Cutting budgets and healthcare spending are high priorities with many policymakers, but an unexpected success in fighting heart failure raises questions about what saves more: holding down budgets or providing the right treatment.
Watch what you cut
Preventive campaigns, care coordination making impact on heart disease
A recent major study showed hospitalization for heart failure dropped nearly 30% for Medicare patients. As a result of the improvement, the Medicare program saved about
$4.1 billion in hospital costs related to heart failure, according to the study.
Cardiologists and cardiac surgeons afterward indicated they had been noticing fewer heart-failure patients, but no one expected such a large and dramatic turn.
What has worked? The answer, I believe, is our nation's aggressive assault on heart disease for many years by coordinating care through different categories of treatment. These categories or legs of treatment are widespread efforts at preventing heart disease, improving routine care and disease management, and research leading to astonishing advancements in interventional cardiac care.
The study is based on data from more than 55 million patients in Medicare's conventional fee-for-service program who were hospitalized for heart failure between 1998 and 2008. As reported in the Oct. 19 Journal of the American Medical Association, 229,000 fewer people were admitted to hospitals for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels.
Clearly, despite some major obstacles, medicine is having a major impact on heart disease. This happened even though obesity and diabetes, both risk factors for heart failure, are increasing and claiming more American lives. Because the study measures the Medicare population, which is 65 and older, it may not capture the impacts of obesity, which have been severe on younger adults.
Heart failure is when the heart is losing its ability to pump blood throughout the body. But prevention, routine care and interventional measures attack heart disease at different stages, creating a body of medical treatment that continues to improve while it helps patients delay or prevent heart failure from happening.
One of the greatest successes has been preventive campaigns to change behavior of patients now to improve their health later. Smoking rates among adults continue to fall, according to the Centers for Disease Control and Prevention. For years, smoking has been one of the leading risk factors for heart disease. High cholesterol, another leading cause, is being controlled through medication in millions of adults.
Through greater understanding of heart failure, doctors are able to teach patients what to look for and how to monitor the warning signs. Many patients weigh themselves twice a day and strictly monitor blood pressure. A change one way or the other indicates how medication should be adjusted to optimally manage heart failure.
Through reforms initiated by the federal government and commercial insurers, primary-care doctors, specialists and other clinicians communicate with each other to coordinate the care of individual patients.
Pioneering work in medical research is another key factor. Our advances in minimally invasive surgeries such as valve replacement, drug eluting stents, and implanted devices such as defibrillators have allowed doctors to fix hearts and keep them functioning optimally.
These three legs of treatment have given elder Americans a level of intervention more complex than ever before. They were developed through rigorous research and proven in our most advanced medical institutions.
As Congress looks to trim budgets and deficits, a task made harder by the inability of the supercommittee to find common budgetary ground, this is important to remember: There are wise ways and there are foolish ways to save money in healthcare. Wisdom calls for everyone to pitch in.
Hospitals must learn to be ever more efficient, to pull costs out of service while maintaining superb quality. Care must be coordinated across multiple settings to avoid redundant tests and procedures. Insurance companies and government payers must standardize their claims to save administrative costs by allowing doctors and hospitals to fill out a single form. Courts need to rein in frivolous malpractice lawsuits that drain billions of dollars from the health system. Wise savings are achievable.
It would be foolish indeed to save money from the very programs and treatments that lead to better health and reduced utilization of service. The reduction in hospitalizations for heart failure will clearly lead to great savings and improved health for older people.
Our wise investment in public education, treatment and research has paid off handsomely. Cutting it doesn't make sense.
Of course, there is more to be done. Americans need to eat better and exercise more. We need to prevent and better control diabetes. Too many people still smoke. Public policy and government support need to increase protocols that help doctors coordinate care, including greater access to information technology.
What we have done has shown us how to move forward to combat disease and manage costs. Investing in preventive health campaigns, routine care and research is now a proven model to improve health for large populations.
Prevention, routine care and advanced procedures: To save lives and save money, all three must be in place to create a full spectrum of care.
Dr. Steven Corwin, a cardiologist, is CEO of New York-Presbyterian Hospital.
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