August 27, 2001 Editorial
Society of Chest Pain Centers
Recent, August 20, 2001 HCFA (CMS) Regulation on Reimbursement for observational services in Chest Pain Centers - ED to be implemented January 1, 2002.
WIN, WIN, WIN!
Win for chest pain centers
Win for HCFA, now CMS
But most importantly,
Win for heart attack patients In the United States
We would like to correct the previous bulletin implying that the Society for Chest Pain Centers and Providers won in its engagement with HCFA on the proper reimbursement for chest pain observational services. Actually we owe a great deal to of credit to HCFA regulators, especially Tom Gustafson, Paul Rudolf, MD, Catherine Ahern, Janet Sanow, Tom Marciniak, MD, Dale Burwin, MD, Kit Scally, RN, Bob Cereghino, Terry Kay, Hugh Hilt, to mention a few as well as Thomas A. Scully, CMS Chief and Tommy Thompson, Department of Health Human Services Secretary for having the wisdom to meet with us to understand the issues from both sides before coming up with the proposed Regulation for Reimbursement of chest pain observational services. The victory could not have been achieved without the collective efforts of both parties and for this we will always be appreciative.
The real Victory, however, belongs to the American public who will benefit from better heart attack care due to a shifting paradigm that places more emphasis on early care where more benefits take place (the strategy of chest pain centers throughout to provide prepared heart attack care at the community hospital level in the more than 5,000 hospitals in the United States).
With the proper reimbursement for observational services, we expect to see a renewed interest that will result in exponential growth in chest pain centers throughout the United States. The present 1,300 chest pain centers is expected to double in the next 1-2 years. It comes at a time when Guidelines for the care of patients with acute coronary syndrome are being promoted by the American College of Cardiology and the American Heart Association in an effort to close the gap that exist between the science based-evidence and the current practice in heart attack care. The Guidelines1 are similar to the ACEP Clinical Policy 2 on the subject. Together they make chest pain centers a Class I recommendation and incorporate observational services for patients with low to moderate risk of having ischemic heart disease (figure 2 - algorithm in the ACC/AHA guidelines, page 1498).
Chest pain center discussion is also present in the Bethesda Conference an Emergency Cardiac, Care (1999)3 as well as in the National Heart Alert Program Position Paper on Chest Pain Centers4
The marriage of a quality improvement initiative with a chest pain center delivery system now having proper reimbursement through CMS (HCFA) is a major step forward in our efforts to significantly impact on the mortality and morbidity seen in the heart attack problem at the grass roots community level.
Furthermore, this creative packaging may further redefine hospital care In the future by changing the landscape to a more efficient, cost effective outpatient type care that Improves patient outcomes by placing emphasis on early evaluation and treatment available at the community hospital level.
Sincerely and Respectfully, Raymond D. Bahr, MD
Society for Chest Pain Centers
We invite all hospitals developing chest pain centers as well as their emergency and cardiologist physicians to join the Society for Chest Pain Centers and Providers to further solidify our approach to the Heart Attack Problem, We expect CMS (HCFA) to monitor these chest pain centers activities. It is expected that acceptance may proceed to certification or credentialing in the future, perhaps even with ICAHO requirements. For this reason, we encourage interested parties to join the Society for Chest Pain Centers and Providers.
1 ACCA/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Mycordial Infraction: Executive Summary and Recommendations - Volume 102, No. 10 September 2000
2 Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting With Suspected Acute Myocardial Infraction or Unstable Angina - Annals of Emergency Medicine May 2001 p521-538
3 Journal of the American College of Cardiology - 31st Bethesda Conference Emergency Cardiac Care (1999) September 13-14, 1999 Volume 35, No. 4, 2000
4 National Heart Attack Alert Program Position Paper: Chest Pain Centers and Programs for the Evaluation of Acute Cardiac Ischema - Annals of Emergency Medicine May 2000, p462-471
