The Changing Landscape in the Interventional WorldChris Nelson RN, RCIS, FSICPDirector, Cardiac Education & TechnologySentara Healthcare - Norfolk, VirginiaJuly 11ChrisChris, 2009

FacultyDisclosureIt is the policy of ACCME to ensure objectivity, balance, independence, and a high scientific standard of educational programs that receive accreditation.All speakers participating in these programs are expected to disclose to ACCME all potential conflicts of interest that might induce a bias in the presentation.Program faculty have disclosure financial relationships with commercial interests cited below.Chris Nelson, RN, RCIS, FSICPNo potential conflicts of interest to disclose

The Landscape:How Do We Compare?Total Spending:$7,600/person in 2007Source: United Nations Population Division, United Nations Population FundOrganization for Economic Co-operation and Development. OECD Health Data 2004

The Cost of HealthcareOne-third of US hospitals are losing money$1500 of each GM car represents the cost of health care; more than the cost of the steel to make itStarbucks spends more on healthcare than coffeeUS healthcare bill was $2.1 trillion or $7,600 per person in 2007J. Appleby, USA Today, E. Beck UPI, S. Lohr NY Times,Smith C, et al. Health Affairs 25:1, 2006: 186-196., Forbes,com

Where have all the procedures gone?PCIDx OnlyACC – Courage ReleaseESCFDA Panel110105>10% decline10010095Normalized to 100908985868075SepOctNovDecJanFebMarAprMayJunJulAugSep20062007Source: BSC Bellwether Franchises

Contributors to the decline?Healthier population: we are not our parentsMedical therapy of atherosclerosisImpact of StentingIn particular DES with its profound impact on repeat business Data from the Courage trial

Provide it and they will come Quality-BasedFeatures-BasedThe Advisory Board: Cardiovascular Roundtable Interviews & Analysis, 2007

Markets ice hospital plansChicago Business NewsThe University of Chicago Medical Center Broad pause in hiring staff; practical solution is to pause in hiring until the length and depth of the current national economic realities becomes better known -Swedish to lay off 200 workersSeattle Post-IntelligencerBudget cuts may affect thousands of health care jobsIndustry officials embrace the governor’s proposal to increase the cigarette tax to offset the reduction in Medicaid funding.Roanoke Times

Modern Healthcare ReportsExecutives at UPMC face 25% pay reductionHennipen County Medical Center, a 431-bed publicly owned hospital, said it is cutting 100 jobs through attrition and layoffs and freezing all capital projects not bound by contracts.Citing low hospital revenue and severe declines in investment returns, officials at Oregon Health and Science University and its OHSU Hospital are cutting between 500 and 1,000 job in fiscal 2009.Crozer-Keystone Health System in Springfield PA will eliminate 400 positions though it’s unclear how many employees will be laid off, said Crozer-Keystone spokeswoman Kathy Scullin.Westchester Medical Center said it would cut 400 positions including 190 jobs that will be eliminated by closing its skilled-nursing home.

The current landscape . . . .CVD effects 25% of the population and is the leading cause of death in the U.S.In 2007, the # of people with CVD reached 79.4 million……this number is expected to be north of 140 million by 2030.American Heart Association: 2006 & 2007 Heart and Stroke Statistical Update

The Outlook for ACSReduction in MI volume expected through 201190 Minutes is only a starting pointExtensive EMS CoordinationEn-route confirmation of MI and activation of CCLCollocation of CCL and EDOn-site Cardiology20-minute response requirement for on-call staffRegionally-Coordinated STEMI to become more commonPrecarious Position for Non-PCI Hospitals in era of regionalization

Endovascular TechnologiesErase Specialty BordersUp for GrabsCarotid Artery RevascularizationThoracic Aortic Aneurysm RepairAAA RepairRenal Artery RevascularizationLE Artery RevascularizationPAD: 18,000,000 – 20,000,000

The Cath Lab of the future Hollingsworth: The Emerging Combo Lab From Basic’s to Management, 2007

InstrumentsstockPerfusionPCBoom and terminalJostraEchoDialyzerKVM extenderAnestheticstockMedi-thermBowl standsAnesthesiaPower and gas supplyCartBoom and terminalMultiple Services / Multiple TalentsHollingsworth: The Emerging Combo Lab From Basic’s to Management, 2007

Possible Growth OpportunitiesAtrial fibrillation ablationAdult congenital heart diseaseAortic diseaseSurgical repair and endograftsValvular heart diseasePercutaneous aortic valve replacement and mitral value repairPeripheral arterial disease

Anybody want to take my call?Physician AssistantNurse PractitionerRegistered Nurse (CCRN, CEN)Registered Cardiovascular Invasive SpecialistRadiologic Technologist (R, CV, CI, VI)Registered Diagnostic Medical SonographerRegistered Vascular Technologist / SonographerCertified Operating Room TechnologistRespiratory TherapistPerfusionistParamedic

It’s not just about economics . . .Regulatory initiatives in pursuit of assuring quality

The Company Picnic

Look what’s going on in Oregon Is licensure in your future?HB 2245 creates licensure requirement for Medical Imaging Professionals (all specialties)This bill also allows the Oregon Board of Radiologic Technology to modernize into the Oregon Board of Medical Imaging.Changing the name of the Limited Permit Holder to the nationally recognized title of Limited X-Ray Machine Operator (LXMO).

1 Radiologist1 Public Member1 Limited Permit Holder1 Radiation Therapist4 Radiologic Technologists1 Professional Imaging or Public MemberCurrent OBRT CompositionNine Members

Medical Imaging Board CompositionAdd Specialties (Eleven Members)One RadiologistTwo Public MembersOne Limited X-ray Machine OperatorOne Radiation TherapistTwo Radiologic TechnologistsOne MRI TechnologistOne Nuclear Medicine TechnologistOne Diagnostic Medical SonographerOne licensed physician, other than a radiologist, in a specialty that routinely supervises the use of multiple diagnostic imaging modalities

Your professional societies at work. . . .Sonography Licensure Coalition:Influence Through CooperationThe American Registry for Diagnostic Medical Sonography (ARDMS)The American Society of Echocardiography (ASE)Cardiovascular Credentialing International (CCI)Society for Vascular Surgery (SVS)Society for Vascular Ultrasound (SVU)Society of Diagnostic Medical Sonography (SDMS)Society of Invasive Cardiovascular Professionals (SICP)

UpdateHouse Health Care Committee gave HB 2245 a “Do Pass” recommendation from the committee. The bill now goes to the joint House/Senate Ways and Means Committee.

Meanwhile back at the outhouse . . . . . On April 6 New Mexico Governor Bill Richardson SIGNED HB 498 "Medical Imaging and Radiation Therapy Health and Safety Act” into law!“The purpose of the Medical Imaging and Radiation Therapy Health and Safety Act is to maximize the protection practicable for the citizens of New Mexico from ionizing and non-ionizing radiation in the practice of medical imaging. This purpose is effectuated by establishing requirements for appropriate education and training of persons operating medical equipment emitting ionizing and non-ionizing radiation, establishing standards of education and training for the persons who administer medical imaging and radiation therapy procedures and providing for the appropriate examination and licensure of those persons.”NM HB 498 4/09

Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 Imaging provision of 2008 MIPPA and facility accreditation standards . . . . . . Services include x-ray, ultrasound and fluoroscopyOutlines considerations for designating accreditation organizationsDirects secretary to designate organizations to “accredit suppliers furnishing the technical component of Advanced Diagnostic Imaging Services”

Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 Secretary to develop criteria that includes:Standards for qualifications of medical personnel who are not physicians and who furnish the technical component of advanced diagnostic imaging services.

So what does this mean for you?Certification and Accreditation are on Congresses' RadarSets requirements for OP labs - no requirements for accreditation of in-patient / in-hospital labs. . . yetWhere does this leave the CARE act?Stalled in 2008 due to MIPPANew version focusing on certification, dropped educationNeeds new sponsorsSenate “not excited” about the same bill returning . . . . .

ASRT will be conducting a Virtual March on Capitol Hill the week of July 13-19Asking members of the AQMIRT to support initiative by having their members call Representatives and Senators that support of the CARE Bill in Health Care Reform can:Reduce Health Care CostsMaximize patient safetyIncrease / improve qualityEngage in Debate

Authentic LeadershipThrive by Changing the landscapeand cultivating

Core PrincipalsThe foundation of leadership is authenticitySuccessAchievementComes from withinOur being in actionCreates Value

The touchstonesKnow yourself authenticallyListen authenticallyExpress authenticallyAppreciate authenticallyServe authentically

Framework for the FutureEfficiencyRapidly diagnosing and treating while practicing resource stewardshipEfficacyExecuting evidenced-based treatments within appropriate patient populationsAccessEnsuring all populations have access to and are able to utilize appropriate treatment strategies

humilityintegrityrespectconcern for othersprofessionalism

humilityintegrityrespectleadershipconcern for othersprofessionalism