Plenary: Economic model of HF care changing

NATIONAL HARBOR, Md. — At the Heart Failure Society of America Annual Scientific Meeting, Robert Califf, MD, emphasized the need for collaboration throughout the medical community, as well as greater physician and patient involvement in the generation of more evidence to guide clinical decisions.

“Health care decisions are best made when we have solid evidence of the benefits and risks. Without good evidence, the chance of waste and harm is substantial,” Califf, the FDA deputy commissioner for medical products and tobacco, said during the plenary session.

Califf, who was recently nominated by President Barack Obama to serve as the next commissioner of the FDA, discussed the Administration’s “huge responsibility” for protecting public health.

“We do much better if we understand what’s effective and use it appropriately,” he said. “But you’re not doing your job and I’m not doing my job – and we’ve got to step it up.” He related this to the link between the availability of information that continues to grow with technology and changing boundaries between medications, devices and software.

HF on the ‘cutting edge’ of care

“Heart failure … may be one of the areas that is on the cutting edge of this frontier in many ways,” he said. One example is the use of implanted devices. “When we don’t have evidence, the costs — and the risks to people — can be extremely substantial.”

Robert Califf

According to Califf, neither patients nor technology limit the generation of evidence. Rather, the concerns come from providers and the systems they work in.

“All of our limitations are cultural, and a lot of it has to do with our wariness about sharing information with other people,” he said during the presentation. “Patients, by and large in America, want their data used for research to advance their quality of care.”

Califf discussed a question he posed to three cardiologists prior to his presentation: What is the most important topic to impart to the audience [at HFSA 2015]? He said all three had the same response: “Please ask them to enroll patients in clinical trials.”

“I think the best way to deal with the economics of health care is to find what works and what doesn’t, and focus on what works,” he said. “The message from the FDA [is]: Participate in the generation of evidence to support decisions. We need American physicians to do a better job of participating in clinical trials and to also help us make clinical trials be the types of efforts that you and I would want to participate in.”

Changing payment landscape

Jim Field, president of research and insights for The Advisory Board, discussed numerous aspects of patient care in the setting of HF, including technological advances, collaboration, payment and future directions.

Field addressed the audience by saying, “To me, you’ve been frustrated — basically inhibited — by a payment system that doesn’t allow us to do what all of us know we should do for [patients]. But we simply cannot because the payment isn’t there, and payment is important.”

He discussed the shift from fee-for-service reimbursement to pay-for-performance metrics and the penalties imposed by CMS if certain metrics aren’t met, as well as the new system of care that this shift results in.

“When this happens, when you are free from fee-for-service, you go into patient stratification,” he said. “Today, large systems around the country are trying to create clinically, vertically integrated systems. What that means is to put three key things together: the insurance plan, the hospital business [and] the physician enterprise. You can do it through employees or a clinically integrated network.”

Field also reviewed 30-day readmission rates for patients with HF, noting a “stark difference” in the rates of 3-day and 30-day readmissions.

“After a patient leaves the hospital, 29 days into the community, these people, in a way, disappear from the hospital’s responsibility,” he said, even though the hospital, under the current payment system, is responsible for caring for these patients 30 days later.

Field concluded by remarking on the future of physician reimbursement. “Today, when every dollar counts, it’s a tremendous amount of money that’s at risk depending on pay-for-performance, and this isn’t going to go away in the future,” he said. – by Julia Ernst, MS

References:

Califf R. Plenary Session: The Economic Model of Heart Failure Care – Cardiovascular Drugs, Devices and Tobacco at the FDA.

Field J. Plenary Session: The Evolving Economics of Heart Failure Care. Both presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 26-29, 2015; National Harbor, Md.

Disclosure: Califf and Field report no relevant financial disclosures.