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

MedStar author(s):

Citation: American Heart Journal. 204:178-185, 2018 10.PMID: 30077336Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *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]Year: 2018 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0002-8703

Name of journal: American heart journalAbstract: 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.All authors: Brindis RG, Gibbons RJ, Weintraub WSFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.ahj.2018.04.001

Date added to catalog: 2018-08-16

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30077336	Available		30077336

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%.

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