This post was authored by Pranav Puri, winner of the best CCA poster award.

Early last summer, as the presidential campaigns began to heat up and national dialogue once again shifted to healthcare policy, I decided to leave the rhetoric of the campaigns aside and take a look at the raw figures of healthcare spending for myself.

After sifting through a couple pages of Google search results, I found myself on the website of the Organization for Economic Cooperation and Development (OECD), an organization of developed economies, and the numbers I found there were truly staggering. The U.S. spends $2.6 trillion on healthcare which is approximately 18% of GDP; to put that figure in perspective, the OECD average is 9.5% of GDP.

More importantly, however, the quality of healthcare in the U.S. ranks far closer to the OECD average than to the top of the list. Further research showed that roughly 3,700 percutaneous coronary interventions (PCIs) per million were performed in the U.S. while the OECD average was close to 1,250. Around that time, Trinity Regional Health System in Rock Island, IL, my hometown, had implemented the ACC's appropriate use criteria (AUC) for coronary revascularization.

With the OECD data fresh in my mind, I approached the cardiology department at Trinity to study the effect of implementation of AUC for coronary revascularization on volume of PCIs and cost savings. Data from six months after implementation of AUC was compared to that of corresponding six months in 2010 and 2011. The number of interventional cardiologists did not change over that time period while the number of patients seen by the cardiologists during the time period increased. The number of diagnostics decreased by 9 percent after implementation of the AUC, and the number of interventions decreased by 27 percent.

Due to a decrease in interventions and diagnostics, total hospital reimbursement over the six month time period decreased by 35 percent from the previous year. If the AUC for coronary revascularization were to be further implemented and similar trends were to be observed nationally, we calculated that $2.3 billion would be saved. The maximum decline, I hypothesize, was in interventions that would be labeled as "uncertain." The AUC's greatest impact, therefore, was on influencing physician behavior rather than cutting back on "inappropriate" cases. By adding an element of oversight and better informing staff and patients, the AUC influenced the physician's thought process and reinforced doubts about prospective procedures.

Upon entering Moscone West late Friday evening to complete my registration and pick up my ACC.13 badge, I was taken aback by the frenzy and sheer excitement surrounding the meeting. Coming from a small town of 40,000, it was hard for me to fathom the magnitude of ACC.13. The next day during my poster presentation, I was greeted by attendees that showed great interest in my poster and posed incisive questions. Overall, the attendees were extremely supportive and made ACC.13 a welcoming place for a 16 year old high school student amongst well tenured physicians and researchers. As I get ready to board my last flight home, I can't help but reminisce on the past few days and look forward to ACC.14 in Washington, DC.

[youtuber youtube='http://www.youtube.com/watch?v=CLBbPNIQ7bk']

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