SCAI’s Hildner Lecture Takes on Tough Issues: Appropriateness, Cost and Quality

Dr. Ralph Brindis Calls for Self-Reflection, Careful Examination of Clinical Practice

LAS VEGAS (May 11, 2012) — Interventional cardiology is in the spotlight these days — some might even say it’s under attack — as an economic vise tightens around healthcare spending. In a keynote Hildner Lecture at the SCAI 2012 Scientific Sessions, and in a town hall-style meeting slated to follow, Ralph Brindis, MD, MPH, FSCAI, made the case for self-reflection as a critically important response to this scrutiny.

SCAI 2012 Program Co-director Kenneth Rosenfield, MD, FSCAI, said, “Dr. Brindis will challenge each of us to engage in self-reflection, to ask ourselves if we are doing the right things, using healthcare resources wisely and being totally transparent.”

Dr. Brindis, a senior advisor for cardiovascular disease for Northern California Kaiser Permanente in Oakland, CA, and past president of the American College of Cardiology (ACC), believes that all interventional cardiologists should examine what they’re doing and make sure they’re practicing true evidence-based medicine.

“We need to ask ourselves, ‘Am I a knight, or am I a knave, or a pawn? How am I as a clinician?’” he said.

Knights put patient values first, Dr. Brindis said. They are wise guardians of limited resources and respected advisors when determining the public good. Their treatments are based on the latest scientific evidence. Knaves, on the other hand, make clinical decisions with personal financial gain and self-promotion in mind. Pawns respond to external forces such as licensing requirements and insurance guidelines, rather than to an internal drive for professional excellence and high-quality care.

“Ninety-nine percent of people who go into medicine truly are interested in helping others, and view themselves as knights,” Dr. Brindis said. “But we still need to re-examine how we’re practicing. Are we true knights or, on personal reflection, are there opportunities for improvement? Is there a smidgen of a knave or a pawn in the ways we act?”

As individuals and as a profession, interventional cardiologists can take several steps to make sure patients always come first, Dr. Brindis said. They include the following:

• Take advantage of SCAI quality improvement tools, appropriate use criteria and appropriateness scores, which are now available through the ACC-National Cardiovascular Data Registry CathPCI Registry. Submit accurate data to registries and actively participate in the evaluation of clinical practice, to find opportunities for improvement.

• Set up a system of oversight to confirm the appropriateness of angioplasty and stenting.
Actively participate in developing new methods of physician payment based on what’s best for patients, not on procedure volume.

• Participate in public reporting initiatives and use public data to inform and educate patients.

• Participate in the development of meaningful outcomes measurements by actively collecting outcomes and cost data, evaluating the impact of the newly developed measures and readjusting these metrics if the evidence does not validate their original promise.

“As professionals, we are the ones best suited to evaluate our practices and determine what is appropriate clinical care and what is not,” Dr. Brindis said. “We cannot afford to abdicate our responsibility or withdraw our considerable expertise in shaping this science.”

Dr. Brindis reports no potential conflicts of interest.

About SCAI
Headquartered in Washington, D.C., the Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's patient education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit www.scai.org [1] or www.SecondsCount.org [2] .