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ACC 2017
Dr Rob Nolan Discusses Behavioral Foundations of eCounseling Programs
June 10, 2017
Dr Rob Nolan Explains Behavioral Principles Behind eCounseling Hypertension Program
May 15, 2017
Dr Seth J. Baum on the Patient's Role in Getting PCSK9 Inhibitors Approved by Payers
May 10, 2017
Dr William Borden Discusses MACRA Requirements From a Cardiologist's Perspective
May 08, 2017
Dr Janet Wright on Cardiologists' Role in Public Health and Prevention Efforts
April 15, 2017
Dr Rob Nolan on the Future Directions of eCounseling Research
April 14, 2017
Dr Seth J. Baum Discusses Payers' Reluctance to Approve Coverage of PCSK9 Inhibitors
April 07, 2017
Dr Janet Wright Discusses How Million Hearts Will Leverage Partnerships for Success
April 06, 2017
Dr Robert P. Giugliano Discusses the Significance of the FOURIER and EBBINGHAUS Trials
April 06, 2017
Dr Seth J. Baum on the Patient's Role in Getting PCSK9 Inhibitors Approved by Payers
March 20, 2017
Dr Jim McDermott Discusses Objectives and Outcomes of CVD-REAL Trial
March 20, 2017
Charting the Path to Health Equity: Steps for Providers
March 20, 2017
Dr Janet Wright Outlines Goals and Roadblocks of Million Hearts Initiative
March 20, 2017
Dr William Borden: Advice for Cardiologists on Adjusting to MACRA
March 19, 2017
Dr Rob Nolan Discusses Findings From REACH Hypertension eCounseling Trial
March 19, 2017
Can SGLT2 Inhibitors Prevent Heart Failure in a Broad Population?
March 19, 2017
Data Show It's Hard to Fill PCSK9 Prescriptions, Confirming Cardiologists' Complaints
March 19, 2017
Dr Robert P. Giugliano on the Results of the EBBINGHAUS Evolocumab Cognitive Study
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March 18, 2017
Currently Reading
Bringing MACRA to Cardiologists, Ready or Not
March 17, 2017

Bringing MACRA to Cardiologists, Ready or Not

Mary Caffrey
Coverage from the American College of Cardiology Scientific Session.
CMS proposed cardiac payment bundles last summer, and there has been speculation about their future in the new administration. But both Goodrich and former CMS Administrator and FDA Commissioner Mark B. McClellan, MD, PhD, said while there will be changes, the underlying shift toward value-based payment will continue.

As healthcare advances, it can do more, but it costs more, too. “People are really willing to pay more for longer and better lives for their loved ones,” McClellan said. Within the context of the federal budget, healthcare spending is now crowds out other priorities. Referring to the “skinny budget” presented this week by the Trump administration, he said the proposed cuts to school nutrition programs and Meals on Wheels shouldn’t come as shock considering long-term trends.

What’s frustrating, he said, is that spending more on good nutrition at younger ages might mean spending less later for cardiovascular or diabetes care. “This is not a Democratic or Republican issue,” McClellan said, and the long-term health effects of poor diets, opioid abuse, smoking, and obesity are affecting the swing voters who decide elections.

Treating these populations requires a different approach, and the rise of value-based care came out of practices that felt they could do a better job with hard-to-treat populations if they had a different reward system. Today, McClellan said, he’s starting to see things like a cardiologist serve as the primary care doctor in a patient-centered medical home. The arrival of the new administration will bring more innovation, not less, he predicts.

“Some health plans are interested in sharing those savings with the consumers,” McClellan said. “This is all very much in process.”

William Borden, MD, an associate professor at George Washington University, said the idea of value-based care must start with good outcomes for complex patients. “If we don’t have good outcomes, we shouldn’t begin to look at the cost component.”

He described a 65-year-old woman who had made 5 emergency department visits in a year before his practice targeted her for special case management. Her care is now coordinated among 8 different providers, and, “she’s always telling her nurse care manager how much she appreciates her.”

Borden walked the group through a 2-year process of how his practice developed quality scores and calculated whether it was eligible for shared savings. One year was successful, one year fell just short. But the practice has no plans to abandon this new way of doing things. Borden believes keeping these metrics will be essential to the practice’s future, for things like contract negotiations, credentialing, or joining a new hospital.

“Society trusts us with these resources,” Borden said. “It is important for us, as physicians, to look at the cost.”

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