"Bit by bit, putting it together"

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Kaitlyn Dmyterko, staff writer

Bit by bit, putting it together. Piece by piece, only way to make a work of art. Every moment makes a contribution. Every little detail plays a part,” sang the actors staring in Steven Sondheim’s 1984 Broadway hit Sunday in the Park with George. The medical industry is similar to the lyrics of Putting it Together, whereas every device, drug procedure and therapy must work together to optimize patient care.

News coming from the Cardiovascular Research Technologies (CRT) meeting this week in Washington, D.C., left us with some interesting questions, answers and also contemplations.

First, Dr. David J. Cohen considered what type of reimbursement hospitals would receive if the FDA approves transcatheter aortic valve implantation ( TAVI) in the U.S. While still uncertain, he said that based on the device's cost in Europe—$27,700 (EUR 20,000)—the price points could be similar.

Currently, the CMS reimbursement policies cover device and implantation costs, but Cohen said the costs will be based on the payment model the U.S. has adopted at the time of approval. He offered that a fee-for-benefit approach, which is the most rational, could have many disadvantages in terms of administration and operations, but a pay-for-what-it-costs approach—which is the most likely candidate—could increase healthcare costs.

Until the cost analysis data of the PARTNER trial are presented at this year’s ACC11 in New Orleans, cardiologists will be left mulling over these types of questions.

Coinciding with these reimbursement and payment issues, Steven Simms, RN, cath lab director at the Washington Hospital Center, offered at CRT that cath labs should be run “like a business.” He said this approach becomes particularly useful as hospitals begin to feel the pressure of real and potential reimbursement cuts. To get over these hurdles, Simms said that a “survival of the fittest” attitude works best.

Ultimately, cath labs must get creative and do more with less, while still providing high-quality patient care.

In other news this week, a meta-analysis in AIM leaves us asking whether or not the bar for cardiac resynchronization therapy in heart failure should be lowered after Canadian researchers found that patients with a reduced left ventricular ejection fraction, prolonged QRS duration and less severe HF symptoms could benefit from resynchronization therapy.

An analysis of 25 randomized controlled trials showed that CRT reduced all-cause mortality by 19 percent, despite NYHA Class. However, the authors said that it is still up in the air as to how generalizable these data will be when resynchronization is performed by less experienced clinicians in small-volume centers.

“Having just a vision’s no solution. Everything depends on execution. Putting it together, that’s what counts,” wrote Sondheim. The industry must mimic Sondheim and carry out the most efficient and cost-effective approach to care, making sure not to waver on patient care.

On these topics or others please feel free to contact me.

Kaitlyn Dmyterko
Senior writer, Cardiovascular Business