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Cardiologists' mantra for the New Year: "Bite me, 2010! Bring on 2011! and take back the attention and accolades we deserve"Jan 8, 2011 09:46 EST
The year 2010 was a most humbling one for cardiologists. Although I'm tempted to discard last year and sum it all up by borrowing the phrase from a Facebook friend, "Bite me, 2010," we can probably better utilize last year as a navigation tool for the next one. Rather than ignoring the past 12 months' worth of revelations, forecasts, and accusations, we should take lemons and make lemonade or better yet, take lemons and make a Jamba Juice of a year in 2011! Here are just a few reflections and observations about what happened to us in 2010. Instead of the threat of a 30% reimbursement cut, we should have had accolades, so I'm going to do what should have been done by the likes of our politicians, our President Obama, and some of our hospital CEOs.
As many of you familiar with our forum can attest, cardiologists became a favorite punching bag last year for mainstream medicine haters and some politicians and has been largely ignored by our president. Mr Obama placed his stamp of approval on a 1600-page healthcare reform bill in which family medicine, trauma docs, and obstetricians were given a nod, but the word "cardiologist" was never mentioned a single time in the entire Tolkienesque piece. This is an incredible omission despite the fact that congestive heart failure is our country's most expensive DRG and heart disease is the number-one killer of our citizens.
Heart specialists were accused in 2010 of driving up the cost of healthcare. My answer to that is, "Live patients are more expensive than dead ones." Heart attack rates are lower, better medications prolong the lives of heart failure sufferers, so we have more folks alive to take care of and we as a nation need to learn to deal with that. Thanks to our EPs, devices save sudden death candidates. Heart-attack mortality is decreased by primary PCI and the guys who get up at 2 am to provide this service need to be rewarded like Michael Jordan rather than be made to feel like lepers. Although it's far more spectacular to point a finger and generate a headline suggesting some sort of espionage or graft, the simple truth is that folks who are purely stenting for dollars are few and far between. Relieving angina with a stent is not a crime and though not lifesaving in the stable-patient, any politician or "PCI hater" who has to take a nitro to have sex with his wife or take out the trash will be the first one on the table.
Noninvasivists need a pat on the back too. Screening for dyslipidemia, management of hypertension, and imaging to prove that chest pain is angina (or not) has progressed light years in a half a century. Although it only takes a few minutes to interpret an echo, it took 25 years of education to be able to read one, so America, stop cutting the reimbursement for it. Let us misinterpret one and you'll quickly tell us the worth of that test in a malpractice case. RNPs and PAs provide patient accessibility in many practices that is lifesaving. They deserve our thanks as well.
The family doctor who delivered me died at a young age in a cardiologist's office in the early 1960s. He had suffered from progressive angina for weeks and was told that nothing could really be done about it. As he was tying his tie, he stepped down off the exam table and suffered a witnessed sudden cardiac death. With no cath/stent/CABG, CPR, or defibrillator available, all that could be done was to inform his family of his demise. Think how far we have come before we complain in 2011 about the status of cardiac services.
As cardiologists, it's time we start bragging about our successes. We all need to renew our pride in being a cardiologist. It took grit, determination, and intelligence to complete a residency and fellowship and establish a practice. We take unmitigated amounts of malpractice risk to help surgeries get done and allow discharges to happen, and most of the time, we just do it because we enjoy it, we are good at it, and it comes naturally. However, we should NOT just leave it at that. Cardiologists should make a few plans and a few demands in 2011. Let's improve on our weaknesses and optimize our strengths.
If there are those among us who are behaving in an unethical or fraudulent fashion, we owe it to our profession to confront them and, if it's a pattern, report them. We owe it to our patients to shore up our practices and make them as efficient and financially sound as possible. Utilize consulting firms, make our payrolls lean; deal with patients in a fair and humane manner. Reconsider the "money up front" stance and replace it with a more patient-friendly payment plan option. Demand attention from our congressional representatives and senators and take time to sit down and discuss our thoughts on healthcare reform and healthcare delivery. Emphasize the importance of prevention in our everyday practices and in the political arena. Become a leader in entities like smoke-free-ordinance movements, previously owned medication repositories, health fairs, and public forums, and generally make it easier to get cardiovascular information and services to our local communities. Champion antiobesity campaigns and focus on fitness.
We took a beating last year, and instead of just lying down and taking a 30% pay cut we should instead demand tort reform, primary PCI availability, a smoke-free nation, and tax breaks for citizens who maintain a healthy lifestyle and businesses who encourage it for their employees. In these few changes, we could find enough cash to fund the very essential prevention movement that is the ultimate gift that keeps on giving, the benefits of which would be affordable healthcare for everyone. Prevention is the veritable Fort Knox of healthcare dollars. This year the walls need to come down, and with that, there would be enough cash that every single physician could receive a pay increase that matches that given to our hospitals. Hospitals, by the way, are becoming top heavy by purchasing more and more properties, physicians, and buildings. They are unwittingly being set up by our government for the same failures that plague our current cardiology private-practice sectors, which feel their rugs being jerked out from under them by government that has forgotten their worth.
I don't know about you, but I think it's time for cardiologists to stick our chests out and hold our heads up high. Our profession has nothing to be ashamed of. We should all stand together and in unison yell "Bite me, 2010" and bring on 2011! Demand the political attention and accolades we deserve. Let's continue to do our part this year as cardiologists, but let's also take our part and stand our ground as well.