Last week, we hosted the first session of the 2013-14 national meeting series, Unlocking Cardiovascular Value, in our Washington, D.C., office. We had a great mix of administrators, managers, and physicians attend who provided lively discussion and gave overwhelmingly positive feedback. In fact, 100% of them thought the research advanced their knowledge of how to cut CV costs, build a CV care management platform, and optimize the CV patient experience.
But don’t just take our word for it—see what attendees had to say, and preview the presentations they’re raving about.
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Carly Anderson, Cardiovascular Roundtable
A new analysis of the "Rule Out Myocardial Infarction Using Computer Assisted Tomography I" (ROMICAT I) study data sheds light on cost considerations for coronary CT angiography (CCTA) in the ED and raises questions about patient selection for this technology.
The ROMICAT I observational trial analyzed 368 patients between 2005 and 2007 who had acute chest pain and were being evaluated in the ED for hospital admission. In the new analysis, researchers used patient data from the trial to compare the cost and length-of-stay (LOS) associated with usual care (using an electronic cost accounting system) to the LOS and cost of care for patients undergoing CCTA in the ED. Patients and clinicians in the usual care group were blinded to CCTA results, allowing estimations of cost in the CCTA group to be based on patient management changes resulting from reading the CCTA scan for presence and severity of coronary artery disease (CAD).
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Megan Tooley, Cardiovascular Roundtable
As previously discussed in Cardiovascular Rounds, a number of recent studies have evaluated the overall costs and downstream impact of coronary CT angiography (CCTA) in various patient populations.
Adding to this list is the ROMICAT II (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial. The study assessed if using CCTA as a first diagnostic test in the emergency department (ED) to rule out acute coronary syndrome (ACS) in low-to-intermediate risk patients is more effective than standard evaluation.
The trial results, published in the New England Journal of Medicine on July 26, further validate the utility of CCTA as a safe alternative to nuclear imaging for certain patients presenting to the ED with chest pain. While overall costs, including all subsequent downstream services, were modestly higher in the CCTA group on average, the efficiency gains from a CCTA-based diagnostic strategy are promising.
Overall, more patients were discharged from the ED with fewer admissions to an observation unit among those receiving CCTA compared to standard evaluation.
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Earlier this month, the National Quality Forum (NQF) endorsed four new measures aimed at tracking resource utilization within certain patient populations. The measures center on diabetes and cardiovascular care costs, requiring organizations to measure per member per month expenditures within each cohort. Maybe not surprisingly, CMS intends to add a similar measure to their VBP program aimed at isolating Medicare spending per beneficiary (MSPB).
These tandem efforts to redefine value of care may be indicators of what’s to come—increased scrutiny over total-cost-of-care management. As risk begins to shift towards providers with the advent of new payment models, organizations must learn to both understand and then inflect total cost of care in order to remain financially viable.
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