Large Cardiac Registries: The Path to Higher Quality and Lower Cost in Our Healthcare System

This observer agrees with Stanford economist Victor Fuchs that the 3 major reasons to undertake systematic reform of the US healthcare system are (1) to provide coverage for the uninsured, (2) to correct significant lapses in quality, and (3) to control the high and rapidly increasing cost of care.1 The “how to” for achieving each of these objectives is clear. It merely requires defining who is to be covered under universal coverage, insisting that we have “effective care,” and deciding the best way to achieve payment reform. On the other hand, the devil is in the details, as became abundantly clear during this past year of congressional debate before the passing of the Patient Protection and Affordability Act. Of the 3 issues cited, coverage is the most clearly addressed in this legislation, although, as it now stands, some millions of uninsured will still remain. The other 2 issues, quality and cost of care, appear the most threatening. Michael Chernow of the Harvard Department of Health Care Policy, in discussing the increasingly larger annual deficits ($1.3 trillion dollars in 2010) and their resultant debt burden ($8.8 trillion at the end of 2010), representing 60% of the gross domestic product, underscores how unsustainable these figures are and cautions that the result will be a financial Armageddon.2 Accordingly, it is imperative that we members of the cardiovascular community provide workable solutions to improve quality and reduce the cost of care because, if we fail, it will bankrupt us.Article see p 2635 In this regard, and equally pertinent to the “devilish details” accompanying health reform law (PL 111–148; PL 111–152), is an informative article published in this issue of Circulation by Hannan and colleagues.3 This “tale of two cities” examines differences in utilization rates, practice patterns, and facilities available for …