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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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Do higher care costs translate to better quality? New research says ‘no.’

February 3, 2014

Meg Voorhis, and Anna Moses, Clinical Sourcing Impact division, Spend Performance Solutions

We continue to hear about tremendous variation in cardiovascular costs and utilization, and that higher spending doesn’t always correlate with improved patient outcomes. A recent study published in JAMA now reinforces this message for endovascular care.

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Cardiac rehab coverage for HF: AACVPR experts answer your questions

January 28, 2014

Megan Tooley, Cardiovascular Roundtable

  • Update: On February 18th 2014, CMS formally approved expanding coverage for cardiac rehab to select chronic heart failure patients. Read the final decision memo here, and read our Q&A below to learn more about the decision.

In November, CMS proposed expanding cardiac rehabilitation (CR) coverage to certain chronic heart failure (HF) patients. This proposal piqued the interest of CV programs across the country, and we’ve fielded a number of questions from members on how this proposed reimbursement expansion could affect their programs and HF patient care.

To learn more, we turned to two American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) experts–Karen Lui, RN, MS, and Randal J. Thomas, MD, MS–to get their take on HF and cardiac rehab.

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Two-midnight rule resurrects age-old question: Can observation care be profitable?

January 27, 2014

Jeffrey Rakover, Cardiovascular Roundtable

For many CV providers, the two-midnight rule will result in a reimbursement decline—the loss from short-stays converting outpatient will exceed the gain from long observation stays converting inpatient. The complex economic repercussions of the rule underscore a need for clearer data on the overall economic impact of observation care.

Two recent papers from JAMA Internal Medicine and Health Affairs offer some insight, drawing distinctions between care provided in different settings and by different providers. The papers are suggestive of how to make the best use of observation to optimize economics while enhancing care quality.

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How (and why) to develop a cardio-oncology partnership

January 10, 2014

Andrew Hresko, Cardiovascular Roundtable

Cardiovascular Business recently published an article exploring the emerging field of cardio-oncology, which developed from the apparent relationship between cancer treatment and cardiomyopathy. Cardiologists and oncologists alike have begun creating protocols to screen cancer survivors for developing heart problems—and some are even pursuing multidisciplinary collaborations to care for the diseases jointly.

During our national meeting research, we found that several institutions are placing a new emphasis on improving care for these complex patients through cross-service line cardio-oncology collaborations.

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Get the new imaging AUC on your cardiologists' radar

January 6, 2014

Olivia Ley, Cardiovascular Roundtable

The American College of Radiology (ACR) recently released an update to its appropriate use criteria (AUC) that includes five new CV imaging topics. This adds to the growing library of AUC available for CV services—but it can be difficult to move these guidelines from paper to practice.

Leaders at Henry Ford Hospital found a solution. We’ve mapped out their education strategy—and its results—that you can use to engage your physicians with the new CV imaging criteria.

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Succeed under HF bundled payments: Strategies to reduce risk from post-acute care providers

December 16, 2013

Jeffrey Rakover, Cardiovascular Roundtable

Many CV providers are accepting bundled payments for heart failure (HF) cases. But during our November national meeting, an attendee asked an important question: How can CV programs succeed under these payment contracts when much of the risk comes from readmissions outside their control? The attendee was particularly concerned with high readmission rates from skilled nursing facilities (SNFs).

To help you reduce this risk, I’ve pulled together a list of our best resources and profiles on preventing SNF-related readmissions and working with post-acute care providers. The approaches range in resource intensity and degree of direct engagement from sending system providers into non-affiliated SNFs to developing preferred SNF networks and improving quality by providing regular performance feedback. 

With increased attention to cost of care in the post-acute space, providers will want to consider these approaches as they work to optimize both bundled payments and readmission risk overall.

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The CV care management dictionary

December 9, 2013

Andrew Hresko, Cardiovascular Roundtable

At our national meeting, we begin our CV care management presentation with a complicated word cloud and two big questions: What do all these new terms about patient care mean? Are they just catchy buzzwords?

Care management jargon certainly can be confusing. But parsing out the nuances between the often similar-in-name and related-in-function terms is an important step in developing a coordinated CV care management strategy. We’ve defined some of these complicated terms below to provide some clarity and identify the relationships between them.

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SCAI’s expert opinion on FFR, IVUS, and OCT

November 27, 2013

Andrew Hresko, Cardiovascular Roundtable

More and more doctors are using fractional flow reserve (FFR) and optical coherence tomography (OCT) technologies to evaluate the extent of coronary artery blockage and optimize the use of coronary interventions. As we’ve discussed in the past, use of FFR—which measures the pressure drop across a stenosis—has increased exponentially over the last decade. Adoption of OCT—which creates high-resolution cross-sectional images of blockages—has not been as rapid, but physicians are excited about its potential for visualizing arteries.

Much of the interest in these tests is due to the growing scrutiny over appropriateness of PCI, as they can support CV decision making and identify the clinical need for an intervention. Although these tests can aid appropriate use decisions, they also raise a new question: How do we ensure these diagnostic invasive tools themselves are used appropriately?

See the latest appropriate use criteria for CV procedures and diagnostic tests »

To address this question, the Society for Coronary Angiography and Interventions (SCAI) has released an expert consensus statement on optimal use of FFR, OCT, and intravascular ultrasound (IVUS, the previous standard for measuring coronary artery blockage). This statement uses evidence released since the technologies were last evaluated in the 2011 guidelines for PCI to provide guidance on which technology is appropriate in various situations.

I’ve summarized three key takeaways from the new guidelines below.

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