MANAGED HEART CARE
Your doctor is forced to use cookbook management in your cardiac care. Managed cardiac care has begun, in an attempt to eliminate and monitor the private practice of cardiology. Guidelines are now being made into rules, to manage your medical care to conform to government mandates.
With the use of electronic medical records, a program has begun, to monitor the office practices of cardiologists. Doctors are monitored and graded by their performance in adhering to “established guidelines” set, by the American heart Association. Doctors will be ranked by their adherence to these programs.
The American Heart Association is collecting data from cardiologist, documenting their testing and treatment of patients during regular office visits. Hospitals have achieved increased improvements in the care of patients who have heart attacks or strokes or admitted with congestive heart failure, by adhering to guidelines. Their registry has spurred life-saving reductions, in their treatment of patients suffering from a heart attack as they reached the hospital.
Only 5 to 10% of your health care occurs in the hospital. What happens after you leave the hospital and what your doctor does in his office care is important and unknown. This outpatient effort, called the Pinnacle Registry, started last month, and relies on clinical data not insurance claims.
17 million Americans are diagnosed with coronary artery disease and millions more are at high risk. Every year 900,000 people get a heart attack and another 800,000 have a stroke.
Only one third of these patients are being treated for high cholesterol and only 45% are treated for high blood pressure, and few have their blood pressures reduced to normal levels. The guidelines also attempt to have doctors prescribe more cholesterol lowering drugs and antihypertensive medication.
Only 50% of Americans regularly get at least 30 minutes of exercise five days a week, and one out of five people still smoke. Diabetes and obesity are on the rise. Guidelines are established to control all these maladies.
There's very little data about the quality of cardiac office care. The registry is looking at the advice doctors give cardiac patients, and how effectively it helps them achieve the Pinnacle guideline targets.
All your lab results and other patient information from your visit are supplied, to the registry. The registry wants to know whether your doctor gave blood thinner warfarin to reduce your stroke risk, if you have an irregular heartbeat.
Your doctor will get a quarterly report comparing his performance with other colleagues. The hope is to make your doctor more "vigilant" about prescribing proven strategies in medications that would reduce the risk of heart attack, stroke, and other lifesaving illnesses.
The registry will monitor if your doctor is controlling your risk factors. This computerized medical record system, showed over 30% of all doctors did not achieve the guideline goals of lowering cholesterol and blood pressure, through cholesterol lowering and anti-hypertensive drugs. By persuading more doctors to forego paper charts and use electronic medical records, their data collection will be easier,
These "evidence-supported guidelines" are meant to help doctors remember to check and ask if you have diabetes or have quit smoking. The completed forms are part of your record and are submitted to the database without extra work. This leads to a rapid accumulation of data that will be useful in tracking and shedding light on what treatment strategies are being used and which require micromanagement.
Over a third of the nation's 1500 hospitals now are already giving data to the guidelines program and are complying to treatment strategies. Now 95% of heart patients admitted to Florida's 17 hospitals are discharged with a prescription for a beta-blocker, compared with only 78% before the program started.
COMMENTARY
The American Heart Association and College of cardiology are attempting to get its members to increase their adherence to the Heart Association prevention guidelines.
By collecting data from doctors, through EMR, they can evaluate their medical work with patients. The office performance across a variety of laboratory tests and targets shows how well your doctor adherence to the set guidelines.
Having found that over 30% of heart specialists did not comply with these guidelines, your doctor is told that he is not complying with over 70% of his colleagues. He must be wrong, and must reevaluate his own performance to perform within regional and national averages as compiled by the originators of the guidelines.
Specialists practicing in cardiology, are required to maintain their skills, by attending over 50 hours of didactic accreditation hours, taking certification examinations, having their hospital work evaluated by hospital review committees, and voluntarily reads pertinent medical journals, and discuss cases with their colleagues.
Why should he be judged and rated by a guideline registry of how he treats his patients in the office. All patients are unique and require tailor made treatments, depending on their behaviors, work styles and physical makeup.
It is hard to imagine that over 30% of our cardiologists are out of tune, and practicing bad medicine. Guidelines are now being made into rules, to manage your medical care in a way the government wishes.
This is the first step to manage care of our health system. Most patients are unique, and require individual treatments, after a thorough physical examination and discussion of their symptoms with their doctors.
Can you imagine the field day trial lawyer will have, if your doctor is not ranked properly according to some cookbook guidelines set by the authors of medical journals, who have vested interests with the drug industry.
Our healthcare cannot maintain its high standards, if your doctor is forced to cookbook management of his patients.