The Changing Field of EP: Your Thoughts on Current Issues in EP

How long has your lab been participating in the ACC-NCDR ICD Registry? What are your thoughts on using the registry? Is it easy to use? At Lancaster General, EP has been using the ACC ICD registry/database since April 2006. Prior to that, LGH was submitting data to QNet. Submission volume for 2005 was 64 cases based on primary prevention criteria. We have submitted 192 cases so far in 2006 (through September 2006). As to the user-friendliness of the form, it is labor-intensive to complete manually, as it is three pages. Average time to complete is about 45 minutes, and then the data must be inputted into the registry for submission, requiring about another 15 minutes per patient. Obviously, the more forms completed, the more familiar you become with the process. The person responsible for actually completing the forms should be a clinical staff member who can navigate through some very complex patient charts to uncover the data needed. A tip we found out early: the form must be totally complete or it will be denied by the ACC. Some feedback related to data entry: Adverse events only need to be filled in if they apply. If adverse events = No, the computer skips past that entire section. Likewise, discharge medications can be set to No, which autofills all fields for individual meds with a No, and then the user can change individual meds to Yes (while the other answers remain No). The Data Quality Report is generated at the end of each quarter to tell you about your deficiencies. There are unique identifiers for each patient assigned to the ACC-NCDR. So, the user must print the list, go into the data entry screen, and fill in the unique patient ID (one at a time) to see the patients' name. This apparently cannot be done with all the names at once due to some HIPAA concerns. In addition, each hospital cannot run their own data or really report anything using the data. We will get canned/prepared reports sent to us. However, it will be interesting to see how informative they are at the individual hospital level. Andrea M. Hostetter, BS, RN, Director, Electrophysiology & Pacing Services, Lancaster General Hospital, Lancaster, PA We have been involved with the ACC-NCDR ICD Registry for about two years. I believe the registry might prove useful in terms of gathering information relating to the type of patients receiving ICDs, the types of ICDs they receive (e.g., proportion of CRT-D devices), and possibly patient outcome. However, the registry does have some limitations; for example, it's not very user-friendly, and not every center may be as diligent in entering/submitting the proper data. Luis A. Pires, MD, Director, Heart Rhythm Center, St. John Hospital & Medical Center, Detroit, MI I had to collaborate with a few peers to get some details, as I don't personally input the information to the ACC-NCDR ICD Registry. My main responsibility is to make sure that the physicians have the most recent forms to fill out, and then those forms get sent to our medical records department. The forms are then collated and picked up by our quality department for data input. We have been participating since 2004, first with standalone software, and then with the ACC ICD web tool. According to Frank from our quality department, the tool is easy to use if the form is filled out thoroughly. There is a large amount of data that has to be manually transcribed, and the validation process is onerous. It requires diligence in having the MDs (we have two electrophysiologist) fill all the data on the forms. Sometimes the MD doesn't think the information pertains to his patient and omits some data entry info. Then there are the follow-up phone calls to retrieve the information to complete the forms. The one frustration from Frank is that CMS is holding us accountable for the MD's responsibility. Another issue that Frank feels is a problem is the requirement for facility information that the ACC keeps updating. However, we here at Eisenhower Medical Center will continue to follow the mandatory requirements of CMS. Sharon L. Duncan, RN, CPAN, Clinical Supervisor EP Lab, Eisenhower Medical Center, Rancho Mirage, CA What are your thoughts on the Tax Relief and Health Care Act as well as the U.S. 2008 proposed national budget, which calls for decreased funding for Medicare payments to physicians and research through the NIH? How has your lab been affected by these tax and/or Medicare cuts? The EP lab has not been impacted so far from a volume perspective. Our volumes are actually about 5% above last year, and we are projecting about the same increase for next year. We have a large Medicare population, and that population is growing and aging. As the baby boomers start to reach Medicare age, our volumes will continue to increase. Increasing costs, shrinking reimbursements, and an aging population are consistent themes in our conversations and planning. We are very mindful of securing value-added items for our cases. We spend time in organized meetings talking about physician/hospital alignment on contracts and product/device utilization. It is a challenge to provide some of the latest life-saving technology, especially in light of expanded indications for ICDs in the face of shrinking reimbursement for providing that care. The hospital and physicians practicing in this lab have built consensus to go with a primary device vendor, and have received aggressive price reductions/rebates for doing so. Keeping expenses down is a primary goal each year. We are very seasoned at looking for ways to reduce cost/expenses; that is an everyday way of life at this facility. However, not at the expense of quality, the two go hand in hand. Having physicians and hospitals being paid under different practices puts us at odds. Many times what is good for one is not so good for the other. Vendors get paid for their product. Until there is some initiative that puts us all on the same playing field, there is inequity in the system for the physicians and hospitals. We are also involved in several NIH studies. From what I am told, it is extremely difficult interacting with them now because of the perceived bureaucracy related to the paperwork with new studies. We actually have one study that was approved a year ago, but we have not started because we have not received the final approval from the NIH.   Andrea M. Hostetter, BS, RN Any legislative proposal that results in further payment cuts to physicians, hospitals and research entities (such as the NIH) is always a big concern for me and, I suspect, other health care professionals. Such cuts often impact patients directly: innovations in state-of-the-art that is, evidence-based medicine require the proper level of expenditure. Luis A. Pires, MD One company recently launched a national advertising campaign to raise awareness of sudden cardiac arrest and ICDs. What do you think of medical advertising? Do you think it will help increase patient awareness? Have you already noticed a difference in your patients' awareness of SCA and ICDs? The public awareness campaign for devices is actually late to the market pharmaceutical companies have been direct marketing to patients for years. Everyone knows about the purple pill. Patients are very savvy; they have Internet capability and will go online and find out about their conditions and options. When the consumers (for the most part) are better educated, outcomes can be better. Public education and awareness can save lives. Even though we have spent years educating about the signs and symptoms of heart attack and calling 911, there are still cases where people don't know what to do. Also with research, patients are surviving other diseases and living long enough to develop cardiovascular disease, specifically CHF. People want to know what their options are. Sometimes their hospital or physician may not have access to the latest technology or procedures for their condition. Actually, I had a speaking engagement at a local long-term cardiology facility, in their independent living section. I showed the ads, and people were very interested and asked questions. They were not negative in any way. In fact, they wanted more information and wanted to know where to get it. Andrea M. Hostetter, BS, RN Sudden cardiac death (SCD) remains a major public health issue despite considerable improvement in how we treat patients with heart disease. Therefore, the Medtronic initiative (the TV version is tastefully done) is welcome and might prove very useful in combating the threat of SCD. ICDs are very effective, and every effort should be made to identify the right patients who might benefit from such therapy. Luis A. Pires, MD I am supportive of any education we can get out to the general public to raise awareness of a possibly fatal yet treatable situation. Of course, my concern is if the companies' sales ploys are to increase business. I would like to see the advertising campaigns be generic or open-ended, with the conclusion impact statement to be, please talk with your physician about the rest of your life. Sharon L. Duncan, RN, CPAN