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Quality Lead Management Begins at Time of Implant June 22, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Uncategorized.
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Effective lead management includes a comprehensive range of issues, many of which are physician-dependent. Ensuring quality care in lead management requires a thorough understanding of these issues, as well as the skills that can only be learned through experience. (more…)

Preventing Stroke in AF Is Within Your Control June 14, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Atrial Fibrillation (AF).
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There is no doubt that finding an ideal– or at least reasonable– balance between the risk and benefit in the use of warfarin for stroke prevention in atrial fibrillation (AF) can be difficult. But in the majority of cases, obstacles should not justify withholding therapy, particularly when potential complications can be mitigated by evidence-based decision-making. (more…)

Device Programming: Knowing Which Buttons to Push and Why June 2, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Scientific Sessions.
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We’ve come a long way from the first generation of implantable cardiac pacing devices. Although the goals of these devices – to reduce/prevent symptoms, improve survival, protect from SCD, heart failure, and syncope, while minimizing morbidity and complications – have remained the same, new tools have emerged to achieve these goals. Today’s devices are now equipped with programming features that help optimize patient outcomes. However, all the extra bells and whistles of a device won’t matter if they’re not employed effectively. Devices are sometimes implanted at nominal values (which are generally conservative) without sufficient consideration given to the specific pacing needs of each patient. (more…)

Defining Success and Quality Care in AF Ablation May 25, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Scientific Sessions.
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Physicians and allied health care professionals have always sought to deliver quality care. But as we move away from a fee-for-service to a quality outcomes-based payment system, many are struggling with exactly how to pinpoint the definition of quality in today’s clinical practice. This might be an especially daunting task given the complexities of the cardiac arrhythmia field. (more…)

Sunshine Act and COIs: Too Much Transparency? May 15, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Scientific Sessions.
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In the interest of moving towards greater transparency across the health care system, the new health care reform legislation includes the Physician Payment Sunshine Act, which will make it mandatory, by 2013, for all drug and medical device manufacturers to publicly report gifts and payments of value greater than $10 made to physicians and teaching hospitals in any one year. Disclosures to the federal government will include physician name, address, national provider identifier (NPI, related to Medicare and other payment programs), the value and form of the payment, as well as the specific drug or device the payment was related to. Beginning September 30, 2013 and each year thereafter, the information will be entered into a searchable database made available online. Of potential concern is the fact that this information (with the exception of the NPI) will be made available to the general public. And the general public is not only your patients, friends, neighbors, etc., but also the institutions that you work for, and, of course, lawyers. In essence and aptly put by Eric G. Campbell, PhD (Mongan Institute for Health Policy, Massachusetts General Hospital) during the Health Policy Town Hall Session at this year’s Heart Rhythm 2010, the release of this information means that “everyone is going to know your business.”

(more…)

Opening Plenary Panelists: It’s Time to Jump in the Game May 13, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Scientific Sessions, Uncategorized.
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They say that the key to a good offense is a strong defense. But that adage need not apply to the practitioner in today’s era of health care reform. One abundantly clear message conveyed at Heart Rhythm 2010’s Opening Plenary Session, was that the true game changers in today’s health care are those that assume a proactive stance to ensure quality care and excellence in medicine. Importantly, quality initiatives must be defined from within, not from outside, the medical community.

Easier said than done, right? Actually, according to several of the session’s panelists, there are potentially less hurdles than you think.  

There is no question, challenges are abound, but the ink has yet to dry in a number of areas in the health care reform legislation leaving opportunities to chart the course as to how to fulfill and implement the aspirations of the legislation. Using a football analogy, former Senator Tom Daschle aptly noted that the enactment of the legislation 6 weeks ago only moved the ball to the 30-yard line, with 70 yards to go and enough time on the clock (considering that parts of the law go into effect 2012-2013) to still make the necessary calls to get the ball to the goal line. But he was quick to point out that while goals and deadlines had been clearly established as it relates to the insurance reform component, there are many remaining questions yet to be answered as to how to implement the payment and delivery reform provisions of the legislation. 

Indeed, those unanswered questions have left many in a lurch, unsure of how the legislation will affect them individually. But instead of taking a defensive “wait-and-see” approach (as many have done), the time is ripe to bring together the required strong team of players, coaches, team physicians, and officials to develop a plan of action to define goals and begin moving the ball down the field.   

And don’t be deceived; team rosters have yet to be announced and the rules of the game have yet to be defined. In fact, yesterday’s Plenary Session enlightened the audience (including this writer) that coaches and officials are actively recruiting and that, in fact, it’s relatively simple to sign-up. This process does not operate in a vacuum and its success is contingent on figuring out a way, as Harlan Krumholz, MD (Yale University School of Medicine) described, “to funnel in the opinions, expertise, and wisdom that reside within the profession.” The path to such an approach is multi-faceted and can begin at any level, whether it’s patient bedside or at the front steps of the Capitol building. 

But importantly, it has to begin and it must include those who are truly qualified to comment on measures of quality; it must include those that take care of the patients; it must include you. 

How do you plan to get involved?

[Editor’s note: Were you unable to attend Heart Rhythm 2010, or did you otherwise miss the exciting and thought-provoking Opening Plenary Session? View a webcast presentation now!]

Bottom Up or Top Down: Where Does Quality Care Begin? May 5, 2010

Posted by Ariana Del Negro, Heart Rhythm 2010 Quality in Scientific Sessions.
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The debate on national health care reform in the United States brings to mind a “trickle-down” theory: the majority of the focus has been on changes at the federal level, with many taking a wait-and-see approach before determining how the landmark legislation affects them personally.

Yes, the fundamental (and critical) goal of the health care reform law is to increase access to care and improve the quality of the care. However, when we consider that health care spending accounted for 16 percent of the total US gross domestic product in 2007 (a 6 percent increase from 2006 and the most recent data available) with hospital spending accounting for 31 percent of the overall national health expenditures in 2007, we all know that cost-savings represents a significant amount of the driving force behind health care reform.  (more…)

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