By Eric Stecker, MD, FACC, member of the ACC’s Clinical Quality Committee The Supreme Court’s decision upholding most elements of the Affordable Care Act introduced certainty that major structural changes in health care will continue to rapidly evolve.  Most discussions of reform have centered on access to coverage, access to care and potential mechanisms of cost savings.  But this is only half of the story.

A critical factor differentiating the current round of health care reforms from the managed-care reforms of the 1990s is an emphasis on “value” across the spectrum of reform approaches.  High value medical services maximize quality while minimizing cost.  The ACC has led efforts among medical societies to structure the debate in Congress to emphasize quality considerations.

As health care reforms are implemented at the national, state and local levels, responsibility for managing quality will fall on cardiologists working in concert with hospital and clinic administrators. In the past, cardiologists added significant monetary value for health systems by generating large patient encounter volumes with only crude measures of quality in a fee-for-service environment.  In the future, individual cardiologist’s importance for an organization will be defined using sophisticated measures of quality balanced with revenues and costs in a global payment (capitated) environment. To achieve this, cardiologists must identify which organizations can succeed in such an environment and work in leadership roles to help those organizations adapt as health care reform evolves.

Anyone reading this blog who has experience with Medicare Meaningful Use could be skeptical regarding the accuracy and impact of quality improvement efforts.  Quality efforts in medicine remain in their infancy and are being rolled out across a fragmented industry that often has 1990s-era information technology infrastructure and entrenched organizational siloes. But many other complex industries have successfully approached quality improvement and some health care institutions such as Intermountain Health Care in Utah have already gained considerable traction and efficiency.Stay tuned next Thursday for the sequel to this blog, which will address several specific aspects of health care reform that are important for cardiologists to gain familiarity with.
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