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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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Findings from ACC 2014—and the resources you need to act on them

April 24, 2014

Andrew Hresko, Cardiovascular Roundtable

At the end of March, two of my colleagues from the Service Line Strategy Advisor program attended the American College of Cardiology’s annual meeting in Washington, D.C. They’ve written several blog posts about what was discussed, including the promising future for transcatheter aortic valve replacement (TAVR) efficiency and length of stay, the need for further investigation of renal denervation, the learning curve for radial PCI, and the future of aortic aneurysm care.

To help you act on findings from the conference, I’ve highlighted the Cardiovascular Roundtable’s available resources on a few of these topics.

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Webconference alert: How to cut low- or no-value services from the CV service line

April 15, 2014

Jeffrey Rakover, Cardiovascular Roundtable

At our 2013-14 national meeting series, Unlocking Cardiovascular Value, we discussed how encouraging the use of high-value clinical substitutes can help reduce CV avoidable costs, and shared strategies that ranged from hardwiring appropriate use criteria to implementing the “heart team” approach for revascularization decisions.

If you weren’t able to attend the meeting (or if you’d like a quick refresher), you’re in luck. Tomorrow, you’ll have one last chance to catch up.

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CV service distribution: The decision aids you need

April 7, 2014

Olivia Ley, Cardiovascular Roundtable

More and more CV leaders have to make challenging decisions about how to distribute services across sites. This not only means thinking more strategically about where and when to offer new services, but, in some cases, when it’s necessary to consolidate programs.

And while these decisions will never be easy, you have resources at your disposal that make them easier.

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Bundle up: CMS proposes new payment models for outpatient care

March 28, 2014  | Comments (1)

Jeffrey Rakover, Cardiovascular Roundtable

CMS recently issued a Request for Information on a proposed payment demonstration program. The focus of the models? Incenting better coordination for outpatient care.

The proposed outpatient payment demonstration would complement existing programs like the Bundled Payments for Care Improvement (BCPI) initiative, shared savings programs, and Pioneer ACO demonstrations.

  • Need a refresher on bundled payments?

    Review what bundled payments are, how they differ from fee-for-service, and the potential benefits and pitfalls of working under this model. Watch now.

As our colleagues at the Health Care Advisory Board noted in a recent blog post, CMS outlined two separate models: one focused on bundling payments for outpatient procedures and the other on incentivizing better outpatient chronic disease management.

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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?

Read more »

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