Dr. Alice Jacobs and Dr. C. Michael Gibson discussed AHA Mission: Lifeline at TCT 2008.
One part that I found interesting:
05:19 Dr. Jacobs: “In addition to the fact that only 50% of patients dial 9-1-1 and activate EMS, we know 10 to 15% of [EMS] vehicles have prehospital [12 lead] ECGs…although it’s said 70 to 80% of the population live within an hour of a PCI facility, 43 million people in the rural areas do not. We know that there are disincentives…cardiac patients are profitable, and something I learned by doing all of this is that Medicare reimburses a hospital based on an acuity index, and cardiac patients have a high acuity index, and if you lose them, your acuity index drops, so you’re reimbursed less for everything else…so all of those are disincentives or difficulties in establishing these regional networks…one of the unique things about Mission: Lifeline is we preserve a role for the non-PCI community hospital — they’re called STEMI referral hospitals — and our hope is that working with the payers and the policy makers, that they [receive an incentive] to treat by the guidelines and rapidly transfer patients to a PCI facility…”
So, non-PCI hospitals are punished by Medicare when they transfer patients for primary PCI. It’s no excuse for letting politics trump patient care, but it’s wrong, and it needs to change.