JACC Vol. IS. No. April
I
I-4
s
(b also decides whether a In some areas, the acemakcr is a~~ropriu~e. Conksted a physician. Aboul 10% of the cases are review42 recertified cases also are subjected lo retros~ec~ivc rcvicw. The penalty for ~~o~co~~~lia~cc is denial ofreimbursemen~ to the physician and the hospitah ivrassachusetts may not be representative of other stales. It is conservative in temperament (remember the “banned in Boston” days) and has a heavy academic influence. An applicant.
pXcmAWr ~~~~~~c~~~~~~~s per YtZibV (0W hillf Of the for 2 would ~berefore years reported by the IX icarc savings 10 $ ~2~~~ 100, reducing the total (0.2% ofthe annual cost of pacing). Thus, the review process appears 10 provide relatively little financial bcnefh. These estirn~~~e~~ however, physicians and hospitals of filing the applications probably of the same order of magnitude as th review. Those of us who live and work within t acutely aware of other costs, nuisance of collecting data from outpatienl records, rcfcrring physicians, Holler monitor reports and electrophysiolo~ic studies, not to mention the numerous and sometimes frus[rating telephone calls to uninformed or i~djffcre~~ chart
creforc, whether we a-62 *Editorials published in Snrtmrrl of !/I@ An~ri~rrr C&gc $ Ctrr;lliobg.v reflect the views of the authors and do not necessarily reprcscnl the views of JACC or the American College of Cardiology. From the Department of Surgery and the Pacemaker Center. Newark Beth Israel Medical Center. Newark, New Jersey. : Victor Parsonnet. MD. Department of Surgery. Newark Beth lsrdel Medical Center, 201 Lyons Avenue. Newark. New Jersey 07112. 01990 by the American
College of Cardiology
getting our money’s worth in ~p~~d~~~ pi,
(~xclud~~~ indirect ccrsts) on r~vi~wi~~ tions to deny only 0.4% of I there is no provaole impact only a very small leap of lo is not uue for the enlire P
1
JACC Vol. IS. No. 5 : 1093-4 April I
PARSONNET EDITORIAL COMMENT
would save US $375 million per year. Surely there are better ways to spend that money. t is cost saving all that the FROs were created
rtainly there was an interest in quality of care owever, would not the denial rate be closer .44%? Are things perhaps actually as good as e importance of establishing and maintaining ards of practice cannot be overemphasized. r the 1911 “revelations” of overusage to which idelines on indicawere published (3,4), The “revelations” r from correct, as revealed by Scherlis and othcrn in subsequent reviews, but the guidein that these criteria were then
Connecticut PRO, in which a limited number of denials was docuenented, sparked several acgry letters q~estio~i~~ the entire process (g-13) and largely echoing the sentiments of our group. It must be acknowledged that some aspects of pacing make it an easy target for outside ~riti~~srn” review is difficult because pacing is not clearly identifi either a surgical or a medical sub training and education re~omrn~~d fege of Cardiology and the America ween man~fact~l My,
excessive reliance on sales r~p~se~tat~v~s in the al create au atmosphere of mistrust. e ~ornrn~~~~tywould be better served if these issues were corrected. Instead of bei su~~~ct~d to costly contra by amateurs, pacing should be practiced by duly accredited physicians afld the
society.
professionals in cooperation with the National Board of Medical Exantiners, Thus the quantity, quality and dissemhave come into play quits on their ymrnt system based on Diagnosishas made hospital finances tight. to keep 8 watchful eye on
nsive) devices. Without
I. Falk RH. impact of prospective peer revie rates in Ma~~cbu~ett~. J Am Cull Cardiol 2. ~t~ca~~ A. Kawey PR. Ra~~~aoa E. W Resewcb Group. Washington. IX.. July 7, 1982. 3. Joint American Gllegc of ~~il~~o~y~Arnerica~ Heart Associatioa Tnsk Force on Assessment of Cardiovascular Proce s. Guidejines for permaoeat drdiac pacemaker implantation, May I J Am Coil Cardiol 1984:4:434-42. 4.
3.
erican College of Cardiology. I y training J Am Call ~a~~~1
thesda~ooference: adult catdit ~~~-~~~.
erlis L. Qembo DH. Problems in health dat permanent pacemaker experience in 1949 and I 31:131-6.
alysis: the Maryland Am J Cardiol 1983;
6. Furman S, Bilirch hi. NASPExAM. BACE 1987;10:278-80.
ivcness of the review process. One PRO the record that, in his view, precertifiand others have said that the primarily to “get the doctor.”
7. Jaffe BM. Does quality assurance assure quality? Surgical Rounds. November 1989:U-4. 8. Imperiale TF. Siegel AP, &de WB. Kamens EA. Preadmission screening of Medicare patients: the clinical impact of reimbursement disep proval. JAMA 1988;259:3418-21. 9. Rarene JE. Letter to the editor. JAMA 1988;260:2833. 10. Lavers GD. Letter to the editor. JAMA 1988;260:2833. I I. Radin AM. Letter to the editor. JAh4A 1988;260:2833. II. Gnff LJ. Radford MJ. Letter ao the editor. JAMA 1988;26&2$33-4. 13. lmperiale TF. Cnde WB. Kamens EA. Reply to letters to the editor. JAMA 1988:260:2834.
I
I-4
s
(b also decides whether a In some areas, the acemakcr is a~~ropriu~e. Conksted a physician. Aboul 10% of the cases are review42 recertified cases also are subjected lo retros~ec~ivc rcvicw. The penalty for ~~o~co~~~lia~cc is denial ofreimbursemen~ to the physician and the hospitah ivrassachusetts may not be representative of other stales. It is conservative in temperament (remember the “banned in Boston” days) and has a heavy academic influence. An applicant.
pXcmAWr ~~~~~~c~~~~~~~s per YtZibV (0W hillf Of the for 2 would ~berefore years reported by the IX icarc savings 10 $ ~2~~~ 100, reducing the total (0.2% ofthe annual cost of pacing). Thus, the review process appears 10 provide relatively little financial bcnefh. These estirn~~~e~~ however, physicians and hospitals of filing the applications probably of the same order of magnitude as th review. Those of us who live and work within t acutely aware of other costs, nuisance of collecting data from outpatienl records, rcfcrring physicians, Holler monitor reports and electrophysiolo~ic studies, not to mention the numerous and sometimes frus[rating telephone calls to uninformed or i~djffcre~~ chart
creforc, whether we a-62 *Editorials published in Snrtmrrl of !/I@ An~ri~rrr C&gc $ Ctrr;lliobg.v reflect the views of the authors and do not necessarily reprcscnl the views of JACC or the American College of Cardiology. From the Department of Surgery and the Pacemaker Center. Newark Beth Israel Medical Center. Newark, New Jersey. : Victor Parsonnet. MD. Department of Surgery. Newark Beth lsrdel Medical Center, 201 Lyons Avenue. Newark. New Jersey 07112. 01990 by the American
College of Cardiology
getting our money’s worth in ~p~~d~~~ pi,
(~xclud~~~ indirect ccrsts) on r~vi~wi~~ tions to deny only 0.4% of I there is no provaole impact only a very small leap of lo is not uue for the enlire P
1
JACC Vol. IS. No. 5 : 1093-4 April I
PARSONNET EDITORIAL COMMENT
would save US $375 million per year. Surely there are better ways to spend that money. t is cost saving all that the FROs were created
rtainly there was an interest in quality of care owever, would not the denial rate be closer .44%? Are things perhaps actually as good as e importance of establishing and maintaining ards of practice cannot be overemphasized. r the 1911 “revelations” of overusage to which idelines on indicawere published (3,4), The “revelations” r from correct, as revealed by Scherlis and othcrn in subsequent reviews, but the guidein that these criteria were then
Connecticut PRO, in which a limited number of denials was docuenented, sparked several acgry letters q~estio~i~~ the entire process (g-13) and largely echoing the sentiments of our group. It must be acknowledged that some aspects of pacing make it an easy target for outside ~riti~~srn” review is difficult because pacing is not clearly identifi either a surgical or a medical sub training and education re~omrn~~d fege of Cardiology and the America ween man~fact~l My,
excessive reliance on sales r~p~se~tat~v~s in the al create au atmosphere of mistrust. e ~ornrn~~~~tywould be better served if these issues were corrected. Instead of bei su~~~ct~d to costly contra by amateurs, pacing should be practiced by duly accredited physicians afld the
society.
professionals in cooperation with the National Board of Medical Exantiners, Thus the quantity, quality and dissemhave come into play quits on their ymrnt system based on Diagnosishas made hospital finances tight. to keep 8 watchful eye on
nsive) devices. Without
I. Falk RH. impact of prospective peer revie rates in Ma~~cbu~ett~. J Am Cull Cardiol 2. ~t~ca~~ A. Kawey PR. Ra~~~aoa E. W Resewcb Group. Washington. IX.. July 7, 1982. 3. Joint American Gllegc of ~~il~~o~y~Arnerica~ Heart Associatioa Tnsk Force on Assessment of Cardiovascular Proce s. Guidejines for permaoeat drdiac pacemaker implantation, May I J Am Coil Cardiol 1984:4:434-42. 4.
3.
erican College of Cardiology. I y training J Am Call ~a~~~1
thesda~ooference: adult catdit ~~~-~~~.
erlis L. Qembo DH. Problems in health dat permanent pacemaker experience in 1949 and I 31:131-6.
alysis: the Maryland Am J Cardiol 1983;
6. Furman S, Bilirch hi. NASPExAM. BACE 1987;10:278-80.
ivcness of the review process. One PRO the record that, in his view, precertifiand others have said that the primarily to “get the doctor.”
7. Jaffe BM. Does quality assurance assure quality? Surgical Rounds. November 1989:U-4. 8. Imperiale TF. Siegel AP, &de WB. Kamens EA. Preadmission screening of Medicare patients: the clinical impact of reimbursement disep proval. JAMA 1988;259:3418-21. 9. Rarene JE. Letter to the editor. JAMA 1988;260:2833. 10. Lavers GD. Letter to the editor. JAMA 1988;260:2833. I I. Radin AM. Letter to the editor. JAh4A 1988;260:2833. II. Gnff LJ. Radford MJ. Letter ao the editor. JAMA 1988;26&2$33-4. 13. lmperiale TF. Cnde WB. Kamens EA. Reply to letters to the editor. JAMA 1988:260:2834.
