Seems like herd mentality and somewhat contrived. The danger of this type of misinformation and 'herd mentality' by our leadership is that there will be no ACC.

If there is no private practice, then there will be no ACC? Has anyone considered this?

Hospital hired cardiologists need not join the ACC. Only private cardiologists. Since 50% of private cardiologists have retired or now work for hospitals, then the ACC membership should decrease by this amount, or thereabouts.

Perhaps we should do a better job in supporting private cardiologists...who in turn support the ACC.

Interested in the thoughts of other members.

Mark Pavell

11/1/2010 4:17:19 AM #

Mark - most private practices in Ohio have joined into hospital systems, including mine here in Columbus (so I would not consider that 'misinformation'). At our center, the cardiologists are working harder than ever, but in a more collaborative fashion with our hospital to streamline and expedite services, and present a united front to the payors. I think the ACC is more critical than ever to employed physicians, for both advocacy and education. At the State Chapter level here, private practice, academic, and private employed cardiologists are represented and actively advancing our collective interests. . . .

Kanny Grewal MD

11/1/2010 10:37:50 AM #

If it is true that '50% of private cardiologists have sold their practices to hospitals' vs. 'working collaboratively', then the ACC can assist private cardiologists.

1. what is the average price paid by the hospitals for caridology practices.
2. set up a site/resources that will better help cardiologists negotiate the deal.

This would be more useful vs. discussions about the latest lab results by iphone, agree?

Perhaps I am mistaken.

Mark Pavell

11/2/2010 10:46:45 AM #

Hi Mark,
The ACC recently conducted a survey over 2,400 U.S. cardiology practices. It found that 60% of private practices (excluding solo practitioners) have engaged in integration/merger activity, either with a hospital or with another practice. Of this 60%, 29% had integrated with a hospital and 10 percent had merged with another practice. Thirteen percent indicated they are in the consideration phase of an integration or merger, and 8 percent said they were participating in a merger/integration activity not included in the survey. The survey was comprehensive and well-conducted, and included data from 49 states. I’ve talked about the study at length in a previous post, which you can read here: http://blog.cardiosource.org/post/ACC-Practice-Census-Provides-View-of-Current-State-of-Cardiology.aspx.

The ACC offers resources for both hospital-based and private practice cardiovascular professionals. Sixty-four percent of ACC members are in private practice – leaving 36% for academia, hospitals and other settings. Clearly, we need to and strive to offer value to all of our members. The ACC currently has resources available on its website to help members who are considering a merger, available here: http://www.cardiosource.org/Practice-Management/Hospital-and-Practice-Solutions.aspx. We’ve also had a regular series in Cardiology magazine addressing integration issues with tips on how to negotiate during integrations/mergers and what types of integration options are available. In addition, we offer a live program (which will be held this week, in fact) on Evolving Models in Cardiovascular Practice Symposium that discusses practice alignment and integration models in depth.

The ACC firmly believes that it offers tremendous value to both our hospital and private practice cardiovascular professionals. We monitor, advocate and participate where the ACC can influence cardiovascular research, training, accreditation, board certification, licensure, medical practice, reimbursement and career opportunities across the entire spectrum of the specialty and throughout its career stages. These apply in numerous practice settings. I personally believe that our colleagues that opt to move to a hospital integration model will continue to find value in the ACC for all that we do for their needs in science and education along with offering the infrastructure tools to be the leaders in the hospital environment for CV quality program implementation and importantly for assuming leadership roles in the hospital environment. Who better can champion healthcare delivery for our patients than us cardiovascular professionals? Certainly not the hospital administrators! The ACC has been poised and nimble to respond for the changing landscape of our membership yet will fervently continue to advocate for those of us who continue to enjoy practicing cardiovascular medicine in the private practice venue.

Thank you for your feedback and readership!!

Ralph Brindis

11/4/2010 8:28:54 AM #

Thanks for your feedback and I hope that my comments are taken constructively and not as criticism. I believe that my views are representative of 64% of the ACC membership.

Sometimes generals lose sight of the concerns of the 'foot soldier'. We used to be known as private physicians, now we are called, 'health care providers'.

To be clear, if 50% of practices have been 'sold' to hospitals, then ACC and AMA membership will also decrease by this amount.

--In local AMA chapters, for example, you know that the membership is comprised of private practice physicians--not hospital-based physicians.

If 50% of practices have folded in 2010, isn't this a failure on the part of the ACC?

Private practices depended upon the ACC not simply to champion 'access to care' but to provide guidance and protection to the clinician.

An article published by the ACC indicated that the very same 'test' performed at the hospital would be 3 times more expensive (due to facility fees).

Why has this not been widely publicized by the ACC?
Why doesn't every patient know this?
Why doesn't every patient's family know this?
Why doesn't every patient's friend, colleage know this?
Why doesn't every politician know this?
Why doesn't every insurance administrator know this?
Why doesn't the secretary of HHS know this?
Why doesn't every member of congress and the senate know this?

'Access to care' was never the issue. If so, then why has the ACC not warned the public that they will not be able to have 'access to care?'as 50% of practices have folded.

Access to care is not the issue.
Quality is not the issue: Insurers do not care about board certifications, ICAEL, ICANL, etc. We all know this.

The issue?

It is choice.

Patient choice. In America we choose where we live, where we work, what food we eat and what school we send our kids to. In America, the patient has a right to choose who their doctor is.

At least, it used to be that way.

Thanks for all of your good work. All of us appreciate it. However, we must accept the reality that is in store for patients, 'providers' and medical societies.

Mark Pavell

11/5/2010 11:23:31 AM #

Mark, thank you for very thoughtful comments. We are always looking to hear from our membership in what we can better do to meet your needs, and I appreciate you taking the time to communicate with me and other leaders reading this blog.

In response to your comment about the increased cost of providing care at hospitals compared to in the ambulatory setting, the ACC has been unabashedly outspoken on this particular issue and have taken this message to Congress, HHS and other health care leaders. I personally have talked to the national press, Democratic and Republican leaders in the House and Senate and the policy wonks, payers and purchasers in Washington and throughout the country. I discuss how this will promote and magnify racial and socioeconomic disparities in care. We give examples of practices closing inner city satellite offices further decreasing care access to those that need it most. Our advocacy division along with Jack Lewin and Jim Fasules are incredibly vocal to all health care stakeholders on this key issue. It simply doesn’t get through to them. We will continue to push this message in our discussions with them well into the future. It is short-sighted for agencies and lawmakers to cut Medicare Part B payments repeatedly by large amounts, without expecting Part A costs to increase in direct proportion.

Your comments have given me and our College leaders much to think about. Please know that we are out there fighting for you and other private practice physicians.
Regards,
Ralph

Ralph Brindis

11/5/2010 11:25:34 AM #

I echoed Ralph's comments about our advocacy efforts on that regard. Check out my post from earlier today for more on my thoughts: http://blog.cardiosource.org/post/The-Election-Revolution-Evolution-or-Just-Plain-Confusion.aspx.

A couple of thoughts on dabigatran:

The key positive on dabigatran’s approval is that it requires no blood monitoring or related dose adjustments. Also, there are no recommended dietary restrictions. It will cost over $6 per day for twice a day therapy.

This is a major breakthrough; and, given the incredible difficulties in managing warfarin therapy. 2.3 million Americans have AF, and far too many of them currently suffer preventable strokes or embolic complications. This is a game changer for patients with AF. Additional warfarin alternative agents are in the pharma pipeline as well.

Dabigatran is not currently approved for AF patients with valvular heart disease, but Phase II studies with AF in patients with mechanical valves will begin in early 2011. Imagine if the mechanical valve/AF research indicates effectiveness and safety---this could shift valve surgery away from tissue valves (that don’t require anti-coagulation but need to be replaced eventually) toward mechanical valves (that do not need to be replaced, but require anti-coagulation).

Jack Lewin