The Journal of Healthcare Contracting

Heart Disease Management Picks Up the Beat
Early diagnosis and better disease management enable hospitals to treat more heart patients in an outpatient setting.

Hospitals recognize the health and economic benefits of earlier diagnosis and better management of heart disease. Still, they have a ways to go.

"There is an emphasis on providing hospital users with equipment they need to offer direct care and treatment, rather than diagnostics," says Frederic Pla, general manager, cardiology care area for GE Healthcare in Milwaukee, Wis. And, while the development of IT systems and hospital information systems has encouraged more interest in screening and disease management, to a large degree the focus continues to be on procedures for treating symptoms or heart attacks, and IDN contracts reflect this approach.

"Government initiatives are pushing hospitals to manage (heart) disease in an outpatient setting," says Paul Elko, marketing manager for ECG analysis technology at GE Healthcare. "The government realizes that hospitals must reach patients earlier in the course of their disease." Earlier treatment can facilitate the movement of patients from hospital beds to outpatient or wellness centers.

"Hospital CEOs and administrators are recognizing that prevention is the next big step," continues Elko. "If they can provide more outpatient and home care, hospitals can save money." Earlier screening and diagnosis is much less expensive, and better for the patient, than treating a heart attack victim.

Heart disease
Heart disease refers to a broad range of health issues. For instance, coronary heart disease can lead to angina or chest pains. Each year, 7 million people with coronary heart disease visit a cath lab to have their arteries unclogged. Another 1.6 million individuals with coronary heart disease suffer from acute coronary syndrome or acute myocardial infarction (heart attack). Those who survive a heart attack are at greater risk for developing congestive heart failure.

"This is a growing problem," says Pla. "These patients are hospitalized frequently and are difficult to manage, and this is costly to Medicare."

Pla adds that more patients survive heart attacks, there is a greater prevalence of fatal arrhythmias, which can lead to sudden cardiac arrest or even stroke (caused by atrial fibrillation), depending on the type of arrhythmia. Government initiatives are expected to focus more on addressing stroke and arrhythmia issues in the future.

While hospitals may be guilty of performing too little upfront screening, detection and disease management, patients must take some of the blame as well. Americans continue to battle high blood pressure, obesity and poor diet. "Heart disease, and the number of heart patients hospitals must care for, is still on the rise," Pla says. This includes both the older population who present heart attack side effects, such as arrhythmias or congestive heart failure, and the young population of tail-end baby boomers who still haven't made healthy lifestyle changes.

Noninvasive screening and future trends
Screening for heart disease should be noninvasive, according to Elko. Internists or family physicians should begin with a patient history, physical and ECG. Depending on these test results, the next step generally involves exercise testing, Holter monitoring, more ECGs or electron beam tomography (EBT), which costs about $200 per scan and examines calcium buildup as a factor in heart disease. Biomarkers, such as C-reactive protein, are also becoming more widely used.

Although doctors continue to screen patients for such risk factors as high blood pressure, elevated cholesterol and smoking, they frequently fail to diagnose heart disease until it is advanced. This should change, however, as genetic profiling and new blood tests are developed to catch the disease in its infancy. As IT-based management programs continue to develop, these, too, will enable physicians to identify high-risk patients earlier and more accurately. Experts also expect to use molecular imaging one day to target the location of heart disease in a patient's arteries and pinpoint areas in the coronaries with plaque buildup, which are susceptible to rupture and heart attack.

"At some point, we will be able to do this long before a patient has a heart attack," says Pla.

Pla says the push for noninvasive testing is driving more screening into outpatient settings. Caring for patients in outpatient centers is less costly and more convenient for the patient. Groups such as the American College of Cardiology and the American Heart Association are encouraging hospitals to follow clinical guidelines more closely for better patient outcomes. Screening is a lot less expensive than disease treatment.

Each day, Cardinal Health does the following: Chest pain centers help hospitals manage heart disease

Hospitals are taking a growing interest in developing programs to address earlier treatment and better disease management for heart patients. In response, The Society of Chest Pain Centers (SCPC), a professional organization comprised of cardiologists, emergency physicians, nurses and healthcare managers, is helping hospitals implement chest pain centers within their facilities.

Hospital chest pain centers can become accredited through the SCPC in an effort to diagnose patients more accurately, reduce treatment times and decrease the number of unnecessary hospital admissions.

To become fully accredited, a hospital must complete the SCPCÕs formal process in the following areas:

Emergency department integration with emergency medical system
Emergency assessment of patients with symptoms of possible acute coronary syndrome (ACS), timely diagnosis and treatment of ACS
Assessment of patients striving for low-to-moderate risk of ACS
Functional facility design
Personnel, competencies and training
Organizational structure
Process improvement orientation
Community outreach programs.

Facilities can work toward accreditation through an accreditation manual and monthly televised workshops. In addition, a society review team visits the facility and makes recommendations to the Accreditation Review Committee, which issues a follow-up report.

The Accreditation Review Committee issues one of the following accreditation standings to a hospital:

Full-accreditation. The facility has met all requirements and is accredited for three years.
Provisional accreditation. The facility has completed the accreditation process and met minimum requirements, and has provided a written commitment to implement recommended changes within the next 12 months.
No accreditation issued. The facility has not met minimal requirements, or it has received provisional accreditation but has not met its commitment to implement recommended changes.