April 22, 2009

Evidence-based incentives key to reform

U.S. healthcare reform should start with paying evidence-based financial incentives to doctors, two cardiologists recommend in a commentary.

Dr. George Diamond, a senior research scientist emeritus of Cedars-Sinai Medical Center in Los Angeles and Dr. Sanjay Kaul, director of the Cardiology Fellowship Training Program and at the Cedars-Sinai Heart Institute wrote that healthcare reform should start with evidence-based reimbursement -- structuring physician payment incentives around existing empirical evidence of clinical benefit -- which would improve quality and reduce the cost of healthcare.

For example, about 500,000 U.S. patients suffering from mild chest pain due to coronary artery disease undergo balloon angioplasty or percutaneous coronary intervention every year, costing about $20,000 per patient, for a total expenditure of $10 billion a year.

However, empirical studies document that 10 percent to 20 percent of percutaneous coronary intervention patients are asymptomatic, only 50 percent have undergone a stress test to determine the severity of their disease and as many as 30 percent aren't taking prescription heart medications that, for patients with mild coronary artery disease, could be just as effective.

The commentary is published in the journal Circulation: Cardiovascular Quality and Outcomes.