Fee-for-service care, recruiting and patient outcomes are some of the concerns cardiology leaders say keep them up at night.
Here, five leaders talk about their top concerns in 2023:
Gopi Dandamudi, MD. Executive Medical Director of the Center for Cardiovascular Health at Virginia Mason Franciscan Health (Tacoma, Wash.): The thing that we never anticipated, even remotely, is the whole issue of staffing. Especially in the cardiovascular realm where we need the entire team that helps us — from nursing to lab staff — across the entire continuum of care. It's by far our greatest challenge, trying to work with limited resources, and there's no constant. You can't predict a week from now what our situation will be. You really have to flex, to adapt to the changing environment, and somehow manage those patients you promised to take care of in a timely fashion.
We have been trying to reduce the burden by empowering patients to care for themselves. We use wearable devices so patients can monitor their own rhythms. We educate them on how to care for themselves so they are not immediately running to the emergency room. We are also investigating how to advance care-at-home and hospital-at-home programs across our Pacific Northwest region to keep patients out of the hospital.
Alina Joseph. Executive Director of Heart and Vascular Services at Kettering (Ohio) Health Network: Healthcare is changing significantly and I wonder, are we changing at the same rate? There is so much focus now on population health and moving from fee-for-service to more value-based care. So when and if it changes, are we going to be ready, because right now we do not get reimbursed in a way that is supportive of keeping people out of the hospital. It's this chicken and egg kind of thing of, we want to put the steps in place so that we're ready to get there, but right now, I don't know that we're fully prepared if the switch came tomorrow and we were getting paid to keep people out of the hospital. I don't know that we have the resources to do that in the way that we should. I think it's trying to stay ahead of the game while being financially viable, but not being so far ahead of the game that we're not playing the game right.
Meera Kondapaneni, MD. Chief of Cardiology at MetroHealth (Cleveland): It's the gaps in the care. I work at a safety-net hospital and we see patients in all spectrums of socioeconomic status. These patients expect us to help them and sometimes you're limited by money. There is this drug that we know is extremely beneficial now with heart failure patients and it is extremely expensive. The deductible is so high that a lot of the time, patients cannot afford them even having Medicare and Medicaid. Even some patients with private insurance can't afford a $600 drug every month. It really bothers me when I have to have these conversations with patients. I can't sleep because we have so much, and there's so much waste of everything, yet we still have people who cannot afford treatments. On the bright side, we have a motivated team and financial counselors who can aid patients to get them treatment they need even without insurance. The fact that I'm in a system where I'm able to do my part to help these patients helps me wake up in the morning.
Mitchell Weinberg, MD. Chair of the Department of Cardiology at Staten Island University Hospital (New York City): The most important element within the cardiology department is the talent of the people, so what keeps me up at night is my ability to recruit great people, retain them and keep them working together. Doing those three things will keep us successful, and that's what I think about most as a leader.
Jonathan Weinsaft, MD. Chief of Cardiology at Weill Cornell Medicine and NewYork-Presbyterian (New York City): Despite advances in therapeutics, despite advances in our understanding of cardiovascular physiology and cardiovascular disease, we continue to have a substantial number of people in New York City and nationwide who have devastating cardiovascular events. We have to do better. We have to do better and identify at-risk populations. We have to do better once we identify those patients, and then we have to do better in delivering innovative and state-of-the-art care to those communities. I think that's absolutely critical, and there's a gap in where we are and where we need to be.