This post comes from ACC President-elect Alfred Bove, M.D., Ph.D., F.A.C.C. Dr. Bove, who will take over for current ACC President Douglas Weaver, M.D., F.A.C.C., later this month, is a professor emeritus, medicine, at Temple University School of Medicine. As president, Dr. Bove will usher in "The Year of the Patient," in which the needs of patients will be at the forefront of all the College’s efforts.

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The world of cardiology is replete with new technology. There are advanced imaging techniques, new implanted devices that measure heart failure status, exercise levels, that pace the heart in complex algorithms and ICDs to prevent sudden cardiac death.  We have a plethora of new medications for the variety of acute syndromes, and have developed life saving programs, like D2B: An Alliance for Quality, that have helped reduce the risk of serious myocardial damage after an acute MI.

However, even in our technology-laden world, the great majority of cardiology patients still come to the outpatient office for the day-to-day maintenance of their condition. It is in the outpatient setting where patients are evaluated for their cardiac problems, receive therapy for their disorder, get advice about minimizing cardiovascular disease risk and learn about the detrimental effects of a chronic cardiac condition.

We live in a reimbursement world that encourages testing and procedures, but does not support the cardiologist who follows a patient for years, maintaining a state of reasonable health, avoiding progression to overt symptoms, and allowing the patient to experience a reasonable quality of life with chronic heart disease.

It is this commitment to good patient care that the ACC wishes to emphasize in the Year of the Patient.  The emphasis is not only on respecting the cardiologist who provides continuous cardiac care to keep patients active and symptom free, but also in bringing patients into the care team and empowering them to participate in their care decisions. ACC’s health care reform goals are to provide reimbursement for the coordination of care that often requires care management time spent beyond the actual office visit, and to recognize quality as a component of reimbursement. 

The movement toward a “Patient-Centered Medical Home” seeks to reward the primary care physician with added reimbursement to integrate care, provide continuity and manage chronic disease.  However, we as cardiologists perform the same duties with our heart patients and should consider developing a Cardiac Medical Home for patients with chronic heart disease.  This concept embodies our goals of patient empowerment, improved quality, adoption of electronic health records and the incorporation of non-physician providers (nurses, nurse practitioners, physician assistants) into a single entity that will optimize care of patients with chronic heart disease.

This team approach, with the patient as part of the care team, is the future of our practices. We will soon find demand for our care increasing to unmanageable proportions due to the aging population and a shortage of both physicians and nurses who can provide cardiac care.  Information technology and a team approach will allow us to manage a large number of patients with heart disorders.

For the next year and beyond, the ACC will emphasize the care team consisting of physicians, nurses, nurse practitioners, physician assistants and the patient, with the hope that we will succeed in increasing reimbursement for continuous cardiac care, and begin a movement that recognizes the cardiologist who chooses to emphasize continuous patient care.

- By Alfred Bove, M.D., Ph.D., F.A.C.C., ACC president-elect

* Dr. Bove's post is the fifth in a new monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!

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