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November/December 2006

The Society for Cardiovascular Angiography and Interventions

Deadline: Nov. 30, 2006

SCAI Accepting Abstracts for 30th Annual Scientific Sessions

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he deadline for submitting abstracts for SCAI’s 30th Annual Scientific Sessions is fast approaching, and Program Chair Ted Feldman, M.D., FSCAI, and Co-chair George Dangas, M.D., Ph.D., FSCAI, are urging physician-investigators to visit www.scai.org and deliver their abstracts before the Nov. 30, 2006, deadline. The Program Committee will consider abstracts in a variety of topic areas (see Table 1) and will recognize the best three abstracts with awards. The best abstract will be selected from among the top 10 highest-scoring oral submissions in a special presentation during the Scientific Sessions, and all accepted abstracts will be published in the May 2007 issue of Catheterization and Cardiovascular Interventions. Abstracts will also be displayed on plasma screens in a continuous slide show, a feature that was very successful at last year’s meeting in Chicago.

Marking 30 Years of Education Physicians Can Use SCAI will hold the 2007 Scientific Sessions May 9–12 in a city ideal for celebration: Orlando, FL, home of Disney and a spectacular array of accompanying

© Disney

family-friendly attractions. It’s a fitting place to commemorate a major anniversary – in this case, the Society’s 30th year of delivering practical, relevant education that physicians can use immediately in their care of cardiovascular patients. (continued on page 2)

Advocacy Call to Action

Important Medicare Fee Schedule News: Call Congress Today to Avert Cuts!

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s the new year approaches, SCAI and the rest of the physician community have redoubled efforts to get the Medicare fee schedule fixed before across-the-board 5.1 percent fee cuts take effect Jan. 1. Crucial to the effort is the engagement of individual physicians, which is why SCAI, ACC, AMA, and other professional medical societies are urging all of their members to contact their elected representatives as soon as possible. What should doctors tell Congress? For starters, say SCAI Advocacy Committee Co-chairs Joseph D. Babb, M.D., FSCAI, and Carl Tommaso, M.D., FSCAI, tell the people who represent you that the sustainable

growth rate (SGR), the formula used to calculate the fees physicians receive for treating America’s seniors, is deeply flawed. Stress that only Congress can intervene to prevent deep cuts slated to take effect Jan. 1, 2007, and that failure to avert these cuts makes it more and more difficult for physicians to provide the high-quality care all patients deserve. On their Web sites, the ACC (http://www.acc.org/ advocacy/legislators/legislators.htm) and the AMA (http:// capwiz.com/ama/home/) maintain easy-to-use portals that link physicians directly to the elected officials in their districts. “Connecting with those who can enact (continued on page 3)




SCAI Scientific Sessions (continued from page 1) This prevailing theme, of “education you can use,” brought last year’s meeting in Chicago accolades from invasive and interventional cardiologists in all stages of their careers, stressed Dr. Feldman, who returns for another year at the head of the Program Committee. He told SCAI News & Highlights that longtime favorites are returning, including – • Judkins Cardiac Imaging Symposium, chaired by Past President Warren K. Laskey, M.D., FSCAI; • Congenital Heart Disease Interventional Program, chaired by Evan Zahn, M.D., Ph.D., FSCAI, and David G. Nykanen, M.D., FSCAI; • Interventional Training Directors’ Symposium, chaired by Past President Joseph D. Babb, M.D., FSCAI; and • Peripheral Symposium, chaired by David Kandzari, M.D., Ph.D., FSCAI, and Steven R. Bailey, M.D., FSCAI. Also back again will be the enormously popular Hemodynamic Symposium that debuted last year to rave reviews. “The only thing we heard from attendees of the Hemodynamic Symposium was to be sure the room could accommodate more people, so that’s what we’re doing,” said Dr. Feldman. Zoltan S. Turi, M.D., FSCAI, and SCAI Past President Morton J. Kern, M.D., FSCAI, will return as the chairs of this unique symposium focused on providing attendees with a thorough update and refresher on the foundational skills in interventional cardiology. “That has always been one of the greatest strengths of the SCAI Annual Scientific Sessions,” said Dr. Feld-

man. “Physicians will get the right mix of the basics – imaging and hemodynamics, for example – alongside the practical and cutting-edge.” Also returning after last year’s very successful first showing will be the Fourth Annual Interventional Fellows Complex Coronary Complications (C3) Summit, chaired by SCAI Past President Jeffrey J. Popma, M.D., FSCAI. The C3 Summit provides graduating interventional cardiology fellows an opportunity to present their toughest cases and complications to an esteemed faculty of moderators. Cordis, a Johnson & Johnson company, is again providing an educational grant so that eligible fellows can attend the C3 Summit with their annual meeting registration fees, coach airfare, and hotel accommodations covered. The 30th Anniversary Annual Scientific Sessions will also launch what is sure to be a new favorite among attendees: a special course on coronary CT imaging, organized and chaired by Past President John McB. Hodgson, M.D., FSCAI, who has led SCAI’s continuing medical education efforts in the ground-breaking imaging modality (see p. 8).

Announcing … the Keynote Speakers Adding to the meeting’s perfect mix are the speakers who will deliver the Founders’ Lecture and the Hildner Lecture. Alain Cribier, M.D., Chief of Cardiology at the University Hospital in Rouen, France, will give the Founders’ Lecture on Thursday, May 10. Dr. Cribier has been an innovator in catheter therapy for valve disease for two decades. He pioneered aortic valvuloplasty; developed percutaneous mitral commissurotomy with the metallic valvulotome; and is the Table 1. SCAI 30th Anniversary Annual Scientific inventor of the Cribier-Edwards aortic Sessions: Abstract Categories heart valve, which made headlines earlier this year when it was implanted in Acute Coronary Syndromes and Miscellaneous the first U.S. patient enrolled in the RE Myocardial Infarction Neurovascular, Carotid, and Stroke VIVAL clinical trial. The experimental Intervention Adult Congenital Heart Disease device may well offer hope to thousands Angiogenesis, Myogenesis, Cell Therapy, Non-Invasive Imaging of patients who have heart valve disease and Gene Therapy Pediatric but are ineligible for open-heart surgery. Atherectomy/Plaque Modification Pharmacotherapy Unlike conventional valve-replacement Carotid Revascularization PTCA surgery, the percutaneous procedure can Complex PCI Restenosis be performed on a beating heart via a Contrast agents Stents Thrombectomy and Distal Protection femoral percutaneous route. Recovery CTO time from the percutaneous treatment is Devices Drug-Eluting Stents reduced from months to days, with less Endovascular and Peripheral Interventions Valvular Interventions (Excluding Neurovascular Intervention) Vascular Access and Arterial Closure worry about surgical morbidity. Devices Imaging: CT and MR Delivering Friday’s Hildner Lecture Intravascular Imaging/Physiology Vulnerable Plaque will be Donald Baim, M.D., FSCAI, Interventions for Myocardial Infarction Women’s Healthcare who is the Executive Vice President and Left Main and Multi-Vessel Intervention Chief Medical and Scientific Officer at Boston Scientific Corporation. Before




joining Boston Scientific a few months ago, Dr. Baim was Professor of Medicine at Harvard Medical School, Senior Physician at the Brigham and Women’s Hospital, and an internationally recognized leader in interventional cardiology who specialized in the development and evaluation of new interventional cardiovascular devices since the introduction of balloon angioplasty. Dr. Baim has been the national principal investigator on dozens of clinical trials in interventional cardiology, and a founder or key consultant for more than 20 start-up companies and medical device incubators in areas ranging from embolic protection, thrombectomy, chronic total occlusions, arterial closure, novel stents and coatings, heart failure, and percutaneous heart valves. Stay tuned to scai.org and future issues of SCAI News & Highlights for announcements on the topics to be discussed by these two distinguished interventionalists.

“By bringing attendees together with faculty of absolutely the very best caliber from all over the world, we get conversations that make SCAI’s meeting unlike any other I attend,” said Dr. Feldman. “That feeling of intimacy takes us a long way toward our goal of ‘education you can use.’” Of course, there are also times of planned socializing, such as during the Presidents’ Reception, when the Exposition takes on a convivial atmosphere. Attendees catch up with colleagues and make new acquaintances, while visiting the booth displays at their leisure. Another always eagerly awaited event is Friday evening’s Annual Banquet, which takes attendees off-site for a wonderful dinner in a fun-filled, relaxing atmosphere. Check scai.org for up-to-the-minute news and information on this and other special 30th anniversary festivities to be announced.

Preserving SCAI’s Intimate Atmosphere Since the first Scientific Sessions, when attendance numbered in the double-digits, to last year’s gathering, when some 1,300 assembled for “The Best of the Best in Interventional Cardiology,” SCAI’s Scientific Sessions have always been stamped with a signature collegiality.

Register Today! Before you turn the page, be sure you’ve marked May 9–12, 2007, on your calendar for the SCAI 30th Annual Scientific Sessions in Orlando. Take a few minutes, too, to submit an abstract and to register online at www.scai.org. n

Medicare Fee Schedule (continued from page 1) both short-term and permanent changes to the way fees are calculated is as easy as typing in your zip code,” said SCAI’s Senior Director for Advocacy and Guidelines Wayne Powell. A permanent solution is the goal, stressed Dr. Tommaso. “If this call to action is starting to seem familiar, it’s because SCAI, and the medical community as a whole, has been fighting this battle for years,” he explained. “Last year, we achieved a temporary reprieve from the threatened cuts when the Deficit Reduction Act was passed. But that was like putting a bandage on the wound. While a short-term fix would be acceptable to get us into 2007, we need to get beyond patch-type solutions and achieve real reform.” Real reform will be hard to accomplish in an election year, noted Mr. Powell, but it’s important to stay focused on this issue and make sure incumbents and non-incumbents alike understand the dangers inherent in allowing these cuts to be made. The bottom line for physicians is fee cuts, year after year, through 2015, amounting to a potential total of 37 percent reductions over nine years. “Such cuts are completely unacceptable in any scenario, but their effects will be further compounded if, as projected, the costs we incur in providing care increase by 22 percent,” said Dr. Tom-

maso. “This is a health care access crisis in the making.” To members, Dr. Babb reiterated this urgent request: “Call your elected Congressional representatives today. There’s no time to spare on this issue.” For more information and analysis of the proposed 2007 Medicare fee schedule, see page 12. n

Talking Points What’s wrong with the SGR? » The SGR does not accurately reflect the cost of providing care to Medicare beneficiaries. It does not account for changes and improvements in technology, shifts in the site of service, and the changing demographics of the Medicare population. » The cost of drugs delivered in physician offices is inappropriately included in the payment formula. What should Congress do? » In the short term, halt the scheduled 5.1 percent fee cuts slated for Jan. 1, 2007. Instead, enact a 2.8 percent increase for 2007, as recommended by the Medicare Payment Advisory Commission. » In the longer term, take steps to repeal the SGR and replace it with a formula that protects Medicare beneficiaries’ access to care.




message from the president

Pay for Quality: In Brief

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have dedicated two President’s Pages in CCI to the issues and challenges that will accompany Medicare’s implementation of a pay-for-performance (P4P), or pay-for-quality (P4Q), program. SCAI’s Senior Director for Advocacy and Guidelines, Wayne Powell, coauthored the Pages and, from his monitoring of activities in Washington, tells me that key congressional leaders continue to push toward P4Q and that mandatory quality reporting may be tied to any relief from pending physician fee reGregory J. Dehmer, ductions. The consensus is that P4Q M.D., FSCAI is on the horizon.

Background, and How SCAI Fits In The Medicare Payment Advisory Committee (MedPAC) has advised Congress to establish a quality incentive payment policy for hospitals, home health agencies, and physicians who treat Medicare patients. MedPAC’s recommendations have gained a following among other groups whose stated goal is to improve patient care – a priority that we share. As currently envisioned, the payments that physicians receive for treating Medicare patients will be affected by the ability to document that the care delivered meets specific performance standards. As in all issues with the potential to affect interventionalists’ ability to deliver optimal care, SCAI is actively engaged in the P4Q issue. Our goal is to assist the healthcare system to implement strategies that improve outcomes for our patients. While the goals of P4Q intersect with SCAI’s mission and quality agenda, SCAI is concerned about how the Centers for Medicare and Medicaid Services (CMS) will design and implement such a program. In addition to its own advocacy efforts, the Society is a voting member of the American Medical Association’s Physician Consortium for Performance Improvement. We are encouraging dialogue about proposed P4Q programs and are urging CMS and its advisory bodies to carefully consider the devils that lie in the details of such quality improvement efforts. Devilish Details The fundamental concern about P4Q programs is that measuring “quality” in the real world of medicine is neither clear-cut nor easy. The challenges faced in developing an acceptable physician-level P4Q program can divided into issues of (1) developing appropriate performance measures and (2) implementing a fair system for implementation.

Consider, for example, door-to-balloon (D2B) time – in many ways an appropriate measure of quality but nevertheless a complex variable because it is affected by multiple factors, many system-related or otherwise not directly related to the interventionalist’s performance. Any P4Q program that uses D2B time metrics must crisply define this term. Another potential problem is that measures like this one do not exist in isolation from the full range of care. An interventionalist can achieve an excellent D2B time, but the patient may experience less-than-optimal outcomes because of problems at discharge or during follow-up. Even after grappling with the complexities of developing fair and appropriate performance measures, there remain challenges of implementation. A great deal will need to be done to establish a system that is appropriately risk-adjusted and to enact data-collection methods that are neither cumbersome nor expensive. CMS will need to take care to make sure physicians will not feel apprehensive about treating patients whose outcomes could lower their quality scores. Other issues crucial to fair implementation of P4Q include auditing to ensure the integrity of the findings and statistical relevance.

What’s Next? To be sure, if a P4Q program is implemented in Medicare, the “scores” physicians receive will find their way into the public domain, which has unintended consequences. I assure you that SCAI is working diligently on this issue. We will keep you informed. Please write to me at president@scai.org n SCAI News & Highlights is published bimonthly by The Society for Cardiovascular Angiography and Interventions 2400 N. Street, NW, Washington, DC 20037 Phone 800-992-7224; www.scai.org; info@scai.org Gregory J. Dehmer, M.D., FSCAI President Morton Kern, M.D., FSCAI Editor-in-Chief Betty Sanger Andrea Hickman Sponsorship and Publications & Committee Development Operations Coordinator Bea Reyes Director, Education Wayne Powell Senior Director, Advocacy and Guidelines

Rick Henegar Director, Membership and Meetings Kathy Boyd David Managing Editor

Norm Linsky Executive Director

Touch 3 Design & Production

Sarah Jones Membership Coordinator

Imaging Zone Printing




SCAI, GE Healthcare Name Recipients of 2006 Invasive Cardiology Grant Program

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t SCAI’s 29th Annual Scientific Sessions in Dr. Garcia will conduct a validation study on the Chicago, the Society and GE Healthcare an- role of multi-slice CTA-based three-dimensional renounced the latest recipients of their Fellows construction in the planning of percutaneous coronary Grant Program in Invasive Cardiology. Now in its sec- interventions. This seminal work may allow intervenond year, the fellows program is designed to provide tional cardiologists to understand coronary blockages grants to invasive/interventional cardiologists-in- and to decide ahead of time which tools will be most training for outstanding contributions to angiography effective and safe for the patient. and diagnostic imaging research. John Dinh Vu, M.D., of the University of California in SCAI Accepting Proposals for 2007 Program Irvine, and Joel Alberto Garcia, M.D., of the University SCAI is currently accepting applications for the of Colorado at Denver, were 2007 SCAI/GE Healthcare each presented with a grant Fellows Grant Program in for $20,000 to support their reInvasive Cardiology. To be search in the coming year. considered, proposals must be “The proposals of these submitted online at www.scai. researchers show great poorg by Jan. 18, 2007. tential for furthering the Successful applicants demfield of imaging technoloonstrate medical excellence gies in invasive cardiology,” in cardiovascular research, said Steven R. Bailey, M.D., focusing on quality in diagFSCAI, who co-chairs the nostic imaging and invasive SCAI/GE Healthcare Felcardiology. The recipients lowship Awards Committee are chosen by the SCAI/ with Neal Kleiman, M.D., GE Healthcare Fellowship FSCAI. “SCAI is pleased to Awards Committee. partner with GE Healthcare Awards are divided into to encourage physicians-inthree categories: six to eight training to pursue careers in applicants are selected to reacademic medicine and to ceive $2,000 to write an arhelp fund promising new reticle on a proposed research search.” topic; four applicants are “This awards program reawarded a trip to SCAI’s Anflects SCAI’s and GE Healthnual Scientific Sessions and a care’s shared commitment to two-year SCAI membership; fostering excellence in patient and two of these final four incare through investment in the dividuals receive a one-year careers of the next generation grant of $20,000 to support of invasive cardiologists,” said The 2006 SCAI/GE Healthcare Fellowship awardees: Drs. John Dinh their cardiology research. Vu (above, with Dr. Steven R. Bailey and GE Healthcare’s Candy Elizabeth Gottshall, associate Kuester) and Joel Alberto Garcia (below right, with GE Healthcare’s Applicants must be servbrand manager of Visipaque™ Dr. Rick Vitti). ing as fellows in an accredat GE Healthcare. “These reited invasive/interventional searchers demonstrate great cardiology training program potential for advancing our current understanding of recognized by the Accreditation Council on Graducardiology, and we’re pleased to be able to support the ate Medical Education and have the approval of their medical community by funding new research.” training program director. Grants are limited to reDr. Vu was chosen to receive an SCAI/GE Health- search conducted in the United States or Canada. care Invasive Cardiology Fellowship grant for his reFor more information about SCAI’s fellowship awards search evaluating atherosclerotic coronary plaques programs, contact Andrea Hickman at ahickman@scai. using 64-slice computed tomography angiography org, or call 800-992-7224. n (CTA) and virtual histology intravascular ultrasound.




SCAI Members On The Move Have you moved or changed positions recently? Do you know anyone who has? Drop us a note, and we’ll let your colleagues know. That’s the purpose of “Members on the Move,” our periodic column that spreads the word about members’ activities and accomplishments. “Members on the Move” shines the spotlight on members with new titles, new affiliations, new practices, …. Send your news to info@scai.org In recent months, SCAI has been pleased to hear from members #3,000 and 3,001, two early-career interventionalists who, back in 2004, completed their membership applications within seconds of each other at one of the Society’s many educational programs. Ajay Agarwal, M.D., and Ricardo Costa, M.D., have both completed their interventional cardiology fellowships and have enthusiastically moved into the next phases of their careers. Dr. Agarwal wrote, “I have moved from New York City to Dayton, OH, where I joined the Veterans Administration Medical Center affiliated with Wright State University as a faculty member.” He added Ajay Agarwal, M.D. that he is enjoying academic practice involving complex patients with comorbidities as well as interacting with veterans. “I also enjoy being actively involved in teaching residents and cardiolRicardo Costa, M.D. ogy fellows,” he said. “And I hope to continue my research activities in the future.” Meanwhile, Dr. Costa was enjoying the summer in Milan, Italy, where he is working with Antonio Colombo, M.D., FSCAI, on a series of prospective and regional pilot studies comparing techniques for treating bifurcation lesions. “This is a great opportunity to be the principal investigator of a trial,” he said. “I am honored to be participating in an effort to improve the techniques used

for treating bifurcation lesions and to enhance patient care.” When we talked to Dr. Costa, he was expecting to have primary results in time for the TCT meeting. “This is a very exciting project, and I’m grateful to Dr. Colombo for helping me to get the project going and serving as my mentor,” he said. He is also enjoying living in Europe for the first time. “We put in long days and work hard, but the city is very cosmopolitan and there is so much history everywhere you go,” he added. “And the food is unbelievable.” Dr. Costa plans to return to the United States and continue work as a clinical investigator at an academic medical center. S In his new position as the Associate Chief Research Officer for Clinical Studies at Geisinger Health System in Danville, PA, Peter B. Berger, M.D., FSCAI, is responsible for en­hancing and ex­panding clinical trans­lational research activities so that patients will benefit from new discoveries much sooner. The Geisinger Health System encompasses three Peter Berger, M.D., hospitals and 41 outFSCAI patient clinics, all of which are connected through an advanced electronic med­ical record and sophisticated data-management system. “I am enjoying collaborating with Geisinger’s team of clinicians and researchers as we explore the possibilities presented in a truly extraordinary setting. Geisinger’s relationship with its community and physicians, its stable patient base, and its sophisticated electronic medical records present outstanding clinical research opportunities.” Until recently, Dr. Berger was a professor of medicine, director of interventional cardiology, and codirector of Cardiac Device Research

at Duke University and the Duke Clinical Research Institute (DCRI) in Durham, NC. “When I came to DCRI and Duke, I thought I would retire from there. There is so much to learn from so many people at DCRI,” said Dr. Berger. “But I am thrilled to be at Geisinger: it’s a fabulous opportunity. I don’t know of a similar situation in the entire country.” S In mid-September, David Cox, M.D., FSCAI, began a new position at Lehigh Valley Hospital in Allentown, PA. He joined Lehigh Valley Heart Specialists, a newly formed hospital-owned cardiology group. He serves as Cath Lab Associate Director and is heading up Interventional Research. He told SCAI: “I am truly excited about joining a hospital with busy clinical volumes and a focus on the drive for exDavid Cox, M.D., FSCAI cellence. I believe a hospital-based practice model, done correctly with physician guidance and leadership, leads to great patient outcomes, allows involvement in clinical research and teaching, and lets me take care of patients without fractionation and fragmentation of care. I have a great set of new partners in a hospital with vision...only good things can come out of that!” Speaking of great things, in his capacity as co-chair of SCAI’s Education Committee, Dr. Cox is helping SCAI to develop and deliver continuing medical education programs on a diverse range of topics, all of great quality and relevance to members’ practice (see p. 15). S SCAI Past President and Editorin-Chief of this publication Morton J. Kern, M.D., FSCAI, has accepted a new position as Associate Chief of Cardiology at the University of California, Irvine (UCI). “My move from pri-




vate practice back to academics completes a work cycle that few physicians have the honor and pleasure of pursuing,” he said, adding that he missed the Morton J. Kern, “stimulation of teaching M.D., FSCAI and research.” During his time in private practice, he “made many new friends and obtained an understanding of the region’s cardiology practices,” he said. “This helps me to bring a new vision and understanding into the now-expanding Division of Cardiology at UCI. I look forward energizing the division and sharing my experiences with my new colleagues, fellows, and staff.” Dr. Kern is also the proud author of the recently released SCAI Interventional Cardiology Board Review Book, published by Lippincott, Williams & Wilkins. The new volume features the work of Section Editors Peter Berger, M.D., FSCAI, Peter Block, M.D., FSCAI, Lloyd W. Klein, M.D., FSCAI, Warren K. Laskey, M.D., FSCAI, and Barry F. Uretsky, M.D., FSCAI.

S After ten years at the Washington Hospital Center, John R. Laird, Jr., M.D., FSCAI, has moved to the University of California–Davis in Sacramento. Dr. Laird’s new title is Director of the Vascular Center. He is looking forward to working closely with the vascular surgery, interventional radiology, interventional nephrology, and cardiothoracic teams to establish a truly multidisciplinary collaborative John R. Laird, Jr., M.D. vascular center. He told Endovascular Today, “We are going to share clinic space, we will see patients together, perform treatments in the office, and have call schedules and conferences together. It will be a real opportunity to establish something unique.” Dr. Laird also stressed that he and his family are looking forward to new experiences in California: “Part of this move was about lifestyle and the hope that I will be able to spend

more time with my kids outdoors, … We are looking forward to playing more outdoor sports, camping, and hiking … things that were tough to do while living in the city.” S After 30 years at the Veterans Administration in Arizona, where he was the principal investigator on the AWESOME trial, Douglass Morrison, M.D., Ph.D., FSCAI, has formally retired and resettled in beautiful Yakima, WA, with his wife Joanne. He has joined Yakima Heart Center, the fourteen-physician practice that serves the Douglass Morrison, region. When we M.D., Ph.D., FSCAI talked to him during the Society’s 29th Annual Scientific Sessions, he was looking forward to the change, “Thirty years with the VA was a good Peace Corps for me, a good way for me to pay back the veterans who served in Vietnam while I was in medical school,” he said. “I’ve had the honor of being a professor at two different universities, too. I’ve accomplished what I set out to do at the VA. Now the adventure will be to bring to private practice what we learned from AWESOME trial, specifically that patients at the highest risk can benefit from PCI.” S William O’Neill, M.D., FSCAI, is the new Executive Dean for Clinical Affairs at the University of Miami Miller School of Medicine, where he is expected to play a critical role in ambitious plans to develop new clinical programs, establish a network of health care sites in the region, and enhance access to South Florida’s only academic medical center. “I am truly excited to William O’Neill, M.D., FSCAI join the senior leadership at the University of Miami Miller School of Medicine,” said Dr. O’Neill. “The opportunity to

create a world-class, internationally recognized health system is fantastic, and I look forward to working with physicians at the Miller School of Medicine and in the greater community to improve healthcare for the entire region.” Previously, Dr. O’Neill was the Director of the Division of Cardiovascular Disease at William Beaumont Hospital in Royal Oak, MI. S This summer, Carlos Ruiz, M.D., Ph.D., FSCAI, joined Lenox Hill Hospital in New York City as the Director of the Structural and Congenital Heart Disease Program. The move follows 21 years at Loma Linda University and, more recently, 7 years as the head of the Department of Pediatrics at the University of Chicago. Dr. Ruiz is excited about his new post at Lenox Hill Hospital in part Carlos Ruiz, M.D., Ph.D., FSCAI because it reunites him with partners who have been his friends for more than a quarter-century. It also eliminates a lengthy commute to see his wife, who is a neonatologist at Lenox Hill Hospital. In addition to the new position, Dr. Ruiz started his term as a Trustee of SCAI this summer. He is eager to work with SCAI and other societies to address the challenges of treating children with congenital heart disease. (See p. 10 for an update on the working group he is co-chairing to improve the approval process for medical devices for pediatric patients.) “There is nothing like treating children,” he said. “We cannot necessarily effect a cure, but we can make them better, give them better quality of life, and make them happier. That has no price.” n


THANK YOU



CT UPDATE SCAI’s Cardiac CT Courses, Timely as Ever

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t press time, SCAI was making final preparations for the Oct. 4–6 Cardiac CT and CT Angiography programs. Both the more didactic Focused Training for Cardiologists and the workstation-centered Learning by the Cases components of the program had drawn attendees interested in developing their skills in this new high-tech modality for evaluating patients with cardiovascular disease. SCAI Past President John McB. Hodgson, M.D., FSCAI, and Matthew J. Budoff, M.D., FSCAI, direct the Focused Training course, which SCAI debuted over a year ago in Phoenix and has since offered periodically. Past attendees praise Focused Training for its informational lectures paired with practical, hands-on break-out sessions. Drs. Hodgson and Budoff deliberately limit attendance, capping it at about 200, so that physicians get plenty of time for interaction with faculty and time to manipulate the two-dimensional axial CT slices into three- and four-dimensional images. As director of the optional case-review session that immediately follows Focused Training, Robert S. Schwartz, M.D., FSCAI, adjusts the cases analyzed to match the experience and training levels of the attendees. As reported in the August/September 2006 issue of SCAI News & Highlights, Dr. Schwartz’s Learning by the Cases program garnered local newspaper headlines when he and his team held the course in Minneapolis in mid-June. All three program directors — Drs. Hodgson, Budoff, and Schwartz — concur that learning by doing is the key to both mastering CT workstation pro-

Cardiac CT and CT Angiography – Focused Training for Cardiologists and Learning by the Cases: An Optional Case Review Course

Oc tober 4–6, 2006 The Society for Cardiovascular Angiography and Interventions expresses deep appreciation for the generous support from the following companies:

GE Healthcare Philips Medical Systems TeraRecon, Inc. Toshiba America Medical Systems, Inc. Vital Images, Inc. Appreciation is also expressed to the following companies for in-kind support of educational workstations for the program:

TeraRecon, Inc. Vital Images, Inc.

Philips Medical Systems GE Healthcare ficiency and analyzing images in three dimensions. SCAI plans to offer Learning by the Cases again in 2007. Visit www.scai.org or call 800-992-7224 for news on dates and locations. These courses fills up, so it’s important to register early. n

Successful Simulation Training Confirms Value of SCAI’s Model for Introducing High-Risk Technologies

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n September, three interventional cardiologists completed the SCAI’s unique training program for carotid artery stenting (CAS). They participated in the Society’s novel first simulation program in CAS, the third tier in a new model for helping physicians achieve proficiency in newly introduced high-risk procedures and technologies. Having already completed SCAI’s Core Curriculum in CAS (tier 1) and the Society’s online self-assessment program, which includes a comprehensive test on the knowledge required to successfully perform CAS (tier 2),

SCAI is grateful to

Cordis Endovascular, a Johnson & Johnson company, for its generous support of SCAI’s carotid stenting educational initiatives.

the physicians spent two days at Emory University’s Angiographic Simulation Training (EAST) Center in Atlanta. There they observed live cases and, working closely under the guidance of three SCAI leaders, completed multiple cases on the simulators. Each physician successfully completed and met established proficiency benchmarks set as minimum technical competency in the new procedure. “The benchmarks and metrics are the key to effective simulation training, which trains physicians to successfully perform new highly technical procedures, like CAS, on patients,” said Program Director Christopher U. Cates, M.D., FSCAI. “As they are performing the procedure, the simulators give them proximate feedback on errors they are making, so that they can correct a mistake right then and there and improve


their skills right then and approach to teach phythere. They can practice sicians new procedures the procedure until they and evaluate their profiget it right.” ciency,” said SCAI PresiDr. Cates was joined dent Gregory J. Dehmer, by SCAI Past President M.D., FSCAI. “This is Michael J. Cowley, M.D. an important first for carFSCAI, and Presidentdiology and is a model Elect Bonnie Weiner, M.D., for how new procedural FSCAI, in mentoring the training should be done.” three participants, each of SCAI plans to ofwhom praised all three tiers fer the next simulation of the educational model. training period in late The components of the pro- Of simulation training, one participant said, “Drs. Cates, Cowley, and Weiner 2006. Enrollment is limwere awesome. Learning in a risk-free environment that is so close to reality is gram “fit together well and great. “I would absolutely recommend this to colleagues,” said another partici- ited to physicians who are in the right order,” said pant, of SCAI’s training program for new, high-risk procedures. have attended the Core one participant. Curriculum and passed Said another participant, the final exam in the onof the educational model: “The didactic Core Cur- line self-assessment program. Attendees are selected *As of Aug. 25, 2006. riculum took us from the basics, and the online course on a first-come, first-served basis. To maximize the walked us through the nuances, such as patient selec- potential for mentoring, only a small number of phytion and device selection, which are not easily available sicians can participate in each training session. Stay any other way. Those prerequisites made the third step tuned to www.scai.org for news on how to register for more than simulation training because it built on the simulation training. n whole course.” Each of the three attendees achieved cognitive and technical proficiency during the training program, as demonstrated by the self-assessment tests built into the program. The Society will provide them certificates that they successfully completed the Curriculum, as well as CME credits, that they can share with the hospitals where they work. Now, with the success of the pilot program, SCAI is moving forward with plans for a number of regional simulation centers throughout the United States. “The idea is that physicians who have completed the first two tiers of the program will be able to sign up for a mentored simulation training session near where they practice and, in time, they’ll be able to return to the center to brush up on their skills as the technology evolves.” While the introduction of CAS was the impetus for SCAI to develop this new training model for new procedures, SCAI leaders expect that this novel approach to continuing physician education goes way beyond one procedure. “We expect that physicians will be able to use this tiered system of training to help in future procedures, such as percutaneous valve replacement procedures, PFO closure, therapies for acute stroke, and other high-risk technologies as they enter the U.S. medical marketplace,” said Dr. Cates. “The success of the pilot simulation program and the feedback attendees gave validates that the Society has developed a very well organized, effective novel

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ADVOCACY AND GUIDELINES UPDATE Advocacy Victory: SCAI Helps Hospitals Avoid Major Fee Cuts

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n a clear demonstration that persistent advocacy works, the Centers for Medicare and Medicaid Services (CMS) revised plans to drastically cut payments to hospitals for high-tech procedures such as implantation of drug-eluting stents (DES) and cardioverterdefibrillators. Instead, when the agency published its final rule on hospital payments in August, hospitals — and, by extension, the patients they serve — emerged relatively unscathed. In place of proposed 33 percent reductions in fees for stenting procedures, for example, the agency dropped fees by only 3 percent in the coming year. In addition, the conversion factor for all procedures will increase by 3.4 percent, resulting in a small payment increase for stenting procedures. CMS’s reversal on this issue is an advocacy victory, said SCAI Advocacy Committee Co-chair Joseph D. Babb, M.D., FSCAI. “All along, we advocated for fees that reflect costs. It is to CMS’s credit that officials listened to the medical community’s feedback on the proposed rule and rethought the payment reductions,” explained Dr. Babb. The agency’s change of heart followed a concerted advocacy effort by SCAI and other societies, including the Heart Rhythm Society, Society of Thoracic Surgeons, Society for Women’s Health Research, and AdvaMed. Among other efforts to avert the dramatic fee cuts, these groups hosted a joint news conference at Washington, DC’s National Press Club. Representing SCAI, Mark Turco, M.D., Mark Turco, M.D., FSCAI, warned that patient care FSCAI could suffer if hospitals were implicitly discouraged from innovative procedures because facilities are not appropriately compensated for the costs of the devices. He also pointed out that CMS’s proposed fee cuts had been developed using a flawed methodology and data collected in the pre-DES era. “Interventionalists will now be able to continue to provide the most technologically advanced treatments to our patients, those that have had such a dramatic impact on improving cardiac care,” said Dr. Turco. “Furthermore, newer and expensive technologies, such as newer drug-eluting stents, septal closure devices, and endovascular valves, will have an easier path into the hands of the interventionalist, allowing for even more dramatic advances in cardiac care in the future.” During the June 2006 news conference, Dr. Turco took questions from reporters representing a number of media outlets. SCAI also coordinated a joint

written response to CMS from multiple societies and submitted its own analysis of the flaws in the agency’s proposed rule. Other notable changes in the Final Rule include a reduction of only 5 percent, rather than the proposed 29 percent cut, for cardiac catheterizations performed in the absence of myocardial infarction. The agency has also separated carotid artery stenting (CAS) from carotid endarterectomy for reimbursement purposes, a move that increases payments for CAS by more than 30 percent.

The Fight Continues The story does not end here, however. Unfortunately, significant payment reductions are still possible over the next two years, particularly if costs reported by hospitals fail to support the fees now in effect. “It is very important for physicians to work with their hospital administrators to ensure that all costs are reported appropriately to CMS,” said SCAI Senior Director for Advocacy and Guidelines Wayne Powell. For additional background and updates on this issue, visit www.scai.org and click on “Advocacy.” Information there will include links to the most relevant postings and fee tables in CMS’s Final Rule. n

SCAI Working Group to Propose Alternative Approval Process for Pediatric Devices

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hen a baby is born with a congenital heart defect, physicians often face a quandary: using devices designed for adults or doing nothing at all. “Most of the devices we use we’re using off-label, so their safety and efficacy for the pediatric population haven’t really been proven,” said SCAI Trustee Carlos E. Ruiz, M.D., Ph.D., FSCAI, of the Lenox Hill Heart and Vascular Institute in New York. “In some cases, we don’t have access to devices that are readily available in Europe and other places.” Now Dr. Ruiz and others are working to increase physicians’ choices. He and Donald J. Hagler, M.D., FSCAI, of the Mayo Clinic, are chairing an SCAI working group that will explore alternative routes to standard Food and Drug Administration (FDA) approval of pediatric devices and push Congress to act. The working group is part of the SCAI Congenital Heart Disease Committee, chaired by Robert Vincent, M.D., FSCAI. The FDA requires rigorous testing of new devices before granting its approval. That requirement protects patients, but, said Dr. Ruiz, it also makes it nearly impossible to get approval for some devices that could help children with heart defects. (continued on page 12)


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Pediatric Devices (continued from page 10) For one thing, he said, the small number of patients with such defects makes it very difficult to conduct a trial with enough participants to actually prove a device’s safety and efficacy. Even if researchers could enroll sufficient patients, the process of conducting trials is lengthy and costly. “Companies would have to make a very significant investment,” explained Dr. Ruiz. “But because the potential market is very limited, they wouldn’t get a return on their investment.” The SCAI working group is determined to find a way to overcome these barriers. To explore possible solutions, the group convened a meeting at the Pediatric and Adult Interventional Therapies for Congenital and Valvular Heart Disease (PICS 2006) symposium in Las Vegas in September. PICS 2006 is an annual conference organized by SCAI Secretary Ziyad Hijazi, M.D., FSCAI (pics Meeting Chair); William E. Hellenbrand, M.D., FSCAI; Martin B. Leon, M.D., FSCAI; Gregg W. Stone, M.D., FSCAI; Ted Feldman, M.D., FSCAI; and Peter Block, M.D., FSCAI. The fact that Dr. Hijazi and his colleagues made time in the conference for the working group to come together attests to the seriousness of the problem, said Dr. Ruiz. So did the presence of representatives from the American Academy of Pediatrics and device manufacturers. Together the participants shared their diverse viewpoints and explored alternatives to the standard FDA approval process. One possibility, said Dr. Ruiz, is improving the humanitarian device exemption process the FDA uses to consider some devices for marketing. Another possible option would be to use objective performance criteria (OPCs). With this approach, an expert panel determines what level of complications and mortality would be acceptable and how many cases would be needed to prove safety; physicians would then report their cases to a registry. If the numbers were lower than the established baseline, said Dr. Ruiz, the device should be approved. At the Las Vegas meeting, participants agreed to broaden the working group beyond SCAI members to others committed to expanding available therapies for pediatric patients. They will develop formal recommendations for improving access to safe pediatric medical devices, which Dr. Ruiz will present to SCAI’s Board of Trustees. Joseph Babb, M.D., FSCAI, and Charles Mullins, M.D., FSCAI, have already met with Senate staff who are drafting a bill to improve access to safe pediatric medical devices. The exchange of ideas was very useful, and SCAI will be working closely with those staff as they refine their proposal. The

ultimate goal? Legislation that would free the FDA’s hands when it comes to pediatric devices. “There are some tremendous barriers at the FDA that hopefully could be resolved with legislation,” said Dr. Hagler. This hoped-for legislative solution is what makes buy-in from other groups imperative, added Dr. Ruiz. “While SCAI’s leadership role is absolutely pivotal, the Society can’t do it alone,” he stressed. “You have to have consensus from all the major groups to be credible to Congress.” n

2007 Medicare Fee Schedule: More News for Interventionalists

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t’s hard to get past the across-the-board pay cuts in the 2007 Medicare fee schedule (see p. 1), but interventional cardiologists will find a silver lining or two hidden among the advocacy challenges. First is the relatively good news about practice expense values, one of three key relative value units (RVUs) used by the Centers for Medicare and Medicaid Services (CMS) for every service that physicians provide to Medicare beneficiaries. Technical changes in the calculation of the practice expense values has tended to increase the relative values for in-hospital procedures, such as most stenting or angioplasty codes. Unfortunately, in-office procedures, especially the 3–5 percent of diagnostic catheterizations done in offices, are facing dramatic cuts. SCAI is working with those facilities to ensure that CMS fully recognizes all of the costs involved in providing such services in nonhospital settings. These practice expense changes are being phased in over four years and are generally positive for invasive/ interventional procedures. SCAI’s contractors developed some of the data used in the practice expense changes, which resulted in significant improvements in these RVUs. Changes in the work value units will significantly increase payments for evaluation and management procedures and result in as much as a 20 percent increase in physician payments for the time they spend evaluating a patient’s condition and conducting follow-up visits. “I think this will be a pleasant surprise for SCAI members,” said Senior Director for Advocacy and Guidelines Wayne Powell, “although it’s important to keep in mind that CMS has to keep its revisions revenue neutral. That means that the work values for most other procedures will see small declines.” Some in-office imaging procedures were specifically targeted for work value reductions as well. The final 2007 fee schedule is expected to be available by Nov. 1, 2006, and will be posted on scai.org as quickly as possible. n


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SCAI Participates in ER Consortium on ACS Performance Measures

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hen the American College of Emergency Physicians (ACEP) convened its Consortium for Quality Improvement, SCAI Advocacy Committee Co-chair Carl Tommaso, M.D., FSCAI, represented the interventional cardiology community. The working group is developing performance measures for treating acute coronary syndromes (ACS) and welcomed the expertise of their colleagues in other specialties. “The group spent considerable time disCarl Tommaso, M.D., cussing standards for emergency room FSCAI physicians who treat ACS, and they also discussed atrial fibrillation and syncope,” said Dr. Tommaso. “They appreciated SCAI’s participation. It is important for SCAI to be represented when topics pertinent to interventional cardiology are discussed.” n

Two Important Documents Coming Soon From SCAI

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t press time, SCAI’s official journal, Catheterization and Cardiovascular Interventions (CCI), was processing two important documents written by SCAI writing groups. • Slated to publish in November is Prevention of Contrast Induced Nephropathy: Recommendations for the High-Risk Patient Undergoing Cardiovascular Procedures, an expert consensus document developed by the Society’s Catheterization Laboratory Performance Standards Committee. The work was spearheaded by lead author Marc J. Schweiger, M.D., FSCAI, Committee Chair Charles E. Chambers, M.D., FSCAI, and Immediate Past President Barry F.

SCAI Laboratory Survey Program “Achieving Excellence in Cardiovascular Catheterization — A Service for Labs”

Uretsky, M.D., FSCAI. The recommendations in this document are the first from any medical society whose members regularly use radiographic contrast media. “Contrast induced nephropathy occurs in a minority of patients, but since we do so many procedures, it’s a major issue for us as interventionalists,” said Dr. Schweiger. “We thought, as a society that deals with these issues on a day-today basis, the time is right to come out with recommendations.” For details on the recommendations themselves, visit scai.org in November and watch for the next issue of SCAI News & Highlights. • Next on SCAI’s publication schedule is The Current Status and Future Direction of Percutaneous Coronary Intervention (PCI) without On-Site Surgical Backup, an expert consensus document authored by SCAI President Gregory J. Dehmer, M.D., FSCAI, James Blankenship, M.D., FSCAI, Thomas P. Wharton, M.D., FSCAI, Ashok Seth, M.D., FSCAI, Douglass Morrison, M.D., Ph.D., FSCAI, Carlo DiMario, M.D., FSCAI, David Muller, M.D., FSCAI, Mirle Kellett, M.D., FSCAI, and Immediate Past President Barry F. Uretsky, M.D., FSCAI. This final document grew out of an earlier effort launched by a working group that also included James Dwyer, M.D, FSCAI, Kirk Garrett, M.D., FSCAI, and Lloyd W. Klein, M.D., FSCAI. “The goal of this document is to improve the quality of coronary interventional care worldwide,” said Dr. Dehmer. The document will be published in a future issue of CCI and on www. scai.org. The Society’s recommendations regarding PCI without surgical backup will be featured in the next issue of this newsletter. Stay tuned. n

• Independent, Objective Analysis of Your Lab’s Strengths and Weaknesses • Undivided Attention of Experienced, SCAI-Identified Experts • Thorough Review and Assessment of All Aspects of Your Program • Same-Day Feedback: Constructive, Candid, and Complete • Comprehensive Written Report With Actionable Recommendations for Improvement • Findings Held in Strictest Confidence

You can contact SCAI, by phone: 800-992-7224, or by e-mail: www.scai.org


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IN THE TRENCHES

Cardiologist Hopes to Improve Future of Patient Care With Genomics

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imberly Skelding, M.D., FSCAI, has never been one to shy away from a challenge. Perhaps that’s why, at just 36 years old, she is one of the principal investigators on the CardioGene study, an NHLBI-supported research project looking at the genomics of in-stent restenosis.

tastic, it’s a challenge to make yourself better,” she says. However, she added, the challenges of treating coronary artery disease bring her back to reality. “It’s frustrating because, as cardiovascular experts, we treat but don’t ‘fix’ the disease progress,” she explained, adding that she keeps in mind some words of wisdom passed on by her new department chair, Dr. Frank Menapace: New Frontiers “We can make patients feel better, but it does not help The rationale behind the CardioGene study is that with the struggles that the patients have ahead, and genomics will not only help determine blood gene and we have a long way to go in curing coronary disease.” protein expression in patients with in-stent restenosis Dr. Skelding appreciates working in a great clinical but will also develop predictive gene and protein bio- practice and applauds a terrific research staff busy workmarkers and identify new targets for ing toward grants. At the end of treatment. Such new frontiers are the day, she’ll often sit and look not out of reach, predicted Dr. Skeldat what she’s accomplished and ing, who will present data from the say to herself, “Wow! I did that!” study at the 2007 American Heart She remembers asking a seasoned Association Scientific Sessions. “By colleague if that feeling ever goes using genetic markers, we’ll be able away. His reply has stayed with to figure out who to treat, who needs her: “It hasn’t gone away for me what the most, and who might be yet!” She hopes she’ll share his harmed from receiving a particular sentiment a long time from now. treatment,” explained Dr. SkeldIn addition to the support she ing, who is director of Cardiovasreceives from her colleagues and cular Genomics and Cardiovascular mentors, Dr. Skelding gives credResearch at Geisinger Center for it to her husband Darrin, who has Health Research at Geisinger Medirelocated all around the country cal Center in Danville, PA. with her. “We share the philosoPatients are currently enrolled in phy that we make wherever we the CardioGene study at the William are happy,” she says. “We honed Beaumont Hospital in Royal Oak, MI, our sailing skills while in Michiand at the Mayo Clinic in Rochester, Making happiness wherever she finds herself, Dr. Kimberly gan and became dogsledders in became a dogsledder when she was working at MN, two high-volume cardiac cathe- Skelding the boundary waters of Northern the Mayo Clinic. terization facilities. Dr. Skelding was in Minnesota while at Mayo.” Last her second year as a fellow at William summer she took a trip of a lifeBeaumont Hospital when she wrote the initial protocol time tracking mountain gorillas in Rwanda. “Ever since I for this study. She gratefully acknowledges mentors Drs. was an anthropology major in college, I have had an inElizabeth Nabel, William O’Neill, and David Holmes for terest in the work of primate experts such as Jane Goodsupport and guidance on this project. “Without their sup- all and Dian Fossey, so I had to see the places I had read port and the hard work of the entire CardioGene team,” about in college. she says, “such a project would not be a reality.” About 50 percent of Dr. Skelding’s time is spent with patients in the cath lab, and the other half she diA Humbling Disease vides between research and clinic. But she always finds In Danville, PA, where Geisinger Medical Center is lo- time to play with her dogs Theodore and Wally and cated, Dr. Skelding already has a busy interventional prac- enjoy dinner with Darrin and friends. She also hopes tice. “Starting out, I have found the skills I learned training to be able to take advantage of her home in the woods under the giants in interventional cardiology at William by doing some snow-shoeing and cross-country skiing. Beaumont and the Mayo Clinic have served me well. “It’s really nice to not battle traffic and be able to get When you work with cardiologists who are technically fan- home to see your family for dinner,” she said.


CME FROM SCAI AND PARTNERS SCAI-SPONSORED PROGRAMS

SCAI COSPONSORED PROGRAMS

SCAI FALL FELLOWS COURSE: CARDIOVASCULAR TECHNIQUES SUMMIT Date: Nov. 29–Dec. 2, 2006 Location: Las Vegas, NV Directors: Michael Cowley, M.D., FSCAI, Sheldon Goldberg, M.D., FSCAI, Daniel McCormick, D.O., FSCAI, and Bonnie Weiner, M.D., FSCAI Contact: 800-992-7224; www.scai.org

FIRST EUROPEAN FELLOWS’ COURSE Date: Nov. 16–18, 2006 Sponsors: Imperial College of Medicine and Royal Brompton Hospital Location Royal Brompton Hospital, London, UK Directors: Carlo Di Mario, M.D., FSCAI, and George Dangas, M.D., Ph.D., FSCAI For additional information, visit http://www.optionsglobal. com/london/default.asp

38TH ANNUAL CARDIOVASCULAR CONFERENCE AT SNOWMASS Date: Jan. 15–19, 2007 Location: Snowmass, CO Director: John H.K. Vogel, M.D., FSCAI, MACC Contact: 800-992-7224; www.scai.org

ICCA VI – 6TH COURSE ON CAROTID ANGIOPLASTY AND OTHER CEREBROVASCULAR INTERVENTIONS Date: Nov. 23–25, 2006 Sponsor: Convents, Congresses & Events Location: Frankfurt, Germany Directors: Horst Sievert, M.D., FSCAI For additional information, call +49 (0) 6106-28-67-880, fax +49 (0) 6106-28-67-882, email nkoebke@convents.biz, or visit http://www.iccaonline.org

22ND ANNUAL CARDIOVASCULAR CONFERENCE AT HAWAII Date: Feb. 12–16, 2007 Location: Kohala Coast, Big Island, HI Director: John H.K. Vogel, M.D., FSCAI, MACC Contact: 800-992-7224; www.scai.org SCAI 30TH ANNUAL SCIENTIFIC SESSIONS, JUDKINS CARDIAC IMAGING SYMPOSIUM, CONGENITAL HEART DISEASE INTERVENTIONAL PROGRAM, AND FOURTH ANNUAL INTERVENTIONAL FELLOWS COMPLEX CORONARY COMPLICATIONS (C3) SUMMIT Date: May 9–12, 2007 Location: Orlando, FL Chairs: Ted Feldman, M.D., FSCAI, George D. Dangas, M.D., Ph.D., FSCAI, Warren K. Laskey, M.D., FSCAI, Evan Zahn, M.D., FSCAI, David Nykanen, M.D., FSCAI, and Jeffrey J. Popma, M.D., FSCAI Contact: 800-992-7224; www.scai.org

SCAI, a Society With “Spirit” Dr. Skelding also devotes time to SCAI, which she describes as “a motivated society, small enough to keep in tune with its members and work together toward common goals.” She adds, “It keeps you motivated, when you see progress being made. There’s a real spirit in the group.” She cites as an example of that spirit the Society’s Interventional Career Development Committee, which she now co-chairs. “When the Society decided to start the Interventional Career Development Committee, I was ready to

ASIA-PACIFIC INTERVENTIONAL ADVANCES CONFERENCE 2006 Date: Nov. 30–Dec. 2, 2006 Sponsor: Asia-Pacific Interventional Advances Location: Sydney Convention and Exhibition Centre Directors: Rohan Jayasinghe, M.D., and Suku Thambar, M.D., FSCAI For additional information or to register, call +61-2-95187722, fax +61-2-9518-7222, email apia@conexion.com.au or visit http://www.apia.org.au ISHAC 2007 Date: June 27–29, 2007 Sponsor: Columbus Children’s Hospital Location: Columbus, OH Directors: John P. Cheatham, M.D., FSCAI, and Mark Galantowicz, M.D. For additional information, call 614-722-4939

be involved because I had worked with the AHA and ACC on similar committees. Mentorship is so vital to the growth and success of the next generation of interventionalists. It’s such a waste of time and talent to see bright, motivated individuals not be encouraged to reach their potential. In just one year, our new Career Development group accomplished the action items and goals identified as important by its members,” exclaimed Dr. Skelding. “It says a lot about the motivation and talents of this young SCAI committee, and I’m proud to be part of it.” n


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In the News Health Policy Decision-Makers Talk “Strategies for Success”

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t this summer’s Strategies for Success XV program in California’s beautiful wine country, cardiologists engaged in candid conversation about many of the challenges facing their practices. Among many timely topics addressed during the four-day CME program was the worrisome issue of how the Centers for Medicare and Medicaid Services (CMS) is revamping its reimbursement policies for the technical components of in-office imaging procedures. Just as SCAI has been actively engaged in the debate about cutting rates for in-office imaging, Strategies for Success XV Program Director Christopher U. Cates, M.D., FSCAI, welcomed frank talk about the impact such cuts would have on Christopher U. Cates, cardiology practices as well as how M.D., FSCAI physicians should prepare for fee reductions. “In many cases, the difference between a profitable practice and an unprofitable practice lies in the technical component charges from in-office imaging,” he said. “We discussed how likely it is that major changes will happen in the reimbursement structure, their potential impact, and ways to prepare. It was a very important conversation for our attendees to participate in.” Such interactive conversations between practitioners and health policy decision-makers have become the hallmark of the Strategies program over its past 15 years, and it may be the aspect of the program Dr. Cates values most. “There is no substitute for the opportunity for a forum to ask personal questions of the people who pull the levers and push the buttons in Washington,” he said. “We try to keep the whole program geared toward that give-and-take, using lots of question-andanswer formats and interactive programming. Because the attendees get to ask the specific questions facing their practices, I always learn a lot more than I bring to the program.” Another burning issue on the minds of attendees and faculty alike is that of pay-for-performance, or P4P (see SCAI President Gregory J. Dehmer’s President’s Message on p. 4). “Another very timely, very important idea that is developing fast in Washington is that physicians should get paid better for a good job than for a not-so-good job,” said Dr. Cates. “It’s hardly unprecedented in other industries, but it’s a challenging idea to implement in medicine, and physicians need to be part of the P4P strategies Congress is considering or we may not like how it ends up being structured.”

The 15th year of the Strategies program also broke new ground this year when officials from the U.S. Office of the Inspector General (OIG) unveiled a statement about physician–industry relationships, a hotly debated topic that has made it increasingly challenging for organizations to partner with industry to offer high-quality continuing medical education courses. Dr. Cates was both pleased by the specificity of the OIG statement and honored that the Inspector General chose to deliver it at Strategies. “It was a very clear statement about what the OIG considers to be abuse and what it finds acceptable,” he said. “And to have a major health policy group like the OIG put something in writing and have it read at Strategies shows the importance of our meeting in their eyes as far as dissemination of information.” What did the OIG say about physician–industry relationships? To read the OIG document, go to www. scai.org, where you’ll also find updates on Strategies for Success XVI. n

World-Class Experts to Speak at Conferences in Snowmass and Hawaii

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rogram Director John H.K. Vogel, M.D., FSCAI, MACC, is convinced that the secret behind the success of the two cardiology conferences he has organized for decades is their focus on what’s new. “These have never been review meetings,” he explained. “That’s why people like them: They can come and learn about what’s on the cutting edge. We cover all the hot stuff that’s going on today.” The 38th Annual Cardiovascular Conference at Snowmass will take place Jan. 15–19 in Snowmass, CO. The 22nd Annual Cardiovascular Conference in Hawaii will take place Feb. 12–16 at the Mauna Lani Bay John H.K. Vogel, M.D., Hotel on the Kohala Coast of the FSCAI, MACC Big Island of Hawaii. Both events are sponsored by SCAI and cosponsored by the American College of Cardiology Foundation. Consider imaging, for example. “Imaging is becoming a much bigger issue in cardiology now, particularly CT scanning and similar techniques,” said Dr. Vogel. “I’ve made a point of putting in a session on imaging at both Snowmass and Hawaii.” The session features George A. Beller, M.D., MACC, and Christopher M. Kramer, M.D., FACC, both from the University of Virginia; Szilard Voros, M.D., FACC, of the Fuqua Heart Center in Atlanta; and Daniel S. Berman, M.D., FACC, from Cedars-Sinai Medical Center in Los Angeles. “These world-class ex(continued on page 18)


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Snowmass and Hawaii (continued from page 16) perts will talk about where we stand,” said Dr. Vogel. At the session’s end, he added, they will share “case reports to emphasize the salient points.” Some of the areas that will be covered are so new they aren’t, as Dr. Vogel put it, “ready for prime time yet.” One example is percutaneous valve surgery, the subject of a presentation called “Percutaneous Mitral and Aortic Valve Repair: Where Do We Stand?” by Peter C. Block, M.D., FSCAI, FACC, of Emory University in Atlanta. “This is an area that’s being explored heavily,” said Dr. Vogel. “Things are happening, so we’ll cover what’s coming along.” Managing the ever-growing number of diabetic patients will be another focus. Kathleen L. Wynne, M.D., Ph.D., of the University of Texas Southwestern Medical Center in Dallas, will demystify the management of type 2 diabetes, summarize lessons learned from recent trials, and give a talk called “Type 2 Diabetes Mellitus in Kids: Will They Be in the Cath Lab in their 20s or 30s?” Of this talk, Dr. Vogel stressed, “Most cardiologists really don’t have a good handle on how to treat patients with diabetes, so I decided we needed more talks about it.” Other highlights will include a discussion of therapies that go beyond LDL to focus on HDL, a look at new guidelines for managing valvular disease, the latest information on synchronized pacing for heart failure, and a debate about the best way to treat multivessel disease. As always, the conferences will also feature updates on diagnostic evaluation and medical and surgical treatment.

The conferences have similar but not identical programs. One of the topics that will be featured at the Snowmass Conference is of more than professional interest to Dr. Vogel, who recently underwent heart surgery himself. His own surgeon, Bruce Lytle, M.D., FACC, of the Cleveland Clinic, will explain the unusual technique he used during Dr. Vogel’s operation. “Many people have never even heard of this technique,” said Dr. Vogel, explaining that the approach Dr. Lytle pioneered uses the axillary artery rather than the aorta for bypass. “His incidence of stroke while using this technique is extremely low, so I thought people should know about it.” Dr. Lytle will also discuss the choice of valve in aortic valve disease. Both conferences leave plenty of time for relaxing, whether it’s on the ski slope or the beach. The schedule at the Snowmass conference features early morning and late afternoon sessions, with time for family and friends scheduled in between. In Hawaii, the sessions are over by lunchtime. “That’s been my goal from the beginning—to have the best speakers in the country talking about cutting-edge therapies in nice places the whole family can enjoy,” said Dr. Vogel. The combination seems to be working, he added. Last year’s Snowmass conference attracted more than 500 participants, and the Hawaii conference set a new record by attracting 230 participants. To learn more or register for either event, visit www. scai.org. n

SCAI Offers CAS Training in Brazil

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n August, SCAI partnered with the Brazilian Society of Interventional Cardiology (SBHCI) to offer more than 100 Latin American cardiologists a 1½day training program in carotid artery stenting (CAS). This program was a first for SCAI in that SCAI faculty teamed up with experts from a counterpart medical society to train physicians on another continent. Christopher U. Cates, M.D., FSCAI, Michael J. Cowley, M.D., FSCAI, Nick Hopkins, M.D., FSCAI, Robert Bersin, M.D., FSCAI, and Stephen Ramee, M.D., FSCAI, joined Brazilian faculty to provide an in-depth Core Curriculum–style didactic program in CAS. SCAI’s team of experts also conducted a unique “train-the-trainers” program for the SBHCI faculty so that, in the coming months, as attendees complete SCAI’s online self-assessment CAS program, they can learn the technical aspects of CAS via simulators (see p. 8 for more on SCAI’s three-tiered training model).

The idea for the joint SCAI–SBHCI program came from SBHCI’s Secretary Valter C. Lima, M.D., FSCAI, who was intrigued by the SCAI’s novel More than 100 cardiologists from approach to physician training. Dr. Cates Latin America attended a joint CAS program sponsored by SCAI was impressed by the number of physi- training and SBHCI. cians who attended the program as well as their rapt attention. “Everyone stayed late on Friday night,” he said. “And no one was daunted by the simultaneous English–Portuguese translation. It was an amazing experience and an amazing opportunity for SCAI to help set a worldwide standard for quality of care in procedural-based medicine.” n


Newsletter_2006-11