Author + information
- Alfred A. Bove, MD, PhD, ACC President*
- ↵*Address correspondence to:
Alfred A. Bove, MD, PhD, American College of Cardiology, 2400 N Street NW, Washington, DC 20037
As this year progresses, we will hear more and more about the concept of patient-centered care. The concept has a number of interpretations, but the basic principle is that care of a patient should involve education about the patient's illness (acute or chronic), understanding of its impact on the patient and family, explanation of the proposed therapy (ideally with several treatment options), and engagement of patients as members of their overall care team.
In cardiology, the best example of success with this type of care is in the area of chronic heart failure. Heart failure care teams, which comprise one or more physicians and nurses, educate patients about heart failure and advise them about the effects of diet and the need to monitor their weight daily, restrict salt, and exercise. Patients are communicated with frequently by their care teams to modify therapy and report their health status. All of these steps fit the concept of patient-centered care.
This kind of care will be needed more in the future as our patient population grows older, more chronic disease appears in our practices, and the health care workforce shrinks—all of which will result in an increased workload on cardiology care teams. In the Obama administration, health care reform is receiving considerable attention, and the tenets of that reform include patient-centered care, the patient-centered medical home, reimbursement for quality and outcome, and a reduced emphasis on procedure-based reimbursement. These changes are driven by worldwide statistics that do not put the U.S. at the top in health care from either a cost or health basis. Health care costs in the U.S. are about twice as much per capita as most other developed countries, and our life expectancy is lower than in other developed countries. These statistics are not lost on state and federal legislators who must allocate funds for health care through Medicare and Medicaid, or on the industries that must purchase health care for millions of employees.
The American College of Cardiology (ACC) decided several years ago that we would try to influence health care reform by supporting quality care and by developing recommendations on appropriate use of tests and procedures, thus helping to reduce overuse and enable health care costs to come down. At the same time, we have campaigned for increased reimbursement for quality of care. The Obama administration has adopted this same approach, and as a result, we expect that there will be some financial incentives for physicians and practices that can demonstrate a commitment to quality standards.
Developing quality standards, in and of itself, is a difficult task that the ACC has undertaken. Practice performance measures that have been developed for a number of cardiovascular disorders can be used to improve practice quality and can help guide the assessment of quality. Besides performance measures, use of electronic medical records and e-prescribing are considered to be quality measures. The new administration has focused on health information technology (HIT) and plans to allocate several billion dollars to support electronic medical records in individual practices. Despite the many economic pressures on the federal government, health care reform continues to be one of the administration's top priorities. As the year progresses, we will have a better idea of the timing of any changes.
Why is HIT such an important component? With HIT, we can bring together patient-centered care, improved practice quality, a new reimbursement methodology, and improved practice efficiency. By connecting the physician, patient, pharmacy, and the hospital together electronically, we can instantly improve communication and provide a patient-centered approach by using a personal health record connected to the practice electronic medical record. Point-of-care decision-making tools can be made immediately available to provide evidence-based care information to physicians while they are seeing a patient, and information on patient care can be instantly transferred to or from another practice that is involved with the same patient.
It is clear that we need to fix our health care system, and that two important components of the repairs are the adoption of HIT and quality-based reimbursement. Use of registries to track the performance of our practices is an important third component. The ACC launched the IC3Program: Improving Continuous Cardiac Care to help you do just that. The data that you provide is reported back to you and can be used by you to evaluate the quality of care in your practice, particularly as it compares to similar practices. The IC3Program enables you to improve your quality of care and to be prepared for discussions about quality.
The ACC is also working on the next step of public reporting, which is being done right now by others who are using administrative claims data. We believe, as do many of you, that it is important to provide performance information that uses accurate clinical data, and we are concerned that claims-based data will not provide an accurate reflection of actual performance. With accurate performance data that is based on guidelines and performance measures, you will have the tools you need to achieve a high level of practice quality.
The coming year promises to be one of change and transition in medicine. We will see changes in reimbursement, changes in chronic disease management, and increased involvement by patients in their own care. Most of all, we will see an emphasis on quality of care. Our goals should be to improve both quality and value in health care, and with some effort, we can achieve both goals.
- American College of Cardiology Foundation