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Issue Date: November 2005

Two Trends May Benefit Physicians
Recent developments make the prospect of health reform seem rather distant. Frankly, the status quo seems more likely. The nation’s largest health insurers seem to be too busy protecting their own turf to embrace sweeping reform measures. At the same time, the federal government is seeking to reduce health care spending by cutting Medicare and Medicaid fees once again. Federal health officials believe physicians can operate their practices more efficiently by using electronic health record (EHR) systems. At the same time, employers are seeking to cut costs by introducing consumer-directed health plans (CDHPs) and asking employees to pay more for care. While both of these trends (the growth of EHRs and the introduction of CDHPs) are unrelated, they offer hope for overworked and underpaid physicians.

Guidelines Complement Performance
Seeking to minimize variation in care practices, the American Heart Association and the American College of Cardiology have established a link between new guidelines and performance measurement. For years, the AHA and the ACC have worked together to produce evidence-based clinical practice guidelines, says Robert O. Bonow, MD, professor of medicine at Northwestern University and chief of cardiology at Northwestern Memorial Hospital in Chicago. “But the guidelines process only goes so far in standardizing the approach to cardiovascular care,” adds Bonow who chaired the ACC/AHA Task Force on Performance Measures. “Although guidelines do help to improve quality, they do not necessarily improve quality in a uniform way. Wide variation and disparate use of evidence-based cardiovascular care still exists, even within the same community. There-fore, it was clear that if we wanted to improve quality, we had to go beyond the guidelines to provide a way that physicians could measure their performance. By publishing the guideline update and the performance measures simultaneously, physicians are able to consider the recommendations in conjunction with strategies to measure performance against them.” The guidelines, Practice Guidelines for the Diagnosis and Management of Chronic Heart Failure. were first published in 1995 and were last updated in 2001. They outline the optimal care process for heart failure patients, including assessment and therapy and special considerations for patients by age, gender, ethnicity, and comorbid conditions. When releasing the new guidelines, the AHA and the ACC released articles on two related topics: “Clinical Performance Measures for Adults with Heart Failure” and “Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Heart Failure.” By concurrently releasing the clinical performance measures and the key data elements, ACC and AHA hope to make the guidelines more actionable, thereby encouraging improvements in quality and outcomes.

A Family Doctor’s Katrina Diary
Editor’s Note: Just three weeks before Hurricane Katrina tore through Louisiana and Mississippi, Ron Kellum, MD, and his wife Bita Ghaffari, MD, opened a family practice in Diamondhead, Miss., a Gulf Coast town of 6,000 residents. In the first three weeks, they saw three or four patients each day. Ghaffari worked part time while also caring for their young daughter. Just before Katrina hit, Kellum took his family to Austin, Texas, to ride out the storm. On Thursday, Sept. 1, he returned to Diamondhead to do what he was trained to do: provide patient care. This is his story.