• CLINICAL INTEREST SECTIONS: Coronary Peripheral SCAI TAVR Center

  • SCAI’s Hildner Lecture Takes on Tough Issues: Appropriateness, Cost and Quality

    May 11, 2012

    Interventional cardiology is in the spotlight these days—some might even say it’s under attack—as an economic vise tightens around healthcare spending. In a keynote Hildner Lecture at the SCAI 2012 Scientific Sessions, and in a town hall-style meeting slated to follow, Ralph Brindis, MD, MPH, FSCAI, will make the case for self-reflection as a critically important response to this scrutiny.

    “This is possibly the most important session any interventional cardiologist will attend this decade,” said SCAI 2012 Program Co-director Kenneth Rosenfield, MD, FSCAI. “Dr. Brindis will challenge each of us to engage in self-reflection, to ask ourselves if we are doing the right things, using healthcare resources wisely and being totally transparent.”

    Dr. Brindis, a senior advisor for cardiovascular disease for Northern California Kaiser Permanente in Oakland, CA, and past president of the American College of Cardiology (ACC), believes that all interventional cardiologists should examine what they’re doing and make sure they’re practicing true evidence-based medicine.

    “We need to ask ourselves, ‘Am I a knight, or am I a knave, or a pawn? How am I as a clinician?’” he said.

    Knights put patient values first, Dr. Brindis said. They are wise guardians of limited resources and respected advisors when determining the public good. Their treatments are based on the latest scientific evidence. Knaves, on the other hand, make clinical decisions with personal financial gain and self-promotion in mind. Pawns respond to external forces such as licensing requirements and insurance guidelines, rather than to an internal drive for professional excellence and high-quality care.

    “Ninety-nine percent of people who go into medicine truly are interested in helping others, and view themselves as knights,” Dr. Brindis said. “But we still need to re-examine how we’re practicing. Are we true knights or, on personal reflection, are there opportunities for improvement? Is there a smidgen of a knave or a pawn in the ways we act?”

    As individuals and as a profession, interventional cardiologists can take several steps to make sure patients always come first, Dr. Brindis said. They include the following:

    • Take      advantage of SCAI quality improvement tools, appropriate use criteria and      appropriateness scores, which are      now available through the ACC-National Cardiovascular Data Registry CathPCI      Registry. Submit accurate data to registries and actively participate in the      evaluation of clinical practice, to find opportunities for improvement.
    • Set up a system of oversight to confirm the      appropriateness of angioplasty and stenting.
    • Actively participate in developing new      methods of physician payment based on what’s best for patients, not      on procedure volume.
    • Participate in public reporting      initiatives      and use public data to inform and educate patients.
    • Participate in the development of      meaningful outcomes measurements by actively collecting outcomes and      cost data, evaluating the impact of the newly developed measures and      readjusting these metrics if the evidence does not validate their original      promise.

    “As professionals, we are the ones best suited to evaluate our practices and determine what is appropriate clinical care and what is not,” Dr. Brindis said. “We cannot afford to abdicate our responsibility or withdraw our considerable expertise in shaping this science.”

    After setting the stage with the Hildner Lecture, Dr. Brindis will help moderate a town hall meeting that will tackle many of the tough questions facing interventional cardiologists today.

    “SCAI members will have an opportunity to engage in a frank discussion about these important issues,” Dr. Rosenfield said. “This session will be meaningful and engaging.”

    Dr. Brindis reports no potential conflicts of interest.