Larry Dean, president of SCAI, and I just sent out an e-mail to our memberships regarding a series of articles that have appeared in the mainstream press about overuse of stents and the opportunity this offers for professional associations like the ACC & SCAI to take a proactive approach to quality issues. Please see the full text below, and leave your comments at the end of the article.

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The American College of Cardiology (ACC) and the Society for Cardiovascular Angiography and Interventions (SCAI) are deeply disturbed by findings in a new U.S. Senate Finance Committee report concerning the ongoing investigation into alleged inappropriate use of percutaneous coronary intervention (PCI) and overutilization of stents at St. Joseph Medical Center, in Towson, MD. While the ACC and SCAI cannot comment on the merits of ongoing investigations, the use of inappropriate or unnecessary procedures is intolerable and a violation of both organizations strict codes of ethics (.pdf) as well as the Hippocratic Oath.

Over the last several months the Maryland Chapter of the ACC and SCAI, working closely with the national ACC, have been proactively addressing the issues raised by these allegations. ACC and SCAI representatives have met with state policymakers and have, at the request of Maryland officials, drafted comprehensive legislation that would require accreditation for all state hospitals performing PCIs.

Meanwhile, the overarching issue of quality and appropriate use of medical procedures is not just confined to the state of Maryland and the use of stents. In fact the Senate Finance report has generated national media coverage in the New York Times, Wall Street Journal and other papers. The investigations and subsequent media coverage provide an opportunity for professional societies like the ACC and SCAI to take the lead locally, regionally and nationally to ensure patients receive the right care at the right time.

Collectively, these developments underscore the need for internal peer-review that is clear, rigorous and objective. A standardized internal process must be followed by independent external oversight performed by an external body, such as the Accreditation for Cardiovascular Excellence (ACE) program. ACE has an independent governing board, allowing for removal of any perceived or real conflicts of interest in oversight of hospital and physician quality performance. ACE accreditation criteria also calls for use of registries like the National Cardiovascular Data Registry (NCDR) and adherence to appropriate use criteria -- both of which are already widely accepted and respected by professional and regulatory communities nationwide.

In addition, quality tools produced by both the ACC and SCAI can provide states, payers and purchasers of care with critical, transparent metrics with which to evaluate quality of care, especially as the health care community adopts a National Quality Strategy and shifts from a fee-for-service reimbursement model to one more focused on outcomes-based care and commensurate reimbursement.

The ACC and SCAI have the knowledge base and expertise as cardiovascular leaders to advise and implement such programs. The efforts under way in Maryland to address quality and appropriate care have far-reaching implications. Addressing them proactively will allow the field of cardiology to remain ahead of the curve and avoid future allegations like those outlined by the Senate Finance Committee. Working together we can ensure our patients receive high quality and effective cardiovascular care delivery driven by physician oversight and leadership.

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