Dalai Lama said, “Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them”

What is being proposed WILL HURT THEM (the entire healthcare system – patients, doctors, hospitals, ERs, families, community, country – EVERYONE).

Please do not allow them to be hurt – you have that power!!

Be the change you want to see – Gandhi

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What is atrial fibrillation and its complications if untreated?

It is the commonest irregular heart rhythm that affects about 6 million Americans. If not treated it can cause stroke, heart failure, failure to thrive, frequent hospitalizations, cardiac arrest, and death. This condition results in 750,000 hospitalizations per year and 150,000 yearly deaths.

How is atrial fibrillation best treated?

For majority patients, the ideal most curative treatment is catheter ablation. This is a minimally invasive surgical technique, requiring 1 night’s stay in the hospital for observation. Follow the procedure, the patient is followed annually and maintained on a minimum number of medications.

Case Example:

Patient RR an active retired patient developed atrial fibrillation. Immediately he felt low energy, constant fatigue, became socially distant, developed congestive heart failure (difficulty breathing, swelling of his feet and legs). His decline was precipitous. He saw his general cardiologist weekly, blood tests were being done frequently, his veins and arms were bruised and painful, he was placed on a host of medications, he lost his appetite, he felt faint all the time, his blood pressure would drop and kidney failure developed. He could not lie flat, he needed oxygen and a hospital bed at home. The heart failure hormone, BNP rose to above 3000, normal being less than 100. The medication used to regulate his heart rhythm slowed his heart rate down and he required a permanent pacemaker. In 4 months, he had 4 hospital admissions, frequent 911 calls, falls leading to bruising and bleeding because he was on a blood thinner; his wife, had to take off work very often, her job was at stake. It was a mess!! He was declining rapidly; there was pain, suffering, increased health expenses (for him and his insurance company), not all medications were covered by his plan. He had become a burden to himself, his family, his friends, his insurance, overcrowded ERs and busy doctor’s office – ALL THIS BECAUSE HIS HEART WAS OUT OF RHYTHM.

The patient finally underwent atrial fibrillation ablation and normal rhythm was restored. In less that a month, he was up and about, seeing his cardiologist once in 3-6 months, the BNP (heart hormone) went from 3000 to 58; number of medications were reduced; he was living again and the wife was able to go back to work; he has not had any 911 calls or visits to the ER. His only question was, “Doc, why didn’t you do this sooner?”

Yes, why?

If it helped RR, could it help others? What is the impact of Atrial fibrillation ablation globally?

Published scientific studies have proven that these procedures improve quality of life (100%), reduce the need for medications (70%), cardioversions (83%), and decrease in hospitalizations (84%) leading to significant cost savings and saved lives.

What is the costs difference between conventional medical therapy (band aiding the problem) versus cure with ablation?

For a single patient: The recurring annual cost of managing atrial fibrillation is an average of $66,800 to $135,450 (rhythm drugs: $4800 + blood thinners: $5000 + cardioversions: $7000 + hospitalizations: $50,000), so over 20 years it would over $2 million (excluding the treatment of the complications of atrial fibrillation).

To the nation it would mean $6 billion dollar/year in health costs.

 

Who does these procedures and has everyone access to this cure?

A fraction of the electrophysiologists (super specialized cardiologists) with over 12 years of medical training are qualified to do this extremely skilled, intellectually challenging and physically demanding procedure. One in 10 atrial fibrillation patients are able to obtain access to the 2200 trained specialists countrywide. There is an extreme shortage.

 

How much does an EP doctor charge for this life improving and saving procedure?

Yes, you read correctly $1200-2100/procedure, inspite of years of training, risks of the procedure, clinical skills and intellectual challenge. Much less than what your car mechanic charges to changes car parts or a plumber to modify faucets or an IT trouble shooter to work on a computer, where human life is not at stake.

 

So what is the problem? Just train more docs and do more  procedures

EP docs are an endangered species, and on the verge of extinction. CMS has made draconian cuts in reimbursement upto 42% over the last 2 years. CMS cut 25-33% for catheter ablation services in the 2022 Now, MPFS and CMS propose a further 10-20% decrease in 2023. Yes, shocking and unbelievable!!

There is already a supply demand mismatch. These proposed cuts will further discourage medical trainees to pursue this specialty. As the number of patients increase, the number of physicians available to do these patients dwindle. The per capita electrophysiologist to patient ratio will dramatically increase to 1: 25,450 (due to 50% drop in enrollments in training programs and an accelerated exit of demoralized highly trained electrophysiologists, forcing several into early retirement or changing specialties or not affording to do ablations.

 

What is the impact if there are less electrophysiologists?

Escalation the healthcare costs for only one disease (diagnosis) to an estimated $20 billion. Can we afford this???

 

Is there a solution to this extremely grave situation? If so, what?

Leaders, policy makers, community advocates and powerful statemen like you, please gather support in Congress to halt CMS cuts to ablation services (Codes 93653-93657); furthermore, physicians and trainees need to be incentivized and encouraged to choose electrophysiology as there calling to help the ever-increasing number of atrial fibrillation patients, and bring them/us back into rhythm of heart beat and rhythm of life.

“And I heard the heartbeat, which was the most beautiful music I every heard in my life” – Beyonce

And thank you for

Being “the change you want to see” – Gandhi

 

by Sheila Kar, MD, FACC California ACC Wellness Catalyst

 

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