Adapting to a Changing Health Care Environment

Adapting to a Changing Health Care Environment

JACC: CARDIOVASCULAR IMAGING VOL. 7, NO. 8, 2014 ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X/$36.00 PUBLISHED BY ELSEVI...

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JACC: CARDIOVASCULAR IMAGING

VOL. 7, NO. 8, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-878X/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jcmg.2014.07.001

IMAGING COUNCIL CHAIRMAN’S PAGE

Adapting to a Changing Health Care Environment Prem Soman, MD, PHD

I

feel very honored and privileged to assume the

show a direct relationship between the outcome

chairmanship of the American College of Cardiol-

measure of mortality and the use of cardiac imaging

ogy Imaging Council (ACC), and would like to

tests. But the concept of mortality as a “hard” event

congratulate Dr. Neil Weissman on a job superbly

is based primarily on statistical convenience rather

done last year!

than clinical relevance, especially in an aging

The Cardiovascular Imaging Section of the ACC was formed in 2011 and is one of its largest (3,800

population. Alternative and more creative measures must be devised for proving value-based imaging.

members as of May 31, 2014), the fastest growing

In this context, the promotion of appropriate

(110% growth since 2012), and certainly the most

use will be important for the continued relevance of

diverse given its structure, comprising the imaging

imaging to clinical care. A recent analysis revealed

subspecialties. In a rapidly changing health care

a marked reduction over the past 2 decades in

environment the section and under its mandate,

the proportion of single-photon emission computed

the Imaging Council have a critical role in re-

tomographic myocardial perfusion imaging results

evaluating the structure and delivery of cardiovas-

that are abnormal, decreasing from 40.9% in 1991

cular imaging services to ensure the continued

to just 8.7% in 2009 (2). Although some percent of

relevance of imaging to the care of patients with

test normality is consistent with the “gatekeeper”

heart disease.

philosophy of noninvasive testing, these data suggest

Central to this question is the perception of value.

that lower risk populations are increasingly being

There are strong indications of impending changes in

tested. In addition to inviting regulatory scrutiny and

the paradigm of health care delivery in this country

reimbursement cuts, inappropriate use also adversely

that make it highly likely that more emphasis will

affects the performance characteristics of imaging

be placed in the future on value-based utilization

tests (3).

than incentive for quantity. Such a change could

There are also changes in the internal milieu of the

empower physicians, who are the best positioned

field of cardiac imaging that merit mention. It is now

party to devise cost-effective management strategies

no longer the exception that trainees finish cardiol-

that are also safe and expedient. However, in an

ogy fellowships with some degree of experience in

environment of accountable care, imaging labora-

multiple imaging modalities. A working knowledge

tories will be “cost centers” rather than “revenue

of the strengths and weaknesses of all modalities is

centers,” and the demonstration of cost-effectiveness

central to the concept of the “imaging consultant,”

and a positive impact on patient outcome will dictate

who will be charged with devising imaging strategies

utilization. The value of imaging to the care of pa-

to answer specific questions posed by the referring

tients with heart disease should be self-evident,

physician. How then does one define the multimo-

given that few clinical episodes of cardiac care are

dality imaging expert? If indeed, one were to define

devoid of an imaging component. But formal explo-

level 3 expertise on the basis of a philosophy of being

rations of factors contributing to the cardiovascular

able to lead an academic laboratory, is the goal of

health of the nation have failed to define the role

acquiring and maintaining advanced expertise in all 4

of imaging (1). Traditionally, it has been difficult to

imaging modalities even realistic? How does one advocate a balance between breadth of knowledge and the focus required to drive innovation in the in-

From the Division of Cardiology, University of Pittsburgh Medical Center,

dividual imaging subspecialties? These are some of

Pittsburgh, Pennsylvania.

the questions that will be addressed in the “Future of

Soman

JACC: CARDIOVASCULAR IMAGING, VOL. 7, NO. 8, 2014 AUGUST 2014:854–5

Imaging Council Chairman’s Page

CV Imaging” initiative of the Imaging Section, being

such as “Imaging Cardiologist” or “Cardiologist

led by Drs. Meryl Cohen and Pamela Douglas.

Imager.”

And finally, on a lighter note, I wonder whether

I look forward to a dialogue in the months to come

we should rethink our designation as “noninvasive”

with the imaging community on several of these is-

cardiologists. It is, I think, a term that defines us by

sues. With the mandate of the Cardiovascular Imag-

what we don’t do. Perhaps it is time to re-establish

ing Section, the Imaging Council will strive for the

our identity more specifically with a designation

continued relevance and vibrancy of the field.

REFERENCES 1. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease 1980-2000. N Engl J Med 2007;356:

2. Rozanski A, Gransar H, Hayes SW, et al. Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing1991 to

3. Doukky R, Hayes K, Frogge N, et al. Impact of appropriate use on the prognostic value of singlephoton emission computed tomography myocardial

2388–98.

2009. J Am Coll Cardiol 2013;61:1054–65.

perfusion imaging. Circulation 2013;128:1634–43.

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