American College of Cardiology

Quality: Definition, Measurement, and Audience
The conference kicked off with discussions geared around the topic of medical quality, including how it is defined and methods of measuring, quantifying, and controlling this too-often subjective measurement tool. The first three presenters, Lee Newcomer, MD (UnitedHealth Group vice president of Health Policy and Strategy), David Pratt, MD (General Electric [GE] Medical Systems director of Health Care and Medical Operations), and Brent James, MD (Institute for Health Care Delivery Research executive director/Medical Research and Continuing Medical Education vice president), addressed quality indicators that payers look for in cardiology providers, data payers use to assess cardiovascular specialists' quality, and how to capture and use appropriate data.

Drs. Newcomer and Pratt focused on quality from a "purchaser's" point of view. They offered measurement ideas and delineated the significance of managing data to reduce risk associated with certain behaviors. They also provided data showing how measuring quality positively affects the benefits patients derived.

Dr. Pratt, who purchases health care for GE Power Systems, discussed quality of care from an employer's perspective. He previewed increasing costs and trends and explained how, as a purchaser, GE Power Systems wants to work with providers to keep costs in line. Dr. Pratt also indicated that, in evaluating providers, GE is looking for certain high-quality "differentiators"—value, pharmacy cost focus, preventive care, "superb" customer service, and "a view that goes beyond the office, hospital, and cath lab."

Dr. James then discussed the genesis of scientific management and its applications in the measurement of quality in health care. He focused on quality indicators and data capturing as well as their relevancy to practitioners and payers. Also covered were appropriateness criteria, quality-measurement tools, quality control, and specifics of the quality-measurement process.

That afternoon, Gail Wilensky, PhD, former administrator for the Health Care Financing Administration (HCFA) and current chair of MedPac (Medicare Payment Advisory Commission), spoke about current and proposed changes within the Medicare system regarding medical necessity, compliance, diagnosis screens, and new changes in the Medicare fee schedule.

In the context of outlining changes in Medicare brought on by the Balanced Budget Act (BBA) of 1997, Dr. Wilensky explained that the BBA, as constructed, portends more changes in the near future than have occurred in the last 30 years of the Medicare program. The changes, she suggested, do not bode well for Medicare program providers.

Dr. Wilensky covered issues such as the sustainable growth rate, practice expense relative value units, and professional liability expense. She discussed cleaning up the BBA to rectify "the unintended/undesirable consequence of legislation." Her presentation also elaborated on the correct coding initiative and the fact that fraud and abuse are top government priorities. More health care funds are being earmarked for Medicare program fraud and abuse efforts.

Aligned Incentives
Later in the program, Dr. Cates launched an in-depth discussion about aligned incentives, such as "gainsharing." Loosely defined, said Dr. Cates, "aligned incentives are variables that can be measured and affected by physicians' and hospitals' activities to manage costs and return a portion of the resultant savings to both parties." Stringent compliance issues exist so that neither party runs afoul of Internal Revenue Service code 501(c)3, the Civil Monetary Penalties Act, Starks I and II, and the Tax-Free Bond Financing Counsel (because many hospitals use tax-free financing for construction). Proponents of aligned incentives hope that the results of such efforts will be decreased costs, increased quality, and a pool of savings to be reinvested or apportioned to participating parties.

Craig Nelson of Ernst & Young reviewed in depth for attendees what is entailed in a comprehensive gainsharing plan; he guided the conference participants through a start-to-finish example, delineating along the way the pitfalls and pratfalls of gainsharing arrangements.

The program progressed with presentations on vascular centers of excellence. Presenters regaled attendees with their success stories and outlined problems they have encountered in implementing disease-state management protocols across specialty lines to form new, integrated vascular centers while coordinating patient care and overcoming potential turf battles. This concept is important, explained Dr. Cates, "Because distinctions among specialties are disappearing, and as providers, we need to find better ways and models to work with our colleagues across specialty lines, with better patient care and disease-state management as goals."

After the presentations, a spirited discussion on vascular centers of excellence ensued. The panel included interventional radiologist and Miami Vascular Institute Director Barry Katzen, MD; vascular surgeon and Jobst Vascular Center Director Hugh Beebe, MD; and Washington Hospital Center Peripheral Vascular Interventions Director John Laird, MD. Also on the panel were Paul Pomerantz, executive director of the Society of Cardiovascular and Interventional Radiology, and John Abele, founder of Boston Scientific Corporation.

Practice Hot Spots
Alice Gosfield of Alice G. Gosfield & Associates treated the group to a lively and animated discussion about regulatory compliance, an area often perceived as a "minefield."

Karen Zupko, president of Karen Zupko & Associates, Inc., discussed the importance of marketing the cardiology practice and having a well-crafted plan to achieve specific outcomes while obtaining measured goals relative to dollars spent on the program.

The focus then shifted to cardiovascular medicine and marketing via the Internet, with Abdulla Abdulla, MD, discussing the Internet and its role in the practice of medicine. He introduced the group to his Web site, http://www.heartsite.com, which he constructed primarily as a patient education tool. Dr. Abdulla, clinical professor of medicine at the Medical College of Georgia and the medical editor of Physicians and Computers, designed the site to be neutral and informative and to "speak" neither up nor down to patients. The site gives a basic overview of the heart and its functions in simple, easy-to-understand language. Among its user-friendly features is the "virtual" cath lab section, which has point-and-click options designed to provide patients with question-and-answer support about cath lab procedures.

Ruth Paine of Paine, Arthur, Pierce & Associates, Inc., capped the informative weekend by offering participants a look at the critical need for strategic planning and the implementation of a formal strategic plan to succeed in today's health market. She covered strategic planning in depth—from plan formulation and environmental SWOT (strengths, weaknesses, opportunities, and threats) analysis to implementation—and emphasized the value of establishing relevant, measurable goals.

Throughout the conference, Dr. Cates used an interactive questioning system to poll the audience on a number of managed care and practice management issues, which gave immediate feedback to all the participants. The program was well received and achieved high marks from the participants. "Our goal with Strategies for Success has always been to give participants the latest practical information in the field of cardiovascular practice management as well as to create a national forum for the exchange of this information among cardiovascular specialists." said Dr. Cates.

Next Year
Planning for next year's Strategies for Success program is well underway, and attendance is expected to be high. The meeting will be held in Bermuda at the Southampton Princess, June 22–24, 2000. Dr. Cates will also offer a "Strategies" course on Saturday, March 11, 2000, in conjunction with the ACC Annual Scientific Session in Anaheim, Calif. For more details, see the ACC 2000 Advance Program, which will be mailed in September.

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