Industry players would like to have a say in how reform unfolds, as the American Medical Association demonstrated last week with its vote to endorse a physician-led framework for team-based clinical care.
But today's launch of a new alliance of hospitals and health systems targeting improved care for atrial fibrillation, also relying on a team approach, may better demonstrate how grassroots efforts could in total have a bigger, more immediate impact.
The alliance of five health systems and one patient advocacy group aims to raise the level of care for afib, as the irregular heartbeat condition is known, and then ensure that that quality is maintained.
Afib is one of those conditions in which the treatment can vary widely depending on the severity, says Jonathan Philpott, M.D., president of the alliance, called the National Alliance of Integrated AFib Centers. Meanwhile, incidence of the condition was expected to rise to 2.6 million cases in 2030 from 1.2 million in 2010, according to a 2013 study in the American Journal of Cardiology. "It's the number one cardiac diagnosis in the United States," Philpott says.
But Philpott says that in his experience patients were unaware of all the options available and their physicians were not always making them available.
In addition, one type of heart specialist may be an expert in, say, catheter ablation, but not in the other surgical and hybrid procedures. That specialist might be more inclined to recommend the procedure that he or she can do, he says.
As a result, a lack of information about which treatment is appropriate for a given patient combined with a lack of competency in all three of the major forms of treatment translates into too many patients getting inappropriate care, Philpott says.
The alliance members hope to raise the level of care by meeting specific clinical benchmarks and eventually becoming "centers of excellence" in afib care, Philpott says. In support of that, members must be transparent about their care and outcomes that if not up to snuff will lead to them leaving the alliance, he says.
Philpott, who has afib, is a cardiothoracic surgeon at Sentara Heart Hospital, in Norfolk, Va., one of the six founding members. The others are: Cedars-Sinai Heart Institute, Los Angeles, Orlando (Fla.) Health Heart Institute, St. Helena Arrhythmia Center, Napa Valley, Calif., St. Vincent's Medical Center, Bridgeport, Conn., and the patient advocacy group StopAfib.org.
The founders would like to see membership grow significantly, which would raise the level of awareness about and the quality of care for afib.
There are other hospitals and health systems working together to improve quality, such as those participating in hospital engagement networks, and their efforts may lead to similarly exciting innovations in care.
Endorsements like the AMA's are an inevitable part of the jockeying that takes place in the health care reform process. But self-propelled groups like the NAIAC are not always expected, which makes such efforts all the more interesting.