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Wednesday Jan 27, 2016

Win-Win? Cardiology Project Could Benefit Patients, FPs

Cardiovascular disease (CVD) is the leading cause of death in the United States, claiming more the 600,000 lives each year. That's more than the population of Wyoming.

CVD accounts for 17 percent of U.S. health expenditures, and those costs are expected to triple between 2010 and 2030. Improving prevention and care processes, however, could substantially reduce morbidity, mortality and the costs associated with CVD, and the AAFP is participating in work that aims to do just that.

I recently attended a meeting at the Brookings Institution in Washington with representatives from the American College of Cardiology, the American College of Osteopathic Family Physicians and the American College of Physicians, as well as CMS, private-payer organizations, health systems, medical schools, research groups and the Veterans Health Administration. Our goal for this meeting, and the conference calls that preceded it, is ultimately to produce a policy paper that would serve as a model to improve the way primary care physicians and cardiologists work together.

The end product could result not only in better care for our patients, but more equitable pay for primary care. Our patients and our practices both have a lot to gain in the process.

It was interesting to see how much common ground primary care has with our subspecialty colleagues. We discussed numerous opportunities to close gaps in care, reduce overtreatment and address undertreatment.

Inadequate communication between physicians, patients and caregivers is one obvious problem we agreed on, and universal dismay was expressed -- from primary care, cardiology and payers -- about the state of electronic health record systems. Current products are not meeting needs and are a barrier to innovation.

We also agreed that physicians -- regardless of specialty -- need more time with our patients than what is typically possible in the fee-for-service world of health care. Cardiology is still firmly based in that fee-for-service model. Roughly three-fourths of practices are owned by health systems. Meanwhile, a recent study showed that roughly one-third of family physicians already are pursuing value-based payment.

So how do we pull the cardiologists into our patient-centered neighborhood? A representative from CareFirst BlueCross BlueShield pointed out that the payer has had tremendous success with the patient-centered medical home (PCMH) model, lowering both ER visits and readmission rates related to CVD. Primary care practices, he said, are receiving better payment as a result of this hard work. Health systems representatives also pointed to the PCMH as a means to improve quality and lower costs.

In addition to how we might work better together, we also discussed how improving care, coordination and communication could also affect payment, including pay-for-performance programs, bundled payments, shared savings and more.

This project, which is an initiative of the new Duke-Margolis Center for Health Policy(today.duke.edu), still has a long way to go. There will be followup work still to come. But the possibilities are intriguing, and if we can get it right, this could serve as a model for how primary care works with other subspecialties, as well.

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Posted at 11:50AM Jan 27, 2016 by Wanda Filer, M.D.

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