Abstract
Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care. However, applying a national standard of value for any treatment is challenging, since value varies from person to person, and the individual benefit must remain the central tenet for delivering best patient-centered medical care. Regardless of the specific operational features of the rapidly changing healthcare environment, physicians must first and foremost always remain patient advocates.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McKinsey. Accounting for the cost of US healthcare, 2011, Centers for American Progress.
McDonough JE, Inside National Health Reform. California Milbank books on health and the public. Berkeley and Los Angeles California: University of California Press; 2011.
Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306(1):53–61.
Ko DT, Guo H, Wijeysundera HC, Natarajan MK, Nagpal AD, Feindel CM, et al. Cardiac Care Network (CCN) of Ontario Variations in Revascularization Practice in Ontario (VRPO) Working Group. Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012;60(19):1876–84.
Cutler DM, Ghosh K. The potential for cost savings through bundled episode payments. N Engl J Med. 2012;366:1075–7.
Berwick DM. Launching accountable care organizations—the proposed rule for the Medicare Shared Savings Program. N Engl J Med. 2011;364, e32.
Nutting PA, Miller WL, Crabtree BF, Jaen CR, Stewart EE, Stange KC. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009;7:254–60.
Anderson JL, Heidenreich PA, Barnett PG, Creager MA, Fonarow GC, Gibbons RJ, et al. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(21):2304–22.
Kohn CG, Parker MW, Limone BL, Coleman CI. Cost-effectiveness of ranolazine added to standard-of-care treatment in patients with chronic stable angina pectoris. Am J Cardiol. 2014;113(8):1306–11.
Lee CP, Chertow GM, Zenios SA. An empiric estimate of the value of life: updating the renal dialysis cost-effectiveness standard. Value Health. 2009;12(1):80–7.
Goldberg A, Menen M, Mickelsen S, MacIndoe C, Binder M, Nawman R, et al. Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources. J Interv Card Electrophysiol. 2003;8(1):59–64.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf. Accessed January 2016.
http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html#. Accessed January 2016
https://www.bcg.com/documents/file64538.pdf. Accessed 2015
Weintraub WS, Karlsberg RP, Tcheng JE, Boris JR, Buxton AE, Dove JT, et al. ACCF/AHA 2011 key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards. J Am Coll Cardiol. 2011;58(2):202–22.
Masoudi FA, Ponirakis A, Yeh RW, Maddox TM, Beachy J, Casale PN, et al. Cardiovascular care facts: a report from the national cardiovascular data registry: 2011. J Am Coll Cardiol. 2013;62(21):1931–47.
Pham HH, Schrag D, O’Malley AS, Wu B, Bach PB. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356:11309.
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-08-25.html. Accessed November 2015.
http://www.beckershospitalreview.com/accountable-care-organizations/how-will-acos-grow-over-time.html. Accessed January 2016.
Pham HH, O’Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians’ links to other physicians through Medicare patients: the scope of coordination. Ann Intern Med. 2009;150:236–42.
Ito K, Avorn J, Shrank WH, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes. 2015;8:252–9.
Puri P, Carroll J, Patterson B. Cost savings associated with implementation of peer-reviewed appropriate use criteria for percutaneous coronary interventions. Am J Cardiol. 2016;117:1289–93.
Miller G, Hughes-Cromwick P, Roehrig C. National spending on cardiovascular disease, 1996–2008. J Am Coll Cardiol. 2011;58(19):2017–9.
Long EF, Swain GW, Mangi AA. Comparative survival and cost-effectiveness of advanced therapies for end-stage heart failure. Circ Heart Fail. 2014;7(3):470–8.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2015 Dec 16
Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57(2):160–6.
Chan PS, Vijan S, Morady F, Oral H. Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2006;47(12):2513–20.
Jenkins LS, Brodsky M, Schron E, Chung M, Rocco Jr T, Lader E, et al. Quality of life in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149(1):112–20.
Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA, et al. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006;114(2):135–42.
Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, et al. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. Heart Rhythm. 2014;11(7):1271–303.
Sanders GD, Kong MH, Al-Khatib SM, Peterson ED. Cost-effectiveness of implantable cardioverter defibrillators in patients greater than or equal to 65 years of age. Am Heart J. 2010;160(1):122–31.
Epstein AE, DiMarco JP, Ellenbogen KA, Estes 3rd NA, Freedman RA, Gettes LS, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013;127(3):e283–352.
Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(24):e783–831.
You JJ, Woo A, Ko DT, Cameron DA, Mihailovic A, Krahn M. Life expectancy gains and cost-effectiveness of implantable cardioverter/defibrillators for the primary prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy. Am Heart J. 2007;154(5):899–907.
Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007;298(4):405–12. Erratum in: JAMA. 2007 Oct 3;298(13):1516.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ray, J.C., Kusumoto, F. The transition to value-based care. J Interv Card Electrophysiol 47, 61–68 (2016). https://doi.org/10.1007/s10840-016-0166-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-016-0166-x