COMMENTARY:

Pre­ven­tive cam­paigns, care co­or­di­na­tion mak­ing im­pact on heart dis­ease

Modern Healthcare - - NEWS - Dr. Steven Cor­win Dr. Steven Cor­win, a car­di­ol­o­gist, is CEO of New YorkPres­by­te­rian Hos­pi­tal.

Be care­ful where you cut bud­gets in fight against heart dis­ease

Cut­ting bud­gets and health­care spend­ing are high pri­or­i­ties with many pol­i­cy­mak­ers, but an un­ex­pected suc­cess in fight­ing heart fail­ure raises ques­tions about what saves more: hold­ing down bud­gets or pro­vid­ing the right treat­ment.

A re­cent ma­jor study showed hos­pi­tal­iza­tion for heart fail­ure dropped nearly 30% for Medi­care pa­tients. As a re­sult of the im­prove­ment, the Medi­care pro­gram saved about $4.1 bil­lion in hos­pi­tal costs re­lated to heart fail­ure, ac­cord­ing to the study.

Car­di­ol­o­gists and car­diac sur­geons af­ter­ward in­di­cated they had been notic­ing fewer heart-fail­ure pa­tients, but no one ex­pected such a large and dra­matic turn.

What has worked? The an­swer, I be­lieve, is our na­tion’s ag­gres­sive as­sault on heart dis­ease for many years by co­or­di­nat­ing care through dif­fer­ent cat­e­gories of treat­ment. These cat­e­gories or legs of treat­ment are wide­spread ef­forts at pre­vent­ing heart dis­ease, im­prov­ing rou­tine care and dis­ease man­age­ment, and re­search lead­ing to as­ton­ish­ing ad­vance­ments in in­ter­ven­tional car­diac care.

The study is based on data from more than 55 mil­lion pa­tients in Medi­care’s con­ven­tional fee-for-ser­vice pro­gram who were hos­pi­tal­ized for heart fail­ure be­tween 1998 and 2008. As re­ported in the Oct. 19 Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion, 229,000 fewer peo­ple were ad­mit­ted to hos­pi­tals for heart fail­ure in 2008 than would have been ex­pected had the rate of ad­mis­sions re­mained at 1999 lev­els.

Clearly, de­spite some ma­jor ob­sta­cles, medicine is hav­ing a ma­jor im­pact on heart dis­ease. This hap­pened even though obe­sity and di­a­betes, both risk fac­tors for heart fail­ure, are in­creas­ing and claim­ing more Amer­i­can lives. Be­cause the study mea­sures the Medi­care pop­u­la­tion, which is 65 and older, it may not cap­ture the im­pacts of obe­sity, which have been se­vere on younger adults.

Heart fail­ure is when the heart is los­ing its abil­ity to pump blood through­out the body. But pre­ven­tion, rou­tine care and in­ter­ven­tional mea­sures at­tack heart dis­ease at dif­fer­ent stages, cre­at­ing a body of med­i­cal treat­ment that con­tin­ues to im­prove while it helps pa­tients de­lay or pre­vent heart fail­ure from hap­pen­ing.

One of the great­est suc­cesses has been pre­ven­tive cam­paigns to change be­hav­ior of pa­tients now to im­prove their health later. Smok­ing rates among adults con­tinue to fall, ac­cord­ing to the Cen­ters for Dis­ease Con­trol

It would be fool­ish to save money from the very pro­grams and treat­ments that lead to re­duced uti­liza­tion of ser­vice.

and Pre­ven­tion. For years, smok­ing has been one of the lead­ing risk fac­tors for heart dis­ease. High choles­terol, an­other lead­ing cause, is be­ing con­trolled through med­i­ca­tion in mil­lions of adults.

Through greater un­der­stand­ing of heart fail­ure, doc­tors are able to teach pa­tients what to look for and how to mon­i­tor the warn­ing signs. Many pa­tients weigh them­selves twice a day and strictly mon­i­tor blood pres­sure. A change one way or the other in­di­cates how med­i­ca­tion should be ad­justed to op­ti­mally man­age heart fail­ure.

Through re­forms ini­ti­ated by the fed­eral govern­ment and com­mer­cial in­sur­ers, pri­mary-care doc­tors, spe­cial­ists and other clin­i­cians com­mu­ni­cate with each other to co­or­di­nate the care of in­di­vid­ual pa­tients.

Pi­o­neer­ing work in med­i­cal re­search is an­other key fac­tor. Our ad­vances in min­i­mally in­va­sive surg­eries such as valve re­place­ment, drug elut­ing stents, and im­planted de­vices such as de­fib­ril­la­tors have al­lowed doc­tors to fix hearts and keep them func­tion­ing op­ti­mally.

These three legs of treat­ment have given el­der Amer­i­cans a level of in­ter­ven­tion more com­plex than ever be­fore. They were de­vel­oped through rig­or­ous re­search and proven in our most ad­vanced med­i­cal in­sti­tu­tions.

As Congress looks to trim bud­gets and deficits, a task made harder by the in­abil­ity of the su­per­com­mit­tee to find com­mon bud­getary ground, this is im­por­tant to re­mem­ber: There are wise ways and there are fool­ish ways to save money in health­care. Wis­dom calls for ev­ery­one to pitch in.

Hos­pi­tals must learn to be ever more ef­fi­cient, to pull costs out of ser­vice while main­tain­ing su­perb qual­ity. Care must be co­or­di­nated across mul­ti­ple set­tings to avoid re­dun­dant tests and pro­ce­dures. In­sur­ance com­pa­nies and govern­ment pay­ers must stan­dard­ize their claims to save ad­min­is­tra­tive costs by al­low­ing doc­tors and hos­pi­tals to fill out a sin­gle form. Courts need to rein in friv­o­lous mal­prac­tice law­suits that drain bil­lions of dol­lars from the health sys­tem. Wise sav­ings are achiev­able.

It would be fool­ish in­deed to save money from the very pro­grams and treat­ments that lead to bet­ter health and re­duced uti­liza­tion of ser­vice. The re­duc­tion in hos­pi­tal­iza­tions for heart fail­ure will clearly lead to great sav­ings and im­proved health for older peo­ple.

Our wise in­vest­ment in pub­lic ed­u­ca­tion, treat­ment and re­search has paid off hand­somely. Cut­ting it doesn’t make sense.

Of course, there is more to be done. Amer­i­cans need to eat bet­ter and ex­er­cise more. We need to pre­vent and bet­ter con­trol di­a­betes. Too many peo­ple still smoke. Pub­lic pol­icy and govern­ment sup­port need to in­crease pro­to­cols that help doc­tors co­or­di­nate care, in­clud­ing greater ac­cess to in­for­ma­tion tech­nol­ogy.

What we have done has shown us how to move for­ward to com­bat dis­ease and man­age costs. In­vest­ing in pre­ven­tive health cam­paigns, rou­tine care and re­search is now a proven model to im­prove health for large pop­u­la­tions.

Pre­ven­tion, rou­tine care and ad­vanced pro­ce­dures: To save lives and save money, all three must be in place to cre­ate a full spec­trum of care.

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