Private practice with Dr Seth Bilazarian

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Choosing wisely for interventionalists: Seth Bilazarian's top 5

May 10, 2012 03:15 EDT


Calling all interventionalists: What five practices would you highlight to promote best patient care and save healthcare dollars? Dr Bilazarian shares his picks:

1. Use FFR liberally for intermediate lesions but not for severe ones
2. Use bare-metal stents if there's any doubt about the patient's insurance status
3. Do complete angiography before intervention
4. Don't send patients home without complete revascularization
5. Take up the radial approach

What's on your list?

See also:

Choosing wisely: The electrophysiology list of five don'ts

Choosing wisely

 





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Your comments
Choosing wisely for interventionalists: Seth Bilazarian's top 5
# 1 of 4
May 10, 2012 08:27 (EDT)
Carolyn Thomas

Hello Dr. B

Thanks for this.

Re bare metal stents if unsure of patient's insurance status: besides asking patients about their insurance coverage, I'm wondering if you also provide each PCI patient take-home info about the Rx Assist programs that virtually all pharmaceutical companies offer to patients who qualify? These programs provide free meds (including Plavix) to people who otherwise cannot afford them. Here's the link:  http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=11

regards,

Carolyn Thomas

www.myheartsisters.org 

# 2 of 4
May 21, 2012 01:40 (EDT)
Todd Kerwin
In my opinion some of the points on this list seem to miss the spirit of the "choosing wisely" campaign which, per their words is designed to help doctors and pts think and talk about overuse of healthcare resources and to encourage conversations between doctors and pts about appropriate individualized treatment plans. I don't think a statement that we shouldn't send a pt home unless they are completly revascularized fits well with this mission.  I infer from your video that you feel strongly about "complete revascualrization", but this does not seem to be strongly supported by guidelines or evidence as we stand today. 
# 3 of 4
May 22, 2012 12:20 (EDT)
DrSethdb

Carolyn,

thanks for posting.  the pharma patient assitance programs are great but completely at the discretion of the company.  for instance the company that makes Ranexa discontinued the patient assistance program so patietn who had been recieving it have to stop it. if this were the case with a DES we would have an option to switch to an alternative DES but it would be an issue. 
# 4 of 4
May 22, 2012 12:24 (EDT)
DrSethdb

Todd, 

Thanks for posting.  I agree that the complete revascularization recommendation is the least defendable, but I intentionally wanted to point out that the "official" choosing wisely are all negtive.  "Don't do" a vaiety of things may be sensible but ends with a feeling of therapeutic nihilism or that the only point of the entire exercise was because of overuse or abuse.  if the latter was the point the exercise should have been called "Don't overuse" rather than Choosing Wisely. 

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.