Comments for EP Insights

Comment on The DOJ investigation: Lessons from Colleagues by Indiresha Ramachandra

Indiresha Ramachandra — Mon, 21 May 2012 22:37:05 +0000

The problem is that NCDs are used as the only yardstick to regulate/proscribe/penalize care instead of the actual condition of the patient. As shown in the report, of the 229 cases identified, only 34 (1.5% of all primary prevention implants) did not meet the NCD guidelines, with the vast majority being due to coding issues or lack of understanding of the clinical situation by the record abstractors. It would be interesting to know how many of these 34 went on to need therapies for any VT/VF or if the clinical situation improved to the point that a device was no longer needed.
These reports (Al-Khatib JAMA article in 2011 and the DOJ investigation) are likely to have delayed ICD implants by physicians in several patients to allow for a greater time interval from the initial diagnosis of heart failure. It is difficult to know if this resulted in some untimely/preventable deaths.
Society has to decide where to keep the equilibrium between cost, care and deaths. As always the who pays the piper chooses the tune and a third party system has these “collaterals”.
The challenge is to provide patient care which is in line with new evidence while being cognizant of slow to update “guidelines” and “NCD”s which can retroactively penalize a practice as these “guidelines” are being used more and more as the only standard of practice applicable to all situations.

Comment on Maximizing Teamwork in the EP Lab by christinechiuman

christinechiuman — Thu, 17 May 2012 14:25:48 +0000

Thanks so much for organizing this important session and this phenonmenal faculty!
It is timely to highlight patient safety issues and human factors methods to apply in the EP arena. If at all possible, please put this session as web cast on the HRS website so that lab staff can view the presentation and hear the discussions.

Comment on The DOJ investigation: Lessons from Colleagues by Westby G. Fisher, MD

Westby G. Fisher, MD — Sat, 12 May 2012 13:21:49 +0000

My response was a bit less nuanced to this investigation:
http://drwes.blogspot.com/2012/03/when-feds-come-knocking.html

The precedent of making guidelines mandates for care should scare us all.

Comment on Guest Blogger: Atrial Fibrillation and Stroke – Education for the Public by wafa'a

wafa'a — Fri, 04 May 2012 20:11:02 +0000

till now I’m afraid from starting warfarin immediatly after stroke due to Afib.

Comment on Is the Board Exam a Good Investment? by Bdoc

Bdoc — Tue, 01 May 2012 20:48:05 +0000

Board certification is important. The cost is prohibitive! Moreso that fellows have to register to take the boards while still earning only a “stipend”, should they desire to achieve board certified status; that will give them credibility; and boost the likelihood of getting job offers in a rapidly shrinking EP job market. Add to that board review courses, books, review material etc. We need to ask ABIM: the cost goes into what? electrograms that are obtained from real life patients (who are not reimbursed), then encrypted and uploaded into a secure internet site online (I bet its google powered)??? How much does prometric or pearson vue get for one person spending 8 hrs at their center taking the boards? Assuming an exhorbitant $50/hr to use a secure internet computer….then $400. All it takes is intellectual mettle to write the questions, which ABIM gets for free from its faculty. So I, like most other fellows desire educational excellence, but we see the exam fees as a rip off….

Comment on Five Reasons Why Patients with Implantable Defibrillators Deserve Their Data by Bdoc

Bdoc — Tue, 01 May 2012 20:28:03 +0000

I agree that an ‘abbreviated’ report can help patients with undersatnding their condition…optivol, % biV pacing, activity level, pacing mode and programming changes. This also helps if patients end up at a different facility with a different doctor ….or for preop check. Suggest integrating this data availability with remote monitoring patient stations

Comment on The DOJ investigation: Lessons from Colleagues by Kathleen Blake, MD, MPH, FHRS

Kathleen Blake, MD, MPH, FHRS — Sun, 29 Apr 2012 01:12:23 +0000

I think we are all struggling with this, and with the challenges of a very tightly worded national coverage decision that has not changed as more evidence has been collected. Opening a coverage decision is a lengthy process, as is the guidelines creation process, so many organizations have been reluctant to ask for a decision to be reopened or guidelines to be changed. However, the limited update to the AFIb guidance following the approval of warfarin alternatives may provide a template to apply more broadly.

Comment on The DOJ investigation: Lessons from Colleagues by r sharma

r sharma — Fri, 13 Apr 2012 23:24:22 +0000

as CMS is authorized regulate the medical practise, one cant simply violate the guidelines (which mayn’t be the latest guideline or something obvious crap).we should understand that the above issue has no simple solution.it requires an drastic change in the present medical exist. till then follow what you can justify.

Comment on Meaningful Use Stage 2: Relevance to the EP by Prakash Desai, MD

Prakash Desai, MD — Tue, 27 Mar 2012 05:22:42 +0000

This “meaningful use ” is just nonsense. Medicare currently can not pay for the services that are rendered, on top of that such mandates to have EMR with meaningful use is just a waste of time and resources and makes no sense. It is time that the EMRS are “simplified” and not made complicated. If you do not have money to pay for the care the physicians provide, you should not mandate more and more. Physicians can not afford to spend 45 minutes of time with each chart to satisfy “meaningful use” This whole thing has nothing to do with patient care or outcome. It is just another stone in the path to patient care.

Comment on CMS RAC Demonstration Project Postponed Until June by A Thometz MD

A Thometz MD — Tue, 07 Feb 2012 17:26:12 +0000

What a RACquet.