Newsletter_2011-11

November/December 2011

The Society for Cardiovascular Angiography and Interventions

www.scai.org www.SecondsCount.org

Super Bowl–Winning Coach Jimmy Johnson Teams Up with SCAI on Public Service Announcement

Coach Jimmy Johnson led the Dallas Cowboys to two Super Bowl victories and had a long

and impressive career in coaching, but heart disease almost took him from the game entirely. This fall the FOX NFL commentator teamed up with SCAI to urge Americans to know their risk for heart disease and seek prompt and proper treatment.

A few years ago, Coach Johnson took on a new challenge when he agreed to participate in the reality television program Survivor. Unfortunately, a physical exam revealed he had significant blockages in two of his arteries, one of which was 90 percent obstructed. He immediately sought

help from an interventional cardiologist and decided to undergo PCI to restore blood flow to his heart. He also heeded the advice of his doctors and changed his lifestyle by eating better, exercising more, and taking his medications. His quality of life and energy greatly improved, and he lost 30 pounds. He was then ready for Survivor, and was able to realize his goal of participating in the show.

Coach Johnson worked with SCAI to film two public service announcements in which he shares his story and urges

others to work with their doctors to get proper treatment. The

(continued on page 4)

2012 Medicare Fee Schedule

CMS Backs Off Threat of 20 Percent Fee Cuts for Cath Codes; SCAI Urges Members: Help Fight for Fair PCI Code Values

The 2012 Physician Fee Schedule Final Rule, released Nov. 1, represents a small victory in the struggle for fair reimbursement for invasive cardiology services. Based on

communications from the Centers for Medicare and Medicaid Services (CMS), the profession had braced for newly bundled cardiac cath codes to be devalued by 30 percent or more. Not only had a precedent been set when echo, nuclear, cardiac CT, and peripheral codes were dramatically devalued after being bundled, but CMS had clearly indicated further cuts were coming for cardiac cath.

Instead, CMS has backed off these threats, settling for the 10 percent reduction in values for these codes that was implemented on Jan. 1, 2011.

“While no one is happy about the cuts that went into effect at the beginning of the year,” said SCAI Advocacy Committee Chair James C. Blankenship, M.D., FSCAI, “we also have to consider what could have been. In this case, it could have been much worse. This is a small but significant victory that SCAI members and staff played a major role in achieving.”

The Path to the Win “It helps to understand how we got to this point,” continued

Dr. Blankenship, “because how we got here foreshadows the next challenge we’re facing and how we must respond.”

In 2011, CMS required that new bundled cardiac catheterization codes replace the older component cath codes, a step it had previously taken with other imaging modalities, including echo, nuclear, cardiac CT, and peripheral codes. Though surveys fielded by the AMA Relative Value Update Committee (RUC) indicated the value of the new bundled codes were equivalent to those they replaced, CMS arbitrarily reduced the value of the new codes by 10 percent, effective Jan. 1, 2011.

Following intense advocacy efforts by SCAI and ACC, the RUC re-surveyed invasive and interventional cardiologists. SCAI launched a campaign urging members to take the time to fill out the cumbersome and confusing surveys, and members

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SCAI's PSA featuring Coach Jimmy Johnson will be seen by millions of people.

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Christopher J. White, M.D., FSCAI, PresidentJ. Jeffrey Marshall, M.D., FSCAI, President-Elect

Larry S. Dean, M.D., FSCAI, Immediate Past President Theodore Bass, M.D., FSCAI, Vice President

Carl L. Tommaso, M.D., FSCAI, TreasurerCharles Chambers, M.D., FSCAI, SecretaryMorton Kern, M.D., FSCAI, Editor-in-Chief

L. Van-Thomas Crisco, M.D., FSCAI, Associate Editor Sandeep Nathan, M.D., FSCAI, Associate Editor

_______________________________________________________________

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

2400 N Street, NW, Suite 500, Washington, DC 20037Phone 800-992-7224; Fax 202-689-7224

www.SCAI.org; www.SecondsCount.org; www.SCAI-WIN.org; [email protected]

TrusteesAlexandre Abizaid, M.D., Ph.D., FSCAILee N. Benson, M.D., FSCAIJeffrey Cavendish, M.D., FSCAITyrone J. Collins, M.D., FSCAIAnthony Farah, M.D., FSCAIRunlin Gao, M.D., FSCAIJames A. Goldstein, M.D., FSCAIJames Hermiller, M.D, FSCAIThomas Jones, M.D., FSCAIUpendra Kaul, M.D., FSCAIClifford Kavinsky, M.D., Ph.D., FSCAIAhmed Magdy, M.D., FSCAIIssam D. Moussa, M.D., FSCAISrihari S. Naidu, M.D., FSCAI Kimberly A. Skelding, M.D., FSCAIHuay-Cheem Tan, MBBS, FSCAI Zoltan G. Turi, M.D., FSCAI

Trustees for LifeFrank J. Hildner, M.D., FSCAI William C. Sheldon, M.D., FSCAI

StaffNorm LinskyExecutive DirectorKerry O’Boyle CurtisSenior Director for Education, Meetings, & CommunicationsWayne PowellSenior Director for Advocacy & GuidelinesTerie King, CPASenior Director of Finance & AccountingBea ReyesSenior Director of Operations & AdministrationKathy Boyd David Communications Director

touch three Design and ProductionImaging Zone Printing

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Medicare Fee Schedule (cont’d from pg 1)NATIONAL MEDICARE FEES FOR COMMON INVASIVE

AND INTERVENTIONAL PROCEDURES*

HCPCS

Mod DESCRIPTION 2011 2012 2013

NUMBER OF SERVICES BY CARDIOLOGISTS NATIONALLY IN 2010

CHANGE 2011 - 2012

CHANGE 2012 - 2013

37215 Carotid Stent $1,168 $1,128 $1,115 4,207 -3% -1%

92978 26 Intravascular us, heart add-on

$96 $91 $89 42,167 -5% -3%

92980 Insert intracoronary stent

$874 $837 $817 291,453 -4% -2%

92981 Insert intracoronary stent

$243 $232 $227 35,490 -4% -2%

92982 Coronary artery dilation

$648 $620 $605 23,124 -4% -2%

92984 Coronary artery dilation

$173 $166 $162 6,283 -4% -2%

92995 Coronary atherectomy

$713 $683 $666 1,057 -4% -2%

93451 26 Right heart cath $148 $146 $149 13,140 -1% 2%

93452 26 Left hrt cath w/ventrclgrphy

$261 $257 $260 9,364 -1% 1%

93453 26 R&l hrt cath w/ventriclgrphy

$341 $336 $341 10,747 -1% 2%

93454 26 Coronary artery angio s&i

$263 $259 $263 254,007 -2% 2%

93455 26 Coronary art/grft angio s&i

$303 $299 $303 141,217 -1% 1%

93456 26 R hrt coronary artery angio

$336 $331 $336 8,253 -2% 2%

93457 26 R hrt art/grft angio $376 $371 $376 8,253 -1% 1%

93458 26 L hrt artery/ ventricle angio

$320 $315 $320 358,544 -1% 2%

93459 26 L hrt art/grft angio $363 $358 $363 75,193 -1% 1%

93460 26 R&l hrt art/ventricle angio

$402 $396 $402 36,680 -1% 1%

93461 26 R&l hrt art/ventricle angio

$443 $438 $445 27,510 -1% 1%

93462 26 L hrt cath trnsptl puncture

$204 $201 $204 144 -1% 1%

93463 Drug admin & hemodynmic meas

$108 $107 $108 143 -1% 1%

93464 Exercise w/ hemodynamic meas

$253 $265 $253 1,705 5% -4%

responded. The second survey reaffirmed that the pre-2011 values were correct.

“As evidenced by the 2012 final rule, CMS could not justify a further reduction,” said Dr. Blankenship. “They had to settle for maintaining the 2011 values.”

SCAI’s representative to the RUC, Clifford Kavinsky, M.D., Ph.D., FSCAI, noted it took two rounds of RUC surveys to thwart CMS’s attempts to eviscerate the value of cardiac catheterization services. “If SCAI members had not stepped up to complete the surveys, CMS would have succeeded in reducing payment for catheterization by 30 percent or more,” he said.

PCI Codes Face Similar AttacksIn the past few weeks, many SCAI members were

called on to participate in the RUC survey process for new PCI codes cath codes that will become effective in 2013. CMS has issued a requirement that new bundled codes for coronary intervention procedures be created. As was done for the cath codes, SCAI and ACC sent surveys to interventional cardiologists to assess the value of the new PCI codes.

“Thanks to our experience with the cardiac cath codes, we knew what had to be done for the PCI codes,” said Dr. Kavinsky. “Anyone who received the survey had to take the time to complete it and provide accurate estimates of the work involved and the time it takes to perform PCI procedures. An insufficient survey response would have resulted in CMS reducing the reimbursement

for PCI procedures by 30 percent or more.”“How these surveys were completed will affect the fees

for these procedures for years to come,” emphasized Dr. Blankenship. “That’s the key take-away from this year’s fee schedule: Members must make the time to complete all RUC survey requests they receive.”

SCAI urges all members to watch their email and act immediately if they are selected to complete a RUC survey. SCAI expects RUC surveys for transcatheter aortic valve replacement and percutaneous ventricular assist device procedures in 2012. Members interested in participating in these surveys should contact Dawn Hopkins by emailing [email protected] n

In addition to the news on the cardiac catheterization codes, SCAI’s analysis of the fee schedule found: • CMS estimates the average cardiologist’s total

relative value units will decline 2 percent in 2012 total and another 1 percent in 2013 as practice expense changes continue to be phased in. While fees for office visits will rise, specialized procedures will face declines as identified in the chart on page 3.

• The sustainable growth rate mandate will result in across-the-board Medicare fee cuts effective Jan. 1, 2012, unless a legislative fix is implemented. As it has for years, SCAI will continue to work with the House of Medicine to overcome these cuts.

For further analysis of the 2012 fee schedule, visit www.SCAI.org.

More on the 2012 Medicare Physician Fee Schedule

Follow us:

@SCAINOW @SCAINEWS @SECONDSCOUNTORG

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NATIONAL MEDICARE FEES FOR COMMON INVASIVE AND INTERVENTIONAL PROCEDURES*

HCPCS

Mod DESCRIPTION 2011 2012 2013

NUMBER OF SERVICES BY CARDIOLOGISTS NATIONALLY IN 2010

CHANGE 2011 - 2012

CHANGE 2012 - 2013

37215 Carotid Stent $1,168 $1,128 $1,115 4,207 -3% -1%

92978 26 Intravascular us, heart add-on

$96 $91 $89 42,167 -5% -3%

92980 Insert intracoronary stent

$874 $837 $817 291,453 -4% -2%

92981 Insert intracoronary stent

$243 $232 $227 35,490 -4% -2%

92982 Coronary artery dilation

$648 $620 $605 23,124 -4% -2%

92984 Coronary artery dilation

$173 $166 $162 6,283 -4% -2%

92995 Coronary atherectomy

$713 $683 $666 1,057 -4% -2%

93451 26 Right heart cath $148 $146 $149 13,140 -1% 2%

93452 26 Left hrt cath w/ventrclgrphy

$261 $257 $260 9,364 -1% 1%

93453 26 R&l hrt cath w/ventriclgrphy

$341 $336 $341 10,747 -1% 2%

93454 26 Coronary artery angio s&i

$263 $259 $263 254,007 -2% 2%

93455 26 Coronary art/grft angio s&i

$303 $299 $303 141,217 -1% 1%

93456 26 R hrt coronary artery angio

$336 $331 $336 8,253 -2% 2%

93457 26 R hrt art/grft angio $376 $371 $376 8,253 -1% 1%

93458 26 L hrt artery/ ventricle angio

$320 $315 $320 358,544 -1% 2%

93459 26 L hrt art/grft angio $363 $358 $363 75,193 -1% 1%

93460 26 R&l hrt art/ventricle angio

$402 $396 $402 36,680 -1% 1%

93461 26 R&l hrt art/ventricle angio

$443 $438 $445 27,510 -1% 1%

93462 26 L hrt cath trnsptl puncture

$204 $201 $204 144 -1% 1%

93463 Drug admin & hemodynmic meas

$108 $107 $108 143 -1% 1%

93464 Exercise w/ hemodynamic meas

$253 $265 $253 1,705 5% -4%

*With no change in conversion factor.

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Coach Jimmy Johnson (cont’d from pg 1)

partnership with SCAI aims to spark conversations that lead to better heart health.

“We are thrilled to partner with Coach Johnson and hope his success story will inspire others to be proactive about their heart health,” said SCAI President Christopher J. White, M.D., FSCAI. “Many people know that heart disease is the leading cause of death among Americans, but they often don’t realize it can be silent, with few or no symptoms. Knowing your risk and talking to your doctor can mean the difference between life and death.”

The public service service announcements have been distributed to television, radio, and online media outlets throughout the United States. At press time, only weeks after dissemination, the public service announcements had garnered nearly 2 million television media impressions in

numerous markets and had aired on nearly 2,000 radio stations. Among stations airing the public service announcements on a regular schedule are CNN and CNN Airport Network. To view the public service announcement, visit www.SecondsCount.org. SCAI encourages members to link to the PSAs on their practice and hospital websites. n

By Steven L. Goldberg, M.D., FSCAI

One night last winter, I happened to see a TV teaser announcing that the popular reality program Survivor might have saved the life of legendary foot-ball coach and now Fox Sports com-mentator Jimmy Johnson. Intrigued by

this headline about one of the most successful football coaches of all time, I stayed tuned to hear the story.

It turned out that Coach Johnson, a long-time fan of Survivor, auditioned for a spot on “Survivor Island” – a remote island where people from all walks of life com-pete to be the last one standing after weeks of isolation from the rest of the world, physically challenging con-tests, and deprivation of all kinds (food, shelter and so on). Because of the extreme conditions, the audition in-cludes a complete physical exam, likely including a stress test that Mr. Johnson must have failed. I learned later that Survivor’s medical team urged him to see a cardiol-ogist as soon as possible. He followed their recommen-dations and was soon treated with PCI and stents.

A few years later, he re-applied for a spot on Survivor, and this time both passed the physical exams and was accepted. Coach Johnson didn’t last too long on the show – his celebrity worked against him as the competi-tors voted their team-mates off the island -- but he says the experience was one of the most grueling of his life. In fact, he said it was more physically demanding than two-a-days or three-a-days playing football, including (I assume) his time playing for Bear Bryant. As a testament

to the quality-of-life benefit delivered by PCI, Coach John-son weathered Survivor’s physical demands and stressful environment with no cardiac symptoms.

His story reminded me of many patients I’ve treated – for example, a man who climbed Mount Ranier after having his entire LAD stented, and another, now in his 70s, who dropped on the tennis court with an anterior myocardial infarction, underwent successful primary PCI and stenting, and is now the number-one-ranked player for his age in the Northwest.

I pondered Mr. Johnson’s story and the image prob-lem we interventional cardiologists have. Let’s face it -- positive reports on what we do are rare, and cardiologists are usually portrayed on TV and movies as arrogant and unpleasant. (Cardiac surgeons seem to have escaped this stereotype; they are often shown as heroes.) It occurred to me how valuable it could be for Coach Johnson’s story to be shared with the world beyond Survivor fans. His story shows how we help people feel well enough to do what they want to do with their lives, to accomplish their goals, no matter how physically demanding they may be.

I mentioned this to my colleague Dr. Larry Dean, then SCAI president. He suggested I work with SCAI staff to explore my idea. The result is the public service announce-ment that Coach Johnson filmed for SCAI. I think the result is terrific – a big step to help correct the public image of interventional cardiology. I am hopeful this is only a start.

Dr. Goldberg is clinical associate professor of medicine and direc-tor of the cardiac catheterization laboratory at the University of Washington Medical Center in Seattle.

Steven L. Goldberg, M.D., FSCAI

From Idea to Reality: Behind the Scenes on SCAI’s Public Service Announcement

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The Third Annual Women in Interventional Cardiology program, hosted by SCAI Women in Innovations (“WIN”) in Chicago in September,

drew a record number of female interventional cardiologist attendees. They gathered for a top-quality educational event as well as networking opportunities that have become unique to the program.

“This was the first year we held the program as an entirely CME’d event,” said Program Director Kimberly A. Skelding, M.D., FSCAI. “We decided it was time to establish the program not only as an opportunity for women in interventional cardiology to get together and share experiences but also as an opportunity for women to be exposed to really top-level education and faculty.”

The program, which featured a keynote reception, abstract presentations, case reviews, and break-out workshops, brought together interventional cardiology healthcare providers from a variety of practice settings and from throughout the United States. Some even flew in from other countries, including Canada, Ireland, Italy, and the United Kingdom.

“We don’t have this type of opportunity in Canada,” said Mina Madan, M.D., FSCAI. “With so few women in the field of interventional cardiology, I felt it was important to make the effort to attend. I’m so glad I did. It is a really unique meeting that I hope will continue for years to come.”

The meeting was developed by Dr. Skelding and Patricia Best, M.D., FSCAI, who teamed up a few years ago when they both perceived a pressing need for a forum where women in interventional cardiology could meet, learn, and express concerns unique to women in the field. “Women make up almost 50 percent of medical students in the U.S. and yet fewer than 10 percent

of board-certified interventional cardiologists are women,” said Dr. Best. “There are very few women on the faculties, let alone in the audience at the large conferences. Women also don’t participate in professional societies as often as men. Our goal is to provide a supportive network for women, and to encourage them to become more professionally confident.”

Women in Interventional Cardiology has become the flagship professional development meeting for WIN, whose two-fold mission is to provide female

interventional cardiologists with professional advancement opportunities and to utilize those opportunities to advance the state of science as it relates to women with heart disease.

“WIN’s dual mission can be confusing for some people, but it makes sense when you consider the impact of gender disparities in health care and the number of female interventionalists whose potential may not be fully tapped,” noted Roxana Mehran, M.D., FSCAI, chair of the WIN initiative.

“The link between women physicians and women patients is undeniable,” continued Dr. Mehran. “Clearly, female physicians are not interested only in gender disparities in cardiovascular care. There are also many male physicians out there who are very devoted to this cause. But if we can start addressing the major issues facing women with heart disease while also elevating and

WIN Update

Women in Interventional Cardiology Program Attracts Attendees From Around the World

Drs. Kelly Epps, Suzanne Sorof, Anna Bortnick, Louise Buchanan, and Rachel Israel pose during an early morning walk along Lake Michigan.

Kimberly A. Skelding, M.D., FSCAI

Patricia Best, M.D., FSCAI

“With so few women in the field of interventional cardiology, I felt it was important to make the effort to attend. I’m so glad I did. It is a really unique meeting that I hope will continue for years to come.”

– Dr. Mina Madan

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Strong Participation, Quality Education Mark First SCAI Fellows Course in South Korea

Education Update

More than 125 interventional cardiologists participated in the first SCAI Fellows course held in Seoul, South Korea, Sept. 23–24,

2011. Held in conjunction with Encore Seoul 2011, the program offered physicians 1½ days of case studies, didactic presentations, and networking opportunities with SCAI faculty.

The SCAI Fellows Course in South Korea is the most recent training program conducted by SCAI outside of the United States. Functioning as a condensed version of the popular SCAI Fall Fellows program, participants gained exposure to topics ranging from interventional cardiology basics to hot topics, including high-risk PCI. The agenda focused on case study presentations, encouraging discussion and interaction between faculty and attendees. Physicians attended workshops presented by SCAI faculty on Rotoblator, IVUS, and FFR.

The program balanced vital information needed by all interventional cardiologists with the specific educational needs of physicians practicing in South Korea. “Interventional cardiologists in South Korea are eager to learn from experts in the field,” said Yangsoo Jang, M.D., FSCAI, course director for Encore Seoul 2011. “We are very happy to offer this opportunity to our fellows-in-training and to physicians who wish to increase their knowledge. We know that the course has found the right audience as part of Encore Seoul.”

Representing SCAI were various faculty, including SCAI Vice President and Chair of the International Committee Theodore Bass, M.D., FSCAI, Michael J. Cowley, M.D., FSCAI; Ty Collins, M.D., FSCAI; and Luis Guzman, M.D., FSCAI.

“The attendance and participation in the Fellows

Courses continues to demonstrate the need for these types of educational opportunities,” said Dr. Bass. “SCAI has emerged as a proud leader in physician education, and these courses raise the bar for quality education on an international level.”

Each of the physicians who successfully completed the course received Affiliate SCAI Membership, allowing them access to educational tools and benefits that will encourage growth and continued education within their profession.

“SCAI membership is the most requested resource during each of the Fellows Courses,” said Dr. Cowley. “Physicians know that education and networking is critical to their professional development, and they recognize SCAI as the society that provides them with these resources.”

The SCAI Fellows Course in South Korea is the third international fellows course co-sponsored by the Society in 2011, joining the SCAI Fellows Course–Asia Pacific held annually in India and the inaugural SCAI Fellows Course in China held in August 2011. Another fellows course will be held in Argentina in December 2011. Courses are slated for India, Egypt, China, South Korea, and Argentina in 2012.

“We continue to receive feedback from participants who appreciate access to this type of education in their home countries,” Dr. Bass said. “Travel can be challenging for fellows-in-training and early-career physicians. Providing a solid didactic and case-based curriculum without requiring time away from the hospital allows for a lasting educational experience.”

For more information about upcoming SCAI fellows courses, visit www.SCAI.org or contact Stephanie Hubka at [email protected] or 800-992-7224. n

promoting the work of the many talented and successful female interventional cardiologists around the world, then WIN will make a major contribution to the specialty and the patients it serves.”

The Women in Interventional Cardiology program will be held again in Chicago, IL, Sept. 20–22, 2012. To learn more about Women in Interventional Cardiology or Women in Innovations, visit the WIN website at www.scai-win.org or contact WIN Director Rebecca Ortega at [email protected]. n

Acknowledgments

WIN gratefully acknowledges support from the following companies for the Women in Interventional Cardiology program: Abbott Vascular AbiomedACIST Medical Systems AstraZeneca Boston Scientific

Daiichi Sankyo, LLC and Eli Lilly USA MedtronicMerck

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“This program should be offered everywhere!” That’s what a 62-year-old woman had to say after attending “Heart Smarts: Complete

Care for Your Heart,” a regional education program SCAI held this fall in New Jersey. The program was part of SCAI’s Know What Counts series.

SCAI is working hard to make this participant’s suggestion a reality. This fall SCAI hosted Know What Counts programs in three states: New Jersey, California, and Louisiana.

Morristown, NJ Directed by Barry M. Cohen, M.D., FSCAI, of the

Gagnon Cardiovascular Institute at the Morristown Medical Center, the New Jersey program featured free blood

pressure and lipid screenings, a heart-healthy breakfast, and an educational program featuring interventional cardiologists, a cardiac rehab nurse, and a heart attack survivor. The program was sponsored by SCAI in partnership with the patient support group Mended Hearts.

Among speaker s were SCAI President Elect J. Jeffrey Marshall, M.D.,

FSCAI, who addressed the progressive and systemic nature of cardiovascular disease. “A lot of people think cardiovascular diasese is confined to the heart, so we wanted people to understand the impact not just of heart disease but also of peripheral arterial disease, renal artery stenosis, and stroke.”

He, Dr. Cohen, and cardiac rehab nurse Remia Arenas spoke on treatment options for heart disease and secondary prevention strategies following PCI or bypass surgery.

“The theme of all the presentations was the importance of taking care of yourself after surgery or stenting,” said George F. Pometti, assistant director of Mended Hearts’ Northeast region who helped to plan and promote the program. “That message came through loud and clear.”

Participants also benefited from the free screenings, he added. “A lot of people were surprised by their numbers; they thought their cholesterol and blood pressure were in check, when they were actually high,” he said. “It really opened their eyes to the importance of being proactive about their health.”

“Providing the free screenings adds to the impact of the educational programs,” said Dr. Marshall. “If a participant learns that their blood pressure or cholesterol is high or borderline, then heart disease suddenly become very real

for them. They want to know what they can do, and the program becomes very relevant and immediately useful.”

San Diego, CA As in New Jersey, attendees also gave enthusiastic

feedback on the Know What Counts program held in San Diego. Titled “Heart Smarts: From Tests to Treatment, and Beyond,” the program featured free blood pressure, lipids/glucose, and ABI screenings; a demonstration by a local chef on heart-healthy cooking techniques; and SCAI’s signature 2½-hour educational seminar. SCAI offered the free program in partnership with the UC San Diego Sulpizio Cardiovascular Center.

The event, directed by Ehtisham Mahmud, M.D., FSCAI, of the UC San Diego Sulpizio Cardiovascular Center, kicked off with a presentation by Holly Green, who told her story of surviving a heart attack at age 47.

“I’m an example of exactly what not to do,” said Ms. Green, as she recounted shrugging off worsening symptoms, driving herself to the hospital, and

believing a heart attack couldn’t happen to her. Themes of her presentation were underscored throughout the program when, for example, JACC Editor-in-Chief Anthony DeMaria, M.D., described the many types of cardiovascular tests and how physicians choose the right tests for individual patients.

SCAI Trustee Jeffrey J. Cavendish, M.D., FSCAI, explained the role of medications in maintaining heart health and the importance of adherence, and Dr. Mahmud showed attendees how cardiovascular disease can be treated with revascularization procedures. His presentation was followed by that of psychiatrist Joel E. Dimsdale, M.D., who specializes in the psychological impact of cardiovascular events on patients. Dr. Dimsdale discussed challenges patients face in making lifestyle changes and adhering to medical regimens.

New Orleans, LA Attendees were lined up a half-hour before the Know

What Counts program in New Orleans began. They came for free blood pressure, lipids, and Framingham risk assessment results as well as a heart-healthy recipes demonstration by Debbie Bermudez, a nutritionist from the Ochsner Heart and Vascular Institute, and the patient-friendly seminar that is the hallmark of SCAI’s Know What Counts series. Directed by John P. Reilly,

Barry M. Cohen, M.D., FSCAI

Ehtisham Mahmud, M.D., FSCAI

Know What Counts Programs Continue Raising Awareness of CVD, Treatment Options

9

SCAI has undertaken the Know What Counts public education initiative with its own resources as well as commercial support from the following companies:

SCAI gratefully acknowledges this support while taking sole responsibility for all content developed and disseminated through the effort.

SCAI Thanks …

M.D., FSCAI, the program featured 72-year-old Louis Biondolillo as well as local cardiologists.

“Mr. Biondolillo helped us launch the program on just the right note,” said Dr. Reilly. “He survived his heart attack because he did everything we hope patients will do, including recognizing the symptoms, calling 911, and chewing up a couple of aspirin while he waited

for the emergency responders. That was an important message for our guests.”

Not only did Mr. Biondolillo respond promptly to symptoms, he also advocated for himself. When paramedics suggested he might be having an anxiety attack, he stuck to his guns and insisted he needed to be checked out at the hospital. An EKG performed while en route to the hospital confirmed he was having a heart attack, so the cath lab team was ready for him when he arrived. “I was awake for the whole procedure, and I could feel the difference as soon as they put the stent in. I knew I was going to be all right.”

Carl J. Lavie, Jr., M.D., spoke next about the prevalence of heart disease and strategies for preventing and managing it. “I had no idea more people die of heart disease than cancer,” wrote one attendee on her evaluation form. “Dr. Lavie was exceptional and very informative.”

Dr. Lavie stressed the importance of making lifestyle changes for both primary and secondary prevention as well as attending cardiac rehabilitation and taking prescribed medications. He stressed that PCI patients such as Mr. Biondolillo have much to gain from cardiac rehab, and more cardiologists should refer their patients for it.

Dr. Reilly and SCAI President Christopher J. White, M.D., FSCAI, also gave presentations during the program. Dr. Reilly focused on how medical news is covered by the media, providing attendees with seven questions to ask themselves when considering medical news stories.

“There is so much sensationalism around medical news, and our patients often call with questions, demonstrating how alarming the coverage can be,” said Dr. Reilly. “We wanted to give patients tools so they can be both informed and appropriately critical of the headlines they see.”

Dr. Reilly reminded patients that they should never stop taking a prescribed medicine without first talking to their doctor, regardless of what the news says. “The risks of stopping a medication can far outweigh the risks of taking it. So, if you’re at all concerned, call your doctor. That’s what we’re here for.”

Being well-informed and accessible are two traits patients should look for when they choose a doctor, said Dr. White, when he spoke to the audience. He urged patients to seek out healthcare providers who show the traits of character, courage, commitment, compassion, and competence.

Unique Access to Cardiovascular Providers Program after program, attendees report they

appreciate the time to ask questions of the faculty. “It’s important for cardiac patients to have face-to-

face time with physicians who can educate them about cardiovascular disease’s medical and psychological impact,” said Dr. Mahmud. “The Know What Counts program represents SCAI very well as an organization that is interested and committed to teaching patients about cardiovascular disease and therapies, rather than just focusing on the technical aspects of performing procedures.”

Many patients left the event with definitive plans to seek medical advice, added Dr. Mahmud. “One attendee stopped me on the way out and told me she got a ‘wake-up call’ at our program and was going to talk to her doctor about PAD.”

To learn more about hosting a Know What Counts program in your area or to join the Know What Counts Committee, contact Kathy Boyd David at [email protected]. n

John P. Reilly, M.D., FSCAI

SCAI Trustee Dr. Jeffrey Cavendish talked with the San Diego audience about the importance of adherence with prescribed medications, including resources avail-able if paying for prescriptions is a barrier.

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Peripheral arterial disease (PAD) remains an underdiagnosed problem in the medical community. Interventional cardiologists are in a unique position

to diagnose, treat, and spread awareness about this disease. As practitioners continue to expand their services to include

vascular and endovascular components, it is critical to recognize the key components for building a successful and reputable PAD program: Expertise, Commitment, Collaboration, and Quality.

Expertise: You must be comfortable with most aspects of vascular medicine and intervention. Obtaining certification from the American Board of Vascular Medicine i s recommended, and it is important to be very familiar with interpretation of vascular ultrasound and physiological testing (ABI, PVR). Obtaining RPVI certification will add legitimacy to your practice.

Commitment: Commit to treating vascular disease by establishing a dedicated clinic and practice. Establish yourself as the local expert who is

passionate about taking care of vascular patients. Your staff must be familiar with managing vascular patients, and your administrators must be on top of an ever-changing billing structure.

Collaboration: Ally yourself with a vascular surgeon whom you can work with as a partner. Your skills should be complementary. You can establish relationships with local primary care physicians, podiatrists, and rehabilitation physicians by offering them easy access to services and good follow-up. Ensure good communication of procedural results in a timely manner. This is good practice for any physician who refers patients to you. You should also establish appropriate relationships with local industry representatives, as they can offer expertise on inventory, help train staff, and provide access for rapidly evolving technology.

Quality: Review your procedural outcomes frequently, and make sure you maintain the highest level of care and safety. Do not perform difficult or controversial interventions in your first two years. If you are faced with complex decisions or interventions, collaborate with an endovascular surgeon or an experienced interventionalist.

Critical Limb IschemiaAfter you become comfortable performing and managing

more complex PAD lesions, you could begin to incorporate

critical limb ischemia (CLI) into your program. CLI is one of the most devastating complications of

advanced PAD. It is responsible for 185,000 amputations per year in the United States. As more interventional treatment options are becoming available and our understanding of revascularization techniques for infrapopliteal vessels continues to advance, we have an opportunity to impact CLI outcomes by improving limb salvage rates.

The first step in integrating CLI treatment into your program will be to educate your own team. Nurses, medical assistants, and front desk staff should be educated regarding the impact of this illness and the importance of treating patients promptly. The whole team needs to understand that patients with rest pain, ischemic ulcers, or gangrene should be identified and treated urgently. Train your staff to prioritize these patients similar to those who call with chest pain and to schedule accordingly.

It should be routine for all patients to be instructed to remove shoes and socks during their first visit. Staff should receive proper training in wound dressing removal and re-dressing techniques, and a Doppler ultrasound should be readily available.

If your practice is in a hospital environment, you should educate and inform primary care physicians, wound care and infectious disease specialists, podiatrists, endocrinologists, orthopedic surgeons, neurologists, and nephrologists about the type of work and level of expertise that you are able to provide. Lectures, grand rounds, as well as lunch and dinner programs are excellent tools for introducing other clinicians to CLI diagnosis and management.

Strategies for raising awareness of PAD and your services include free screening programs, community seminars, local media outreach, and collaboration with your community service liaison and hospital foundation.

Finally, it is crucial that you and your team stay current. Attending relevant PAD conferences is critical and, as you expand into treatment of CLI, participating at wound management conferences can improve your approach and understanding of your patients. If you want to be considered a thought-leader and pioneer during this revolutionary stage in PAD and CLI management, you must also participate and contribute to clinical research as well as educate fellows. n

Dr. Sokol directs cardiac catheterization and endovascular services at the Jacobi Medical Center in the Bronx, NY, and is the assistant program director for the cardiology fellowship training program for the Albert Einstein College of Medicine / Montefiore Medical Center. Dr. Diaz is an interventional cardiologist at the Metro Heart and Vascular Center at Metro Health Hospital in Grand Rapids, MI. Both are members of SCAI’s Interventional Career Development Committee.

How to Start Your PAD and CLI ProgramsBy Seth Sokol, M.D., FSCAI, and Larry Diaz, M.D., FSCAI

Seth Sokol, M.D., FSCAI

Early Career

Larry Diaz, M.D., FSCAI

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NEW MEMBER TYPE: SCIENTIST MEMBER1. Doctorate in a relevant scientific field, and2. Works regularly in the area of cardiac and/or

endovascular angiography and/or interventions

Scientists who are qualified are encouraged to apply for Membership/Fellowship in the Society.

MEMBER1. Board eligible for subspecialty in country of practice; if

no such formal certification exists, then satisfaction of #2 below will suffice

2. 12 months of appropriate training in cardiac and/or endovascular angiography and/or intervention, or in a related field (including non-invasive fields)

3. Practice and perform cardiac and/or endovascular procedures (or related medical care) with an appropriate level of skill and judgment and acceptable success and complication rates

4. Unrestricted privileges to perform cardiac and/or endovascular procedures or in their area of expertise

FELLOWSHIP: TWO PATHWAYS Fulfill the requirements of one of the following two pathways:

Pathway #1 (intended for invasive / interventional cardiologists):

Have met all requirements in the “Member” category above, AND meets at least one of the following conditions:1. Been in practice for 5 years and performed a combined

total of 2,000 diagnostic and/or interventional procedures after training; OR

2. Achieved ABIM or AOBIM certification in Interventional Cardiology and been in practice one year and performed 100 interventions as primary operator (post training); OR

3. (For pediatric/congenital interventional cardiologist) Performed a combined total of 400 diagnostic and/or interventional procedures (post training)

Pathway #2 (intended for non-physician scientists or non-invasive physicians):

Have met all requirements in the “Member” category above AND have demonstrated meeting at least two of the following criteria:1. Have substantive number of relevant peer-reviewed

articles2. Minimum of 10 national and/or international conferences

as faculty3. Held one or more leadership positions in the field, such

as service in a relevant professional society, academic/research institution, or certification examination contributor

SCAI's Credentials Committee will apply these new criteria when reviewing applications received on or after Jan. 1, 2012. If you have any questions or concerns, contact Credentials Committee Chair Barry Uretsky, M.D., FSCAI, at [email protected] or Membership Manager Andrea Hickman at 202-683-9182 or [email protected].

SCAI Changes Criteria for Membership

At SCAI’s 2011 Annual Business Meeting in Baltimore, MD, SCAI Fellows and Senior Fellows approved important changes to the Bylaws with regard to criteria for membership in the Society. The first of these three changes updates the Bylaws terminology to reflect the expanded scope of interventional practice (including endovascular procedures uncommon at the time of the Society’s founding). The second set of changes enables the Society to invite a highly select group of Ph.D. scientists and closely aligned physicians (such as vascular specialists and surgeons who perform interventions) to apply for SCAI Fellowship. Third, SCAI slightly revised the requirements for Fellowship to reflect the Society’s deep commitment to quality and excellence. These changes do NOT impact the membership status of current SCAI members (any membership category).

In accordance with these changes, the Board of Trustees subsequently approved modifications to the criteria for the following membership categories:

Credentials Committee Members:Barry F. Uretsky, M.D., FSCAI, Credentials Committee ChairJeffrey Cavendish, M.D., FSCAI Neil Cumpston, M.D., FSCAI Liliana Grinfeld, M.D., FSCAI Tarek Helmy, M.D., FSCAI Ziyad Hijazi, M.D., MPH, FSCAI William LaFoe, M.D., FSCAI Huay Cheem Tan, M.D., FSCAI Rita Watson, M.D., FSCAI Gerald Werner, M.D., FSCAI