As I wrote earlier this week, ACC’s President Doug Weaver, M.D., F.A.C.C., participated in President Obama’s White House Summit on Health Reform. We’re proud to have had him in attendance, representing the physician and cardiovascular community, because of the keen insight he offered. Members have been writing into ACC all week to share their thoughts on health care reform topics, and I thought I highlight just a few of them here. This is a forum – so please continue the discussion by adding a comment below!

Here’s just a sample of the comments we received: 

On Inappropriate Use:

Until we reimburse cardiologists for outcomes instead of performing procedures, inappropriate use of technology will continue.

One big problem we face is the abuse of in office cardiovascular imaging in non-cardiovascular specialists. ... They farm these out to cardiologists to read remotely. This is certainly contributing to the cost of medicine, not providing any real benefit to patients, and needs reform. Does the ACC have any plans to deal with this problem? Or will we wait for CMS or some other regulatory body to reform this abuse for us? 

On Payment:

This is great. We have been participating in the PQRI now for two years and have accredited echo and nuclear labs and following the ACC Guidelines but I still feel used by the system that is penalizing us by across the board cuts along with echo this year and nuclear last year.  We are committed to quality of care but want to be treated fairly in our compensation. If this is not rectified it will effect the quality of medical students which will effect the quality of physicians and patient care.

On Tort Reform:

What I do not hear being discussed is the need for national tort reform. The Price-Waterhouse audit last year estimated that $200 Billion was spent on defensive medicine in 2007. Furthermore incentives must be reversed- more for cognitive and preventive care and less for interventions, many of which are not indicated.

On Health Care Rationing:

I applaud your efforts to cooperate with the present administration.  Unfortunately, I think their priority is more cost savings and less on quality. 

I believe that if our country really wants universal type health care, the public must accept the concept of rationing of health care services.  Dialysis of demented nursing home patients comes to my mind since I have worked for years at a hospital with a dialysis center.  Who should make these decisions is unclear; but at some point cost must become a determining factor in providing these kinds of services.

On Guidelines/Defensive Medicine:

I really appreciate Dr Weaver taking part in this summit ...  I agree there is a lot of saving of funds to be accomplished by setting up guidelines for both diagnostic and therapeutic activities.  I see so many patients admitted with chest pain who then stay in the hospital overnight and get a nuclear treadmill the next AM who have nothing that sounds like acute coronary disease.  The fear of some kind of litigation seems to drive doctors to always obtain the set of studies. 

On Improving Care:

My colleagues and I have been doing our part to contain costs in Minnesota where as you know, we already provide unusually high benefit to cost care for our patients despite poor payer mix and miserably low Medicare reimbursement... . Through foresight and necessity, we have succeeded in development of chronic care programs utilizing midlevel practitioners drastically reducing CHF admissions and improving management of atrial fibrillation. We are willing to continue doing our part to help our nation solve the economic mess we are in but that willingness is much tempered by the already extremely financially stressed environment our facilities are facing. 

*** Image from Flickr (Johan Jonsson). ***

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