Drawing a line in the sand

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This oft-used expression may originate from the time Macedonian King Antiochus IV and his army sought to invade a Roman protectorate, and was met at the border by Roman statesman Popillius Laenas, who ordered the king to withdraw. After the king began to stall for a time, Popillius Laenas drew a circle around the king in the sand with his cane, and demanded that Antiochus withdraw his army before he stepped out of the circle. The king, apparently impressed by the senator's nerve (or, the Roman Empire in general), withdrew.

Regardless of whether Roman historian Titus Livy’s account of this dramatic event is hyperbolic, the expression has come to mean making an artificial boundary or taking a definitive stand, in challenge to an opponent. This stance has been taken on with new umbrage in the past week by a variety of individuals in the cardiovascular space.

MedPAC, which presented its most recent report to Congress last week, is seeking further prevention on physicians who benefit from referrals that provide them with financial gain. The commission outlined that the law prohibits physicians from referring patients to an imaging center or lab that they own; however, the in-office ancillary services exception allows physicians and practices to provide designated health services in office when certain criteria are met. The report suggested additional changes to the Stark Law that would “reward providers for constraining volume growth.”

Likewise, a perspective in the New England Journal of Medicine, released today, calls for a legislative mandate that would allow the FDA to better monitor and regulate the use of CT scanning in the provider setting. Perspective author Dr. Rebecca Smith-Bindman, who is working with the National Institutes of Health on this topic, told Cardiovascular Business News that with this mandate, the “agency could require that institutions demonstrate their capacity to meet these targets, as well as regulate and monitor facilities over time, which could lead to dramatic lowering of the radiation dose associated with CT.”

Conversely, a presentation at the recent Society of Vascular Surgery conference in Boston is calling for less involvement from state and federal policymakers, with regards to restrictions on industry and physician interactions. Dr. Carey Kimmelstiel, an interventional cardiologist at Tufts, explained how the Massachusetts state gift ban has hindered “free trade and interaction between manufacturers and prescribers [that] truly reduce innovation, efficiency and productivity."

These organizations and individuals are drawing lines in the sand about issues in healthcare on which they are seeking change. While others in the healthcare community begrudge these issues as bid timing and trivial, Titus Livy reminds us: “Events of great consequence often spring from trifling circumstances.”

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

Justine Cadet