Newsletter_2006-3

The Society for Cardiovascular Angiography and Interventions

www.scai.org March/April2006

No matter how big their practice or how di-verse their patient mix, all of the attendees of SCAI’s 29th Annual Scientific Sessions will

take home information they can put to use in short order. The 2006 meeting will be held May 10–13 at the Sheraton Hotel & Towers in Chicago, a city whose central location and hub status for many airlines will enable busy interventionalists to attend the conference and then return to their patients without delay. They’ll be taking home extremely practical, relevant knowl-edge that will be immediately applicable to treating their patients, says the meeting’s chair, Ted Feldman,

M.D., FSCAI. Will there also be cutting-edge infor-mation about devices, indications, and therapies com-ing down the research pipeline? “Of course,” said Dr. Feldman, “the meeting will deliver many glimpses into the future of interventional cardiology.” However, to illustrate the meeting’s focus on “news you can use,” we invited a handful of the meeting’s many speakers to describe briefly what attendees will learn, and soon apply to patient care, from their specific sessions or talks. Here, in the presenters’ own words, is a sampling of what’s on the educational tap at SCAI ’06.

Cardiovascular CT has a bright future, and in-terventional cardiologists plan to be part of it. For proof of that, Phoenix was the place to

be in January, as nearly 300 attendees filled the seats at Cardiac CT and CT Angiography, SCAI’s second intensive course on cardiovascular CT, tailored specifi-cally for cardiologists.

“Cardiovascular CT is a fan-tastic, paradigm-shifting tool,” said the course’s co-director, John McB. Hodgson, M.D., FSCAI, chief of academic cardiology at St. Joseph’s Hospital and Medical Center in Phoenix. “In a half-hour outpatient study, we can actually see the wall of the artery and make a diagnosis of athero-sclerotic heart disease at a very early stage.”

SCAI is taking a leader-ship role in cardiac CT—one

that combines assertive advocacy, clinical and cost- effectiveness research, development of training guidelines and appropriateness criteria, and a com-mitment to high-quality education.

The Phoenix conference offers a perfect example, distinguishing itself from other offerings by its hands-

on, practical approach. In ad-dition to information-packed lectures, lengthy break-out

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May 10–13 in Chicago

SCAIScientificSessionsDeliverEducationPhysiciansCanPuttoWorkinTheirPractices

SCAITakesaLeadRoleinCardiovascularCT

At the helm of the Phoenix course, from left: Matthew Budoff, M.D., FSCAI, John McB. Hodgson, M.D., FSCAI, and Robert Schwartz, M.D., FSCAI.

InThisIssue...Strategies for Success Program Fills Void in Physician Education .....................4Register Today for SCAI ‘06— Fax Back the Form Provided ....................5SCAI, NCQA Host Historic Conference ....................................8

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SCAI News & Highlights is published bimonthly byThe Society for Cardiovascular Angiography and Interventions

9111 Old Georgetown Road, Bethesda, MD, 20814-1699Phone 800-992-7224; Fax 301-581-3408; www.scai.org;

[email protected]

Barry F. Uretsky, M.D., FSCAIPresident

Morton Kern, M.D., FSCAIEditor-in-Chief

Norm LinskyExecutive Director

Wayne PowellSenior Director,

Advocacy and Guidelines

Bea ReyesDirector, Administration

Rick HenegarDirector, Membership

and Meetings

Sarah JonesMembership Coordinator

Jen WoolPromotions Coordinator

Andrea FrazierPublications & Committee Operations Coordinator

Anne Marie SmithEducational Programs

Betty SangerSponsorship and

Development

Kathy Boyd DavidManaging Editor

Touch 3Design & Production

Imaging ZonePrinting

SCAI Scientific Sessions (continued from page 1)

PercutaneousValveTherapyThursday, May 11, 8:30 – 10 a.m. Co-chair: Ted Feldman, M.D., FSCAI

Percutaneous valve therapy is in an explosive phase. Few of us believed

we would be repairing mitral valves or replacing pulmonic and aortic valves just a few years ago. These therapies are all a reality now, and the SCAI an-

nual meeting is a place to get a current update on the status of these therapies.

PeripheralSymposiumSaturday, May 13, 8 a.m. – 5:30 p.m.Chair: David Kandzari, M.D., FSCAI

Catheter-based interventions for peripheral arte-rial disease are likely the most rapidly develop-

ing skill set among interventional cardiologists. The peripheral vascular symposium for this year’s SCAI meet-ing was developed specifically for the interventional cardiologist, focusing on a practical, case-based review of routine challenges and dilemmas, but it will also provide a compre-

hensive review of recent trials, noninvasive imag-ing, and up-to-date guidelines. I’m especially excited about this event, given the extensive expertise among the faculty presenters.

FFRCaseReviewsThursday, May 11, 1 – 2:30 p.m. Co-chair: Morton J. Kern, M.D., FSCAI

Using FFR in the cath lab can save time, money, and trouble for interventionalists. Consider just

a few examples: Many interventionalists need help in treating patients with multives-sel disease more than with angi-ography and IVUS. This is where FFR is most useful. Is it possible to tell when an LM lesion is clinically important? FFR can identify the hemodynamic

significance of an LM to assist in critical decision-making.

Consider a patient who has vague and atypical chest pain and undergoes coronary angiography

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and has intermediate lesions. How many, if any, stents will you use? FFR identifies whether and how many stents will be helpful. Serial lesions often require a full metal jacket. FFR pull-back can tell you where the end of diffuse disease occurs and can limit the length of both the procedure and stent numbers.

IntimateSession:CarotidStenting—TipsandTricksThursday, May 11, 3 – 5 p.m. Presenter: William A. Gray, M.D., FSCAI

As the practice of carotid stenting becomes more widespread as the result of both a second stent

system approval (and several others expected by year’s end) and increased training opportunities via both societal and other courses, a greater number of early-experience operators are enter-ing the field. Given the variability exhibited by these patients, including clinical, access, lesion, and collateral

circulation considerations (among other qualities), it is difficult for the early operator to anticipate many of the possible outcomes or management techniques. Our dis-cussion at the SCAI Scientific Sessions will reflect on the broad experience in carotid stenting over the past 10 years in order to summarize some helpful tips that have been gathered along the way.

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TapedCases:Complications—“TheWorstNightmareofLastYear”Friday, May 12, 10:45 a.m. Presenter: David R. Holmes, Jr., M.D., FSCAI

There is a famous quote that says, “Percutaneous coronary intervention is like a marriage, easier to

get into than to get out of.” This has great relevance for interventional cardiology. In the past, prior to the ubiquitous use of stent implantation, interventional cardiologists were accustomed to life-threatening acute or threatened closure, the need for emergency sur-gery defined as a “true emergent,” as well as other major complications.

With the advent of new adjunctive therapy and stent implantation, the acute or threatened closure rates have decreased, and the need for emergency surgery has likewise decreased. We are still left with those patients and those situations where it is easier to get into than it is to get out of. Focusing on the worst nightmares gives us an opportunity to share awful cases. Some of these awful cases will have a good out-come, and we will be able to learn approaches trying to achieve such a good outcome; some of these awful, worst-nightmare cases will have an awful outcome. We then need to also learn from those cases to decide how to either prevent or to treat a problem before it reaches end stage. Worst-nightmare sessions are of-ten some of the most important and informative ses-sions because we are able to share with the operator the need for creative thinking and problem-solving as well as the emotional challenge of major stress.

IntimateSession:VascularClosure—CurrentPracticeThursday, May 11, 8:30 – 10 a.m. Chair: Timothy A. Sanborn, M.D., FSCAI

You may have just completed treating a com-plex bifurcation lesion with double wires and

kissing stents, but your patient will only remember whether your nurse had to press on their groin for a long time or how long they had to lie flat in bed. At SCAI’s Scientific Sessions, learn more about the current “state of the art” in vascular closure devic-es and how to treat vascular com-

plications without having to go to surgery.

NewModalitiesforCoronaryImagingFriday, May 12, 8:30 – 10 a.m.Chair: John McB. Hodgson, M.D., FSCAI

Novel methods of cardiac imaging, particularly of the coronary arteries, are fast becoming a reality.

Of special interest is the ability to visualize atheroscle-rosis in the vessel wall, both grossly noninvasively and in near-histologic detail invasively. We are now able to truly answer the question “Does my patient have atherosclerosis?” rather than only screening for late-occurring ischemia. These new im-aging techniques will fundamentally

shift the paradigm in which we evaluate, treat, and monitor patients.

CoronaryAngiography,CoronaryAnomalies—OptimalViewSelectioninthePCIEraWednesday, May 10, 1:30 – 2 p.m. Presenter: Michael J. Lim, M.D., FSCAI

The number of coronary angiograms and subse-quent angioplasty procedures performed contin-

ues to grow on a year-to-year basis. Seemingly, many of these patients have complex anato-my with multivessel disease, thereby making the decision-making process in the cath lab many times more dif-ficult. Also, some of these patients have anomalous origins of their coronaries, which complicates the process even further. This session

will focus on complexities seen in angiography with anomalous coronaries and outline which lesions subsets are particularly worrisome and which may be benign. Furthermore, we will visit additional test-ing modalities that can be utilized to aid in the deci-sion-making process, such as FFR, CT angiography, and MRI/MRA. n

Register Today for SCAI ‘06

Log on to www.scai.org or complete the registration form provided on page 5

CHICAGOPhysicians historically aren’t trained to run busi-nesses. Regardless of their specialty, a doctor’s training years are focused, 100 percent, on treat-

ing patients. That focus turns out very good doctors, says Christopher U. Cates, M.D., FSCAI, but it also sets them up for frustration as they attempt to establish practices that de-liver optimal patient care in today’s complex healthcare en-vironment. “Ultimately,” adds Dr. Cates, “doctors who under-stand business issues and the healthcare environment will be better patient advocates.”

This philosophy is a big part of the reason Dr. Cates launched the first Strategies

for Success program in 1990. As a young faculty mem-ber, he had searched high and low for a CME program where he could learn about practice management. The best he could find were courses either not geared toward medicine or seminars aimed at selling attendees spe-cific products. To fill the void, he created the first CME program developed by doctors for doctors for the pur-pose of discussing the business of medicine. Dr. Cates explains the goals of the Strategies program like this: “We wanted to empower doctors with three things: the tools necessary to practically implement sound busi-ness ideas in practice; a forum for exchanging informa-tion about the business of medicine with colleagues; and a place to interact with other stakeholders in the healthcare marketplace.”

Now, as Dr. Cates and his team of healthcare policy leaders, experts on business law, and renowned cardiol-ogists are gearing up to offer Strategies for Success XV in Sonoma, CA, June ��–�4, �006, SCAI has be-come the program’s primary sponsor. “SCAI has been a

cosponsor of Strategies for several years,” says Dr. Cates, “and the Society has taken on such a leadership role in healthcare policy, that it seems like a really good fit to have Strategies offered under SCAI’s banner.”

Exchange Information and Take Home ToolsStrategies for Success has developed a tremendous

following, with many physicians attending year after year. According to Dr. Cates, the course’s popularity is a testament to the charge each faculty member is given: to deliver at least three or four practical “pearls” that attendees will be able to implement in their prac-tices within one year.

“Every year, we build the Strategies syllabus from the ground up, depending on the issues that are most rel-evant,” says Dr. Cates, who at press time was finalizing the agenda for this year’s program. (The agenda will be posted on www.scai.org in the near future and prom-ises to include faculty from the Office of the Inspec-tor General, Department of Justice, Food and Drug Administration, Centers for Medicare and Medicaid Services, and highly regarded law and financial-plan-ning firms.)

The program will include something for everyone, says Dr. Cates, ranging from CEOs of major health sys-tems to cardiologists who are running a one- or two-physician practice to fellows just out of training. Among the sessions Dr. Cates is planning is one that looks at the controversial issue of gainsharing. He has confirmed that a representative from the U.S. Inspector General will be the main speaker and will specifically address appropriate models for physicians and hospitals to work together to improve quality and efficiencies. Other fea-tured sessions will include practical tips for marketing a practice, how to incorporate new technologies, estate planning for physicians, a discussion on the increasingly complex rules governing physician–industry relation-

June 22–24, 2006, in Sonoma, CA

StrategiesforSuccessProgramFillsVoidinPhysicianEducation

Christopher U. Cates, M.D., FSCAI

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Cardiovascular CT (continued from page 1)sessions gave attendees the opportunity to follow along as experts reviewed cases in detail, demonstrating how to analyze a study from start to finish. Approximately 80 attendees also signed up for an optional two-day inten-sive case review, honing their skills in the use of high-powered computer workstations to reconstruct, analyze, and interpret CT images.

“The conference was excellent,” said John Quinn, M.D., FSCAI, an interventional cardiologist from Win-chester Medical Center in Winchester, VA. “Presenters spent a great deal of time going through cases, giving us tips on how to read the studies, pointing out anatomic variants, and advising us on pitfalls.”

Workstation proficiency is crucial, said Robert Schwartz, M.D., FSCAI, course director for the optional case review. “We feel the best way to learn is by doing. You have to master ‘buttonology’—using the keyboard and the screens—and know which tools are available in your toolbox and how to use them. But it’s also challenging to look at images and start to think in three dimensions.”

Dr. Schwartz is the director of an upcoming case-based course that will focus on developing worksta-tion proficiency. Sponsored by SCAI, it will take place June 15–16, 2006, in Minneapolis. The Society is also planning to offer Cardiac CT and CT Angiog-raphy again in the fall of this year; for details, visit www.scai.org.

Changing PracticeIn many ways, Dr. Quinn exemplifies how the

futures of interventional cardiology and cardiovas-cular CT are intertwined. Approximately 85 miles northwest of Washington, DC, Winchester Medi-cal Center draws from a referral population of about 250,000. Perhaps 5,000 patients a year pass through

its busy cath lab for diagnostic angiography or coro-nary interventions.

An interventional cardiologist for some 20 years, Dr. Quinn predicts that CT angiography will play a central role in the diagnosis of heart disease. “Given its relatively noninvasive approach, its convenience for the patient, the diagnostic information we get—cardiovascular CT is the wave of the future,” he said.

He and his colleagues—a team made up of both cardiologists and a radiologist—are currently using a 16-slice CT scanner to image selected patients with chest pain and a low-to-moderate likelihood of coronary artery disease. They have a 64-slice CT scanner on order and plan to expand the imaging practice to include preprocedural planning prior to im-plantation of biven-tricular pacemakers, evaluation of patients prior to valve surgery, and assessment of left ventricular function.

The Phoenix course’s co-director, Matthew Budoff, M.D., FSCAI, adds to this list of CT applications peripheral angiography, accurate sizing of atrial-sep-tal defect or patent foramen ovale prior to implantation of a closure device, evalua-tion of valve structure and function prior to percutaneous repair or replacement, and assessment of coronary artery bypass graft patency in CABG patients who ex-perience recurrent chest pain.

“Over time, we will rely on CT more and more,” Dr. Budoff said. “Most in-terventionalists are going to want to be the one making the diagnosis, and they’ll need to be very facile with the technology. Others will just need to understand the technology, its capabilities, and its limitations, so they know how confident to be going into a case.”

John Schatz, M.D., FSCAI, concurred. Cardiol-ogy chief at Natividad Medical Center in Salinas, CA, Dr. Schatz is intrigued by cardiovascular CT but hasn’t decided how hands-on he’ll be in incorporat-ing it into his practice. “Whether I end up processing and reading studies or just need to know where they fit into the work-up of people with coronary disease, cardiovascular CT is going to be the nuts and bolts of what we do,” he said.

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Dr. Hodgson demonstrates cardiac CT applications at one of many workstations at the Phoenix course.

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AdvocacySCAI is committed not only to providing high-

quality education in cardiovascular CT but also to ensuring that interventional cardiologists are free to incorporate CT into their practices and receive equi-table reimbursement for imaging services.

The successful development of cardiac CT CPT® codes was an important step in that direction. The cat-egory III CPT codes (0144T–0150T), which took effect on Jan. 1, 2006, describe not only coronary CTA and coronary calcium scoring but also assessment of ventric-ular function, and studies of cardiac morphology that would typically precede electrophysiologic procedures.

Intentionally detailed, the new codes will enable Medicare and other health insurers to gather data on the overall utilization of cardiac CT and the frequency with which specific substudies are performed in com-bination with one another. Perhaps more importantly, the new codes will distin-guish cardiac CT from the less labor-in-tensive CTA of the thorax (�12�5) and pave the way for permanent cardiac CT CPT codes as early as 2008.

It is critical that billing for cardiac CT and coronary CTA incorporate the new codes, said Wayne Powell, SCAI’s senior

director for advocacy and guidelines. “SCAI mem-bers must switch to the new codes because Medi-care requires physicians to use the most precise codes involved,” he said.

Currently there are no payment amounts assigned to the new codes—reimbursement must be negotiated with each local health insur-ance carrier—but SCAI is participating in the de-

velopment of specific payment recommendations. In the meantime, Congressional limiting of pay-

ments for in-office imaging appears to have unin-tentionally exempted cardiac CT. A five-year deficit reduction bill, which the President signed into law on Feb. 8, eliminated a 4.4 percent across-the-board reduction in physician fees that took effect Jan. 1. Re-scinding the fee cut came at a price, however: a cap on reimbursement for most office-based imaging. Since cardiac CT has not been assigned permanent CPT codes, billing for office-based cardiac CT studies is not expected to be affected by the cap, Mr. Powell said.

SCAI also collaborated in the development of a recommended local coverage policy for cardiac CT. Released in December 2005 and sent to Medicare carrier medical directors, the model Local Coverage Determination was developed by representatives from American College of Cardiology (ACC), American College of Radiology, North American Society for Cardiac Imaging, Society of Cardiovascular Com-puted Tomography, American Society of Nuclear Cardiology, Empire Blue Cross Blue Shield Medi-care Services, and United Healthcare, in addition to SCAI. It incorporates the new category III CPT codes and ACC/American Heart Association clini-cal competence and training standards for physicians and technicians, which were published in Journal of the American College of Cardiology in July 2005.

SCAI members and staff continue to play a vital role in the Coalition for Patient-Centered Imaging (CPCI), as this multispecialty group fights to ensure that appropriately trained specialists, not just radi-ologists, are allowed to incorporate CT and other ad-vanced imaging techniques into clinical practice. In 2006, action teams are focusing on five key areas:

Private insurance/radiology benefits management companies; Federal legislation;Federal regulation;State legislation; andResearch and peer-reviewed publications.Each action team is tackling a lengthy checklist

that includes monitoring efforts by radiology groups to limit access to imaging technology, gathering data to document the benefits and cost-effectiveness of in-office imaging by clinicians, and meeting with health insurers and legislators to educate them on the com-mitment of clinicians to high-quality imaging.

In a step that further underscores SCAI’s commit-ment to quality, President Barry Uretsky, M.D., FSCAI,

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Courtesy J. Hodgson

During an optional two-day case review, attendees honed their skills at computer workstations.

Attendees examined images like these at the cardiac CT course in Phoenix.

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In mid-December, SCAI and the National Commit-tee for Quality Assurance (NCQA) convened an im-

portant conference at the headquarters of the Agency for Healthcare Research and Quality (AHRQ). The purpose of the conference was to develop strategies for improving the way new, high-risk procedures and tech-nologies are introduced into medical practice. Attend-ees included representatives from many of medicine’s most influential stakeholders, including the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) as well as organizations that maintain cardiovascular data registries, such as the American College of Cardiology (ACC) and the Soci-ety for Vascular Surgery (SVS). Data registries will be a key component in the model that is developed from this conference, predicted SCAI President Barry F. Uretsky, M.D., FSCAI, who participated in the conference along with several other SCAI members.

Dr. Uretsky explained that conference attend-ees focused on carotid artery stenting (CAS) as they discussed how best to coordinate data collection and analysis of procedural outcomes. “CAS is among the first of a number of highly complicated procedures to be introduced into the medical armamentarium, and so it made an ideal case study.”

The proactive role that SCAI has taken in recom-mending stringent competency guidelines for physi-cians who wish to perform CAS and in developing the Society’s ground-breaking, three-tiered (didactic, online, and simulation) educational program for this new procedure set the stage for SCAI to cosponsor the landmark conference. Working NCQA, the Society was awarded an AHRQ grant to explore how registries might be used for improving patient safety and pro-moting quality improvement. “The notion of registries as tools for ensuring patient safety and ongoing evalu-ation of new technologies is gaining momentum,” said NCQA President Margaret E. O’Kane. “We believe that registries also hold potential as tools for clinicians and institutions. To optimize their value, we need to think through such issues as data ownership and vali-dation, governance, and accountability.”

The participation of representatives from organiza-tions such as SCAI, NCQA, and AHRQ, whose missions revolve around the concept of quality, alongside officials from government agencies such as the FDA and CMS el-evated the significance of the conference to historic, said SCAI Board of Governors Chair Christopher U. Cates,

M.D., FSCAI, who co-directs the Society’s tiered carotid educational program and Carotid Initiatives Committee. “We had all the players in medicine coming together to try to answer questions as to how we can define quality as medical professionals, measure quality, and ultimately re-ward quality,” said Dr. Cates. “It was clear that, although we had different people representing different groups, all with different perspectives and agendas, over the course of the conference, all of those people came together. They all saw that we have a real opportunity to define what quality means and put what has been just a good idea into real practice.”

In addition to Drs. Uretsky and Cates, SCAI was rep-resented by its immediate past president and Core Cur-riculum co-director, Michael Cowley, M.D., FSCAI; its secretary, Bonnie Weiner, M.D., MBA, MSEC, FSCAI; and the lead author of the SCAI/SVS/SVMB Clinical Competence Statement on CAS, Kenneth Rosenfield, M.D., FSCAI, who also represented the ACC at the conference.

Next Steps At press time, more than 800 hospitals in the Unit-

ed States were collecting data on the CAS procedures performed in their facilities, as required by the CMS restricted coverage decision set forth in March 2005. Those data are, at present, lying idle; however, they are crucial to the vision set forth at the SCAI–AHRQ con-ference. “The vision,” explained Dr. Cates, “is to create the forum for those data to be analyzed and physician and procedural quality to be measured. By doing this, we’ll be able to tie physician operator performance to clinical outcomes and, ultimately, to payment policy.”

The next step toward that goal is a white paper that lays out the vision and the plan for implementation. That vision includes a kind of “super-registry” that works with data from existing registries. “This will help us to identify programs with good outcomes and the factors involved in those outcomes, and it will assist new programs in achieving equally good outcomes,” said Dr. Weiner.

Helping physicians and facilities whose outcomes don’t achieve quality benchmarks is also crucial, add-ed Dr. Cates. “That’s part of what we’ve created with SCAI’s tiered CAS training curriculum — a feedback retraining loop for physicians who need more practice so they can improve their quality and will do better the next time they’re measured.”

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SCAI sees this new tiered educational system as an-other model that will serve the medical community well as more and more complex therapies emerge and need to be incorporated into practice. “CAS is the right thing at the right place and time,” said Dr. Cates. “It’s allowing us to learn how to develop new models for improving qual-ity, patient safety, and physician education. But what’s really important is that we’re developing consensus we can apply to future high-risk technologies.”

For updates on the work coming out of the SCAI–NCQA conference, visit www.scai.org n

SCAI’s Guidelines Activity Increasing

Reflecting SCAI’s growing role in all issues related to quality cardiovascular care, the Society’s par-

ticipation in the development of practice guidelines and other standard-setting documents has increased at breakneck pace. In 2005, SCAI published triple the number of documents it participated in the previous year, and the roster of documents targeted for release in 2006 indicates steady growth.

The Society’s role in document development has varied, ranging from taking the leadership role, as in

the publication of last year’s Clinical Competence State-ment on Carotid Stenting, to peer-reviewing and/or en-dorsing guidelines developed by other organizations. Below is an at-a-glance summary of documents cur-rently in the pipeline:

COCATS �: At press time, SCAI had endorsed this extensive document’s section titled, “Training in Advanced Cardiovascular Imaging (Computed Tomography).” The document is posted on scai.org. SVS/SIR/SCAI/SVMB Clinical Competence Statement on Thoracic Endovascular Aortic Re-pair (TEVAR): SCAI is working with the Society for Vascular Surgery, Society of Interventional Radiology, and the Society for Vascular Medicine and Biology to finalize and publish this document on scai.org in April 2006. Robert M. Bersin, M.D., FSCAI, has served as SCAI’s representative on the writing committee. ACC/AHA Guideline Update on the Manage-ment of Patients With Valvular Heart Disease: SCAI Past President Ted Feldman, M.D., FSCAI, and Zoltan Turi, M.D., FSCAI, have served on the writing committee for this guideline update, which

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Phenomenal Income Potential– Interventional Cardiologists!

To further expand and compliment its existing staff, Springfield Clinic located in Springfield, Illinois, is recruiting additional Inter-ventional Cardiologists to join its 173-physician organization. Unlike most multispecialty groups, Springfield Clinic utilizes a cost account-ing system that provides a much higher salary potential than most other multispecialty – and single specialty – groups!

The clinic is proud to announce the opening of its new Springfield Clinic 1st facility, scheduled to open in late 2005. Located adjacent to Memorial Medical Center and Southern Illinois University School of Medicine, this site will house approximately 60 Springfield Clinic phy-sicians, including the Cardiologists and surgical-based specialties.

Springfield, the capital of Illinois with a metro population of 170,000, is home to beautiful Lake Springfield. Located only 90 minutes north of St. Louis, and 3 1/2 hours to both Chicago and Indianapolis, the region provides exceptional academic, cultural, shopping, recreational, and housing options that will suit every taste! To learn more, contact Pam at (800) 528-8286, extension 4102, e-mail [email protected], or fax (217) 337-4181. Not J-1 eligible.

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is expected to be released this spring. ACC/SCAI Clinical Expert Consensus Document on Carotid Stenting: SCAI is aiming to publish this document in time for its 29th Annual Scientific Sessions in Chicago, May 10–13, 2006. With leader-ship from Kenneth Rosenfield, M.D., FSCAI, and Christopher U. Cates, M.D., FSCAI, the Society is working with the ACC Foundation to develop this important update to the Clinical Competence Statement on Carotid Stenting. ACC/AHA/SCAI Cardiac Interventional Proce-dures Clinical Competence and Training Document: Targeted for publication this summer, this document is a collaborative effort of SCAI, ACC, and AHA. Two SCAI Past Presidents, Michael J. Cowley, M.D., FSCAI, and George Vetrovec, M.D., FSCAI, are representing SCAI on the writing committee. This list just skims the surface of practice guide-

lines, competence statements, expert consensus, and other documents that SCAI is currently developing in partnership with various counterpart societies. SCAI encourages members to check www.scai.org often for newly published documents and updates on forthcom-ing papers. The Society also welcomes new volunteers to participate in the development of such documents. For more information on how to get involved, email [email protected] or join one of the SCAI document-de-velopment committees assembling Wednesday, May 10, during the Scientific Sessions. The schedule of committee meetings will be posted in mid- to late-April on www.scai.org.

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Medicare Fee Cuts Averted for Now

On Feb. 8, President Bush signed into law a five-year deficit-reduction bill that nullified the 4.4

percent across-the-board fee cuts for physicians treat-ing Medicare patients, which took effect Jan. 1. The Centers for Medicare and Medicaid Services commit-ted to implementing that change in early February. Physicians will not have to resubmit claims, and all reprocessing should be completed by July 2006.

SCAI leaders caution that the waived across-the-board fee cuts do not warrant celebration because the Medicare physician fee update system remains broken and under-funded. Current law calls for approximately 5 percent fee cuts annually for the next six to seven years. Furthermore, the just-enacted deficit-reduction law contains fee reduc-tions for in-office imaging procedures starting in 200�.

“The average fee for invasive and interventional car-diology procedures will rise about 0.6 percent in 2006,” said SCAI Advocacy Committee Chair Joseph D. Babb, M.D., FSCAI. “This increase is a direct result of SCAI’s advocacy efforts, which persuaded Medicare of-ficials to increase malpractice relative value units for in-terventional procedures. As a result, payments for these procedures will rise $15–$20 each.” More important at this juncture, added Dr. Babb, is that this slight increase proves that advocacy works. “We physicians are going to have to remain politically active to avert the fee cuts we narrowly avoided this year,” he stressed.

To get involved in SCAI’s Advocacy Committee, email [email protected]. n

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Advocacy and Guidelines Update (cont. from p. 9)

SCAI is pleased to announce the launch of e-TOC, a new benefit of membership that gets its name from publishing jargon. TOC is edi-

torial shorthand for “table of contents”; in this case, members will receive a monthly e-message from SCAI giving them a sneak preview of the next issue of Cath-eterization and Cardiovascular Interventions.

The Society’s e-SCAI Committee, chaired by Bon-nie Weiner, M.D., MBA, MSEC, FSCAI, developed this new membership benefit while working with Karl Wilkens, president of MultiWeb Communications, a Cleveland firm that specializes in serving the physician and healthcare community. “The monthly email mes-

sage itself provides a convenient way to go directly to the latest CCI journal articles,” said Mr. Wilkens. “It’s also fast – the member’s SCAI login is automatically entered so they can simply click a link and view the article.”

Members who have provided SCAI with their email contact information should have already be-gun receiving e-TOC. Formatted to be a quick read, e-TOC is a simple run-down of the studies slated to be included in the upcoming issue of CCI. Members who prefer not to receive e-TOC may opt-out.

If you are an SCAI member and haven’t received e-TOC yet (and would like to), send an email message to [email protected]. n

OntheWaytoYourPC:APreviewofCCI

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“I’ll never forget a one-month-old Sudanese boy I saw earlier this year. He had complex congenital heart disease. His parents had already lost two other chil-

dren to congenital heart disease. We treated him, and he went home in October. His parents still call me almost daily to tell me how he is doing. They are very appreciative, but for me there is nothing like seeing parents carrying their baby out of the hospital after treatment has been successful.”

In a small country sur-rounded by turmoil, Khaled Salaymeh, M.D., is working hard to make a difference for the children of the Middle East. He is one of only six pe-diatric/congenital heart dis-ease cardiologists in the King-dom of Jordan. Of those six physicians, only he and one other pediatric cardiologist practice in the private sec-tor. Dr. Salaymeh’s patients come from Jordan’s popula-tion of 5.5 million as well as from nearly all the surrounding countries; many of them are desperate parents who have very sick children and few places to turn for help.

These children brought Dr. Salaymeh back to Jor-dan six years ago. He had completed his training in the United States, first as a pediatric resident at the Univer-sity of Nebraska Medical Center and then as a pediatric cardiology fellow at the Cincinnati Children’s Hospital. He could have stayed in the United States, but he never considered it. He knew he was needed in Jordan.

“Medicine is a very elegant profession, one that con-tributes so much to our personalities and souls,” he ex-plains. “There is no other profession in the Middle East that can give so much. We need to help these children as much as we can. Because of everything happening in this part of the world, they have not received the atten-tion, care, and systems for health care that they need.”

Special Empathy With Patients’ FamiliesThese days, about �0 percent of Dr. Salaymeh’s pa-

tients are Iraqi, although just getting to Jordan is a major challenge. “Their access to me is greatly limited because of road blocks and curfews,” he explains, adding that he understands better than some the dangers that accompa-

ny travel in the Middle East. Last year, his father, whose business in Baghdad requires him to travel to and from Iraq, was kidnapped and held for five days. Dr. Salaymeh and his family paid a steep ransom to free his father, but they still worry every time he travels.

Dr. Salaymeh empathizes with his patients in another way, too. His daughter Joud, now 4 years old, was diag-

nosed with critical pulmonary stenosis shortly after birth. She is doing well, he reports, in part because of the efforts of SCAI Trustee Ziyad Hijazi, M.D., FSCAI, who performed the second angioplasty Joud required, when she was 9 months old. “I acted as a con-cerned dad, not as her physi-cian, so I have some idea of how the parents of my patients feel,” says Dr. Salaymeh.

A Jordanian Homecoming “In the United States,”

says Dr. Salaymeh, “I saw how far the treatment of congenital heart disease has come. If kids are well-managed, they can lead normal, or near-normal, productive lives. I really think we can give this to the children of the Middle East, perhaps now quite to the extent that America has, but we can come close.”

This professional calling was undeniable, he says, but there was something else beckoning Dr. Salaymeh back to Jordan, too: His family. Today, his parents, an aunt, his two brothers and their wives and children, as well as his wife and three children all reside in one big apart-ment building in Amman. Their lives are wonderfully intermingled, which allows him and his wife, Rania, to go to work each morning certain that his children, Han-nah, Jamal, and Joud, are in the best of hands. “If I don’t have to work the next day, we all gather in my apart-ment at 10 or 11 p.m., after the children are asleep, to watch DVDs,” he says. “I love American movies. The Godfather is my favorite. I could watch it one hundred times and never get bored. Al Pacino is the man!”

Keeping in Touch With the Land of MedicineThe opportunity to buy all the latest releases on

DVD is a nice plus when Dr. Salaymeh visits the

In THe TRenCHeS

JordanianCardiologistDeliversHopetoFamiliesThroughoutMiddleEast

Dr. Salaymeh and his wife, Rania. Along with their children, Hannah, Jamal, and Joud, they reside in the same Amman apartment building as Dr. Salaymeh’s parents, his two brothers, and their wives and children.

(continued on page 12)

1� SCAI Membership Application

United States once or twice each year. More impor-tant, of course, is time to brush up on advances in the treatment of congenital heart disease and to get re-acquainted with some of his mentors and colleagues. “America is the land of medicine,” he explains. “It is a beautiful safe haven for foreigners to get their train-ing. Americans are known for being fair in educating all trainees, for treating foreign residents as well as they treat Americans in terms of duties and salaries.” With gratitude, he points out two of his mentors: Drs. John Kugler and Robert Beekman, III, who made sure he “learned all the tricks and technical training to be like any American physician.”

His American training has come in handy both in inside and outside of the clinics he holds daily. For ex-ample, in the American tradition, he has established monthly pediatric Grand Rounds at the prestigious Al-Khalidi Medical Plaza, where he is a consulting pediatric cardiologist. And, as vice president of the Jordanian Society of American Medical Graduates, he hosts monthly scientific discussions and is directing

Jordan’s Second Annual Pediatric Review Course. For two days, residents and staff will immerse themselves in lectures and presentations by three guest speakers from the United States as well as 16 American-trained Jordanian physicians.

The quality of SCAI’s educational programs is one reason Dr. Salaymeh joined SCAI at the recent PICS conference, he said. The other is CCI, which Dr. Sa-laymeh views as one of the best benefits of SCAI mem-bership. “SCAI’s journal provides the most current information on pediatric interventions, which will help me to distinguish myself here in Jordan,” he says. “I really feel that membership in SCAI can help me improve myself, and that will help me provide to Jor-danian and non-Jordanian children the best medicine that America has to offer.” n

Editor’s Note: We got back in touch with Dr. Sa-laymeh after the recent bombings in Jordan. He as-sured us that he and his family are safe. He is praying, he says, that “Jordan remains safe so people can come and visit us and see our lovely country.”

In the Trenches (continued from page 11)

represented the Society in the development and peer review of a focused update of the COCATS 2 train-ing statement. This document, released in February, includes a new section that defines basic, intermedi-ate, and advanced training in cardiac CT imaging. Dr. Hodgson is representing SCAI on a technical panel developing appropriateness criteria for cardiac CT, and John P. Reilly, M.D., FSCAI, is representing SCAI in the development of a new Clinical Competence State-ment on Vascular CT/MR.

Dr. Hodgson and co-author Lloyd W. Klein, M.D., FSCAI, conducted a survey to assess interest in car-diovascular CT and published the results online in the November edition of CCI, whose editor-in-chief, Christopher J. White, M.D., FSCAI, recently created a new category called “Non-Invasive Imaging.” (Dr.

Hodgson is acting as the section editor and Dr. Reilly as the associate editor; together they are developing a core curriculum and content for the Journal’s new category.). The survey showed that interventional cardiologists are intensely interested in cardiovas-cular CT—nearly three of four respondents planned to interpret CT studies—but may underestimate the amount of training required to develop proficiency.

“The technical aspects of getting a good study and interpreting the study are very different from cardiac catheterization or standard CT,” Dr. Hodgson said. “You have to be committed to doing it. Cardiac CT is not something you do in your spare time.”

For up-to-the-minute information on all of SCAI’s cardiac CT–related activities, including forthcoming educational opportunities, advocacy initiatives, and new guidelines, visit www.scai.org. n

14

Cardiovascular CT (continued from page 7)

Strategies for Success (continued from page 4)ships, and a workshop on financial benchmarking.

The bottom line, stresses Dr. Cates, is that attend-ees will hear from experts about issues that impact de-cision making in health care. “We physicians spend a lot of time talking about new treatment strategies and devices, many of which quickly come and go,” continues Dr. Cates. “Meanwhile, we spend almost no time talk-ing about the macroeco-nomic health policy and advocacy issues that affect medical practice in general and have a profound and lasting impact on our indi-vidual practices, on patient care, and on the doctor–patient relationship. This is why Strategies exists.”

Get to Know Decision-Makers

Dr. Cates has designed the Strategies program to keep attendees “glued to their seats” throughout the morning and then to give them plenty of time for building relationships in the afternoons and eve-nings. The sessions are “intense experiences” for attendees and faculty alike in part because they are highly interactive. Almost all of the sessions include use of an audience interactive system and a question-and-answer period that helps the speakers to get a lead on what attendees are interested in and helps attendees understand what their colleagues think about the issues.

The result is a mentally taxing but also highly rewarding experience for everyone, says Dr. Cates, who is proud that his course has evolved to include sessions that examine the major macroeconomic issues in healthcare. By steadfastly refusing to get educated and involved in such issues in the past, Dr. Cates believes, physicians relinquished their natural

right to make many of the important business deci-sions that have shaped to-day’s healthcare climate. That’s why, for years now, the Strategies syllabus has included sessions aimed at teaching physicians how regulatory and gov-ernmental agencies work and how physicians can work with them. “It’s so important for us as doc-tors to take up the role of

advocate for our patients and our profession and to define quality.”

To that end, he includes plenty of time in the ses-sion for relationship-building, and he encourages at-tendees to embrace the opportunity. “There is no substitute for dialogue with others in the healthcare space, especially with those who are defining health-care policy,” he stresses. “Strategies attendees are col-lecting the tools necessary to enter that environment and take back their seat at the table.”

For more information or to register for Strategies for Success XV, visit www.scai.org or call 800-992-�224. n