| Issue: |
Scientific
advances and new technology development have improved
patient outcomes and spurred significant growth in the
number of cardiac catheterization procedures performed
and an upsurge in the establishment of new cardiac catheterization
laboratories. This expansion of service, combined with
escalating health care costs, has led to increased efforts
by some states to regulate cardiac catheterization laboratories.
|
| Background: |
State certificate-of-need (CON) laws
first emerged 30 years ago to prevent overprovision and
utilization of services and to control health care costs.
These laws require health care providers to receive state
approval for major capital expenditures, the purchase
of high-technology equipment, or expansion of services.
Proponents of CON laws also believe that such regulation
is necessary to ensure quality. Opponents of CON laws
argue that market forces produce more effective controls.
In the case of cardiac catheterization laboratories, it
appears that some states are using CON laws to place strict
and rigid controls on the practice of medicine through
regulatory enforcement of volume criteria incorporated
into clinical practice guidelines published by professional
organizations. |
| Why Is It Important
to Cardiologists? |
Public demand for high quality health
care has never been higher. Public scrutiny is forcing
hospitals and other health care providers to implement
quality control systems to enhance quality and accountability.
In addition, some health policy leaders are advocating
that outcomes should be measured and tied to physician
reimbursement rates. |
| ACC and SCAI Position: |
The American College of Cardiology and
the Society for Cardiovascular Angiography and Interventions
(SCAI) are leaders in setting standards for quality cardiovascular
care. The College and SCAI are committed to working with
ACC chapters, legislators and state regulatory boards
to assist officials in leveraging ACC/SCAI expertise and
quality evaluation and improvement strategies. The ACC
and SCAI encourage the use of continuous quality improvement
initiatives and outcomes data monitoring as mechanisms
by which states may measure cardiac catheterization laboratory
performance. |
| ACC Guidelines: |
The ACC, in conjunction with the American
Heart Association (AHA), and with the involvement of SCAI,
has developed practice guidelines and expert consensus
documents to guide and measure clinical performance. The
ACC has also established Guidelines Applied in Practice
(GAP) which deploys customizable tools to improve adherence
to evidence-based guidelines. |
| Data Collection:
|
The ACC has developed the National Cardiovascular Data
Registry (NCDR). The ACC-NCDR® enhances local quality
improvement initiatives by providing participants with
standardized data elements and definitions and provides
quarterly comparative reports on the performance and outcomes
of cardiac catheterization procedures. The ACC also has
launched the ACC-CathKIT™ for use in improving the
performance of cardiac catheterization laboratories through
self assessment. Available since spring 2004, the ACC-CathKIT™
guides cardiac catheterization laboratories through a
quality improvement methodology to effectively and efficiently
improve quality of care. |
| State Action: |
A number of states have faced regulation
of cardiac catheterization laboratories. Most state
action has centered on:
- Establishing minimum volume standards for individual
practitioners and cardiac catheterization laboratories
- Requiring participation by cardiac catheterization
laboratories in data collection and monitoring through
the NCDR or Society of Thoracic Surgery databases,
or some other means.
States that have developed regulatory schemes based
on outcomes data monitoring include Massachusetts, Ohio,
New York, West Virginia and California. |
| ACC and SCAI Contacts:
|
Adam Nelson, CAE, senior specialist,
State Legislative Affairs, 301-897-2612
SCAI regional governors – call 1-800-992-7224 |
