Moving from volume to value for revascularization in stable ischemic heart disease: A review. [Review] - 2018

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS AND RELEVANCE: The use of revascularization procedures in patients with SIHD is potentially a model for how care might be improved with health care policy intervention. We suggest that the status quo, although apparently improved over the last 5 years, is still unacceptable when 25% of hospitals have a rate of unnecessary PCI in patients with SIHD that approaches 25%. Copyright (c) 2018 Elsevier Inc. All rights reserved. IMPORTANCE: Although percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are both commonly employed in the treatment of stable ischemic heart disease (SIHD), their ability to reduce subsequent heart attacks and death is currently in question. These procedures will come under increasing scrutiny as the healthcare reimbursement system moves away from the traditional fee for service model in favor of "pay for value". OBSERVATION: Both international and domestic data show wide variability in the use of PCI and CABG in patients with SIHD. There is evidence of ongoing quality improvement over the last 5 years in reducing the use of inappropriate procedures, but there is still room for improvement. We present ideas regarding health policy interventions that might help manage the transition to value-based payments in this area, including improvements in national registries, more rapid revision of appropriate use criteria, shared decision making, and evidence-based management of PCI in SIHD.


English

0002-8703

10.1016/j.ahj.2018.04.001 [doi] S0002-8703(18)30108-X [pii]


*Coronary Artery Bypass
*Health Policy
*Myocardial Ischemia/su [Surgery]
*Percutaneous Coronary Intervention
*Value-Based Health Insurance
Coronary Artery Bypass/ec [Economics]
Coronary Artery Bypass/sn [Statistics & Numerical Data]
Costs and Cost Analysis
Decision Making
Evidence-Based Medicine
Humans
Myocardial Ischemia/ep [Epidemiology]
Percutaneous Coronary Intervention/ec [Economics]
Percutaneous Coronary Intervention/sn [Statistics & Numerical Data]
Procedures and Techniques Utilization
Registries
Reimbursement Mechanisms
United States/ep [Epidemiology]
Unnecessary Procedures/ec [Economics]


MedStar Heart & Vascular Institute


Journal Article
Review