This post was authored by Ralph G. Brindis, MD, MPH, MACC, senior medical officer of external affairs for the NCDR.

An article published today in U.S. News and World Report asks the question, “Are Doctors Exposing Heart Patients to Unnecessary Cardiac Procedures?” The article strongly implies that many doctors who are performing unnecessary procedures are doing so in order to “reap the benefits in Medicare payments.” The ACC acknowledges that there is a marked variation in percutaneous coronary intervention (PCI) rates and there are indeed nationwide opportunities to improve appropriate patient case selection for PCI. This assessment is not the same of the authors’ implications of “reaping the benefits of Medicare payments.”

The article explains that one way the College has addressed this issue and guided physicians’ judgment is to publish appropriate use criteria. The Criteria help inform us when a procedure is considerate “appropriate,” “rarely appropriate,” and, when there is not enough evidence-based data, “may be appropriate.” The article notes that “applying these standards nationwide could cut the number of catheterization procedures significantly, research shows. One study of more than 140,000 procedures, for instance, found that nearly 12 percent were unnecessary.” While I concur that we indeed have opportunities to decrease unnecessary PCI procedures nationwide, not stated in this article was that these were patients with stable ischemic coronary disease which represent approximately 29 percent of PCI procedures in the U.S., and that when added to the patients receiving PCI with acute coronary syndromes, the percentage of all PCI in the U.S. would represent 4 percent of U.S. PCI’s being categorized as “rarely appropriate” (see the JAMA study “Appropriateness of Percutaneous Coronary Intervention” here). The article also does not properly delineate the issue of physician volume from the issue of clinical appropriateness. Clinicians with “high volume” may be quite appropriate in their case selection and the converse, physicians with low case volume, might perhaps have a high rate of rarely appropriate procedures.

The article explains that the ACC’s NCDR  which gathers clinical data on heart disease cases nationwide, has moved to address the issue by encouraging cardiologists to monitor their own practice patterns. Registry participation is voluntary, with over 1,600 NCDR member hospitals supply data on 95 percent of the nation’s angioplasties. Through the CathPCI Registry physician dashboard doctors can compare their own procedural volumes, complications, outcomes and appropriateness against those of their peer clinicians, available as benchmarked averages. I personally encourage all of my interventional colleagues to take advantage of the opportunity to review their own physician level PCI data in order to best assess their own practice patterns.

These can be powerful tools, and promoting the use of clinical data to improve care is one of the ACC’s key advocacy priorities for 2015. Today I represented the ACC on Capitol Hill and educated congressional staff about how NCDR is fostering innovation and improving care. I presented during separate House and Senate briefings and shared the ways in which the ACC's registries are leading the way for harnessing clinical data.  I also underscored the critical role they play in the ever-changing health care landscape. In the coming weeks and months, ACC staff and members will continue taking cardiology’s message to Capitol Hill and working with lawmakers to shape the future of health policy.

When we first become physicians we take the Hippocratic Oath, vowing to “apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

When we become members of the ACC we further our commitment to quality cardiovascular care by promising to live its mission: “to transform cardiovascular care and improve heart health,” as well as its enduring purpose: “to strive to improve cardiovascular health through education, research, quality care and health policy.”

The College will continue to provide its members with the education, tools and resources to help them provide the best, quality cardiovascular care to patients. The ultimate in ACC member value!

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