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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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Overcome barriers to CV shared decision making

August 14, 2014

A growing body of evidence suggests that educating patients about available treatment options and including their preferences in medical decisions has the potential to reduce utilization, lower costs, and improve patient experience.

One recent study reported that this practice of patient-provider collaboration, known as shared decision-making, can reduce use of major invasive heart surgery by 20% and lower per-member-per-month costs 9% compared to standard care. Shared decision making is especially relevant to cardiovascular care because the specialty treats so many conditions for which one treatment option does not have clear clinical benefit over alternatives.

Given the many potential benefits of shared decision making, it’s important to make sure you’re implementing strategies that have proven successful. In last week’s issue of Circulation: Cardiovascular Quality and Outcomes, researchers from the Mayo Clinic, Palo Alto Medical Foundation, and UCLA published a review of techniques for implementing shared decision making.

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Sizing up the AF ablation market: Q&A with Brian Contos

July 29, 2014

Amid recent reports of declining procedural volumes and inpatient admissions for CV services, some services are poised for growth.

Atrial fibrillation (AF) programs, like structural heart and valve programs, present an opportunity for increased revenue and market capture. As we describe in our Blueprint for Atrial Fibrillation Centers, the prevalence of AF in the U.S. is expected to increase more than five-fold by 2050. Unsurprisingly, we get a lot of questions from members interested in market trends and clinical updates in this area, especially for AF ablation.

We recently sat down with the Cardiovascular Roundtable’s executive director, Brian Contos, to understand current dynamics in the AF ablation market, including volumes, cost, and reimbursement trends.

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What can you learn from FY 2013 TAVR data?

Brian Contos , Megan Tooley July 24, 2014

It’s safe to say it’s been a busy summer for transcatheter aortic valve replacement (TAVR). In the past few months, we’ve seen a number of significant updates related to the procedure, including:

  • CMS proposed new TAVR-specific MS-DRGs in its FY 2015 Inpatient Proposed Rule, which would likely lead to an overall bump in reimbursement for the procedure if approved in August
  • Indications for Medtronic’s CoreValve device were expanded to include TAVR in high-risk patients in June, following initial approval of the device in Jan. 2014 for extreme-risk (i.e., inoperable) patients
  • Edwards Lifesciences’ next-generation Sapien XT device was approved for use in high-risk and inoperable patients just days later

So it seemed a fitting time to provide an update to the benchmarks we shared last year on TAVR cases performed across the United States. We analyzed TAVR claims from the latest Medicare Provider Analysis and Review (MEDPAR) data set, which includes all Medicare cases performed in Fiscal Year (FY) 2013 (from Oct. 1, 2012–Sept. 31, 2013).

Read on for the latest benchmarks on TAVR volumes, patient characteristics, efficiency, and reimbursement, and to get a sense for how these changed in the first two years following FDA approval.

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Want a better picture of performance? Financial integration offers a panoramic shot.

May 27, 2014

Olivia Ley, Cardiovascular Roundtable

While financial integration requires an investment of time and resources, many programs are beginning to realize the substantial value of having a more holistic and transparent view of their performance. Some programs are integrating across specialties, while others are integrating across different sites of care beyond the hospital setting.

We’ve included examples of both below and shared how these programs are already starting to benefit from the results.

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Pick the right risk stratification tools for your CV program

May 5, 2014

Andrew Hresko, Cardiovascular Roundtable

In our study Blueprint for Cardiovascular Care Management, we stress the importance of using risk stratification to pair patients with appropriate clinical and non-clinical providers and to determine the intensity and frequency of follow-up care. This targeted approach will not only help optimize clinical care, but also enable more efficient use of limited resources.

While risk stratification is a powerful strategy, the reality is that no existing tool is perfect. There are many classes of tools that assess different nuanced aspects of patients’ well-being and ideal care plans, and within each of those classes there is a multitude of tools that rely on slightly different metrics. The best risk stratification strategies often involve some combination of available models.

To help you begin to weed through your options and select the best suite of risk stratification tools for your CV care management program, I’ve provided a list of links to some of the most commonly used, publicly available care management risk stratification tools.

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The case for palliative care

May 1, 2014

Olivia Ley, Cardiovascular Roundtable

CV programs are starting to embrace palliative care as a means to improve quality and reduce costs—and they’re backed by some compelling evidence.

We've reviewed some of this research below, and offered guidance to help you integrate these services into your care continuum strategy.

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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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