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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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One way to make discharge education stick: Group discharge sessions

March 19, 2014

Andrew Hresko, Cardiovascular Roundtable

CV leaders know that post-discharge self-management plans are crucial to avoiding readmissions. For more than a decade, studies have shown that discharge planning can reduce readmission risk for heart failure (HF) patients. But these plans are only effective when patients are willing and able to comply.

To make sure patients can adhere to these directions, programs must provide thorough education on self-management skills. However, education often becomes a “cram session” that occurs shortly before discharge, when patients and family are anxious and less able to process complex instructions.

Fortunately, you don’t need to revamp your entire discharge planning approach to make instructions stick. CV leaders at South Nassau Communities Hospital in Oceanside, N.Y., supplement traditional one-on-one bedside delivery with group HF education sessions.

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10 steps to lower TAVR length of stay from The Queen's Medical Center

March 10, 2014

Megan Tooley, Cardiovascular Roundtable, and Dr. Christian Spies, The Queen’s Medical Center

It’s been over two years since the FDA approved the first transcatheter aortic valve replacement (TAVR) device for use in the United States, and interest in the groundbreaking procedure—and the opportunities a TAVR program can offer patients and hospitals—has not waned.

But CV leaders are now facing increasing pressure not just to develop a program that meets the robust infrastructure requirements set forth by vendors and regulators, but one that also demonstrates long-term sustainability and value to the community and hospital. This means uncovering new strategies to optimize TAVR efficiency and cost-effectiveness.

With this in mind, many programs have started focusing on reducing length of stay (LOS) for TAVR cases. Doing so not only improves clinical quality and the patient experience, but also the fiscal viability of a TAVR program under current reimbursement models.

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How the two-midnight rule will affect your hospital

February 19, 2014

Eric Fontana, Practice Manager

CMS recently announced that it will extend the two-midnight related “probe-and-educate” period. While this sounds like a risk-free educational period, Medicare Administrative Contractors (MACs) will still be actively auditing and denying claims until September 30, 2014. So while the probe-and-educate period offers an opportunity to get up-to-speed on the rule with less RAC scrutiny, this isn’t an opportunity to sit idle.

To help you understand the potential impact of this rule on your hospital, our team has prepared custom two-midnight impact assessments for all hospitals paid under Medicare’s IPPS. These institution-specific analyses show services “at risk” of moving from inpatient to outpatient and, conversely, long-stay observation cases that may be eligible for admission as inpatients.

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Not so 'symple' after all: Renal denervation trial fails to show significant benefit

February 12, 2014

Andrew Hresko, Cardiovascular Roundtable

Over the past few years, we’ve reported on the cardiovascular community’s excitement about renal denervation. Many believed that the procedure, which aims to lower blood pressure through radiofrequency or ultrasound ablation of the renal sympathetic nerves, would be a volume-generating, minimally-invasive method of treating hypertension in the many patients who have not found success through medical treatment.

However, Medtronic recently reported that its SYMPLICITY HTN-3 trial failed to show significant efficacy of the procedure, casting serious doubt that the FDA will approve the company’s renal denervation system. This begs the question: what’s next for renal denervation?

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What’s the relationship between surgical volumes, costs, and quality in CV?

February 10, 2014

Olivia Ley, Cardiovascular Roundtable

Many researchers have investigated the relationship between surgical volumes, patient outcomes, and operation expenses. Their findings are increasingly important for today’s providers, who are under pressure to deliver higher-quality care at lower costs. So what’s the consensus?

We’ve examined some of the top research on this subject—and by and large, it suggests that higher volumes are associated with lower costs and better quality.

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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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