Cardiology in a Time of Change: A Viewpoint from the Front Lines


Dr. Matthew T. Bramlet Physicians are some of the most “burned out” professionals in the country, with 46 percent of cardiologists reporting that they suffer from burnout. Changes in reimbursement, physician shortages and other changes in healthcare are affecting cardiology departments around the country.

In this Q&A, Matthew T. Bramlet, M.D., a pediatric cardiologist and assistant professor of pediatrics at the University of Illinois College of Medicine at Peoria, shares his viewpoint from the front lines of cardiology. He discusses cardiology trends, challenges and changes he’d like to see that support care improvements in this era of change.

Q: What are the biggest trends in healthcare that you see affecting cardiology departments?

A: The biggest change we’re navigating is a continual push for expecting more with less. We’re being held accountable for reimbursement at new standards that can be difficult to attain if you’re not an expert in coding and billing. It’s a difficult topic.

The care we provide to patients today is no different than a year ago from motivation and delivery of care. However, every year the reimbursement for that same care is more stringent as far as documenting for this or that component. It’s more difficult to have a sustainable practice because of stringent regulations.

This is a big opportunity for companies that offer structured reporting. We need the ability to view built-in mechanisms or fields that can be calculated with algorithms that identify and stratify patient disease. The trick a clinician has is maintaining quality of care without falling into the trap of the cookbook; I want to take care of the patient but there’s such emphasis on how I code and identify care. If I’m not following guidelines my care may not meet specific criteria. How we put medical diagnoses into categories that are complex and rigid in structure and still fit the understanding of the clinician into this tool is challenging.

Some physicians resent having to become an expert in coding and billing. At the end of the day you ask, “Is this for the betterment of the patient?” It’s hard to remain engaged if you feel as though you’re crossing t’s and dotting i’s because you just have to.

Q: What tools are you finding helpful as you navigate regulations that require more stringent documentation?

A: Initiatives from the government are asking us to make more universal and current the system of how we report patient information, which will dramatically change as we try to improve the care we’re delivering that requires more data.

The McKesson Cardiology™ echocardiography reporting tool gets me through a report efficiently and provides tools for the longitudinal tracking of data. Take an aortic root dilation – the echo tool can plot it on a graph and score it over time, which is especially critical in my pediatric patients. Longitudinal assessment is built into the system to track data points over time. It may be predictive of slow progression, so where there are no major changes for three years it helps me determine how often to order a study. If the data predicts after a certain rate the speed will increase, then I’m going to monitor more closely. The ability of the tool to pull data right in front of you and integrate it into algorithms for the future is where the potential is greatest.

Q: What tools do you predict will become needed as cardiology departments collect vast amounts of data?

A: Currently the only data that anyone looks at is information that is published. Tools that can take data from one region, compile it from all users, and create a database that then uses that to guide and transform practices – that’s where the true opportunity lies. If you can analyze that data in an efficient manner, that’s how you’ll have a physician go, “Oh, OK, that’s not what I expected.” Studies demonstrate there’s value in regional practice and tracking normal values within a system. If I track normal echoes on pediatric patients and all of those parameters go into a unique database, after two years’ time I have an enormous database of normal values.

The trend in science and technology is to gather more data and disseminate and integrate it with new ways and crowdsourcing. In healthcare we’re lagging behind in sharing information and need to speak to that and how to overcome barriers of sharing information across all borders.

Q: What benefits are you experiencing from today’s cardiology solutions?

A: Today we have the ability to efficiently interpret a study longitudinally. If I look at a single number for an aortic root dilation and see a change of 3.5 to 5 centimeters in a year that’s going to be worrisome. But if I can look at the z score and it hasn’t changed because my patient grew a foot during puberty, that provides me with a different perspective on that data, and that’s what allows tor transformations in how you care for patients.

Q: What type of “practice changing initiatives” do you see departments undergoing?

A: We’re all trying to get a good handle on quality metrics. Nobody wants to be focused on checking boxes. But we can engage physicians if we provide evidence about trending data, live, with information compiled from different regions and that helps us change on the fly in a fluid manner. And that’s all about managing good data.

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