In addition to providing excellent patient care, cardiologists must also prioritize lowering healthcare costs. Unfortunately, COVID-19 has exacerbated financial stress across the care continuum. According to FAIR Health, cardiology revenue dropped 57% year-over-year in March 2020, and, as TCTMD reports, practices expect a slow recovery.
Reducing wasteful spending will be a key driver of cardiology's economic recovery, as overtreatment and low-value care account for $75.7 billion to $101.2 billion of healthcare's annual financial waste, according to JAMA. Investing in diagnostic accuracy can help cardiologists drive these costs down and improve patient care, saving money and, more importantly, lives.
The Multidimensional Costs of Diagnostic Errors
Misdiagnoses are a common challenge in cardiology. One study published in the European Heart Journal: Acute Cardiovascular Care found that nearly a third of patients with acute myocardial infarction ended up with a different diagnosis from the one they received initially. More specific factors, such as sex-based differences or even unconscious racial biases, have the potential to drive further diagnostic errors if they are left unchecked.
Such errors are costly. A report from the Canadian Agency for Drugs and Technologies in Health that analyzed misdiagnoses from troponin testing—a form of testing which is argued to be unreliable—pinned the readmission cost of a missed NSTEMI diagnosis at nearly $12,000 (Canadian dollars).
False positives are another common diagnostic mistake. One study in Mayo Clinic Proceedings found that 16.5% of patients from a single-site cohort were misdiagnosed as having STEMI when they did not. The study's authors noted that the double-edged sword that led to those misdiagnoses was clinicians enacting more aggressive early detection measures to drive down door-to-balloon times—an approach that doubled the number of patients sent to the cath lab who didn't need to be there.
Since the average cost of angioplasty is around $32,000, according to the Chicago Tribune—atop the fact that it can be a dangerous procedure for patients who aren't indicated for it—false-positive results could drive up wasteful costs and worsen patient outcomes.
Misdiagnoses can also raise the risk of malpractice and associated legal costs. The American College of Cardiology reports that diagnosis failure is the most common malpractice claim, being involved in 1 in 4 closed suits. The errors cited in these cases range from missing MI to not noticing noncardiac problems, such as aortic dissection or pulmonary embolism. One 25-year study reported by Becker's Hospital Review quantified the inflation-adjusted cost of diagnostic error claims (as of 2016) at $386,849 per malpractice case.
To learn more about the power of the ECG in today's clinical landscape, browse our Diagnostic ECG Clinical Insights Center.
The Importance of Accurate ECG Interpretation
Investing in diagnostic ECG can make a substantial difference in caring for patients and reducing costs. As an efficient, lightweight, and affordable technology that can be available at the bedside, a 12-lead ECG can help ensure prompt and correct treatment when patients need it.
As with any other diagnostic technology, however, ECG accuracy depends on interpretation. If providers misread ECGs, it can negatively affect patient care and drive up unnecessary costs.
For example, one study in JRSM Cardiovascular Disease noted that up to 72% of unnecessary catheterization activations have been linked to ECG misinterpretation. At least in part, these misreadings may be due to the fact that ST elevations can present in other non-MI clinical contexts, such as left bundle branch block or left ventricle aneurysm, as the Indian Heart Journal notes.
These misinterpretation rates should not undermine the utility of taking prehospital or in-hospital ECGs. The American College of Cardiology (ACC) recommends that all patients with suspected ACS be evaluated with 12-lead ECG within ten minutes of medical contact. The ACC also underscores the importance of learning how to use 12-lead ECG.
This comprehensive guide from Healio can help providers train themselves and others on the essentials, from bundle blocks and rhythm abnormalities to atypical ECG findings. Providers should also take advantage of available resources from manufacturers, such as these training videos, posters, and quick-reference guides from GE Healthcare.
Now more than ever, creative approaches to virtual learning may help bridge knowledge gaps as well. In a 2019 study of EMS personnel in CJC Open, for example, ECG diagnostic accuracy improved by 10.4% after the roll-out of an online case review program.
Mitigating Healthcare Costs and Improving Patient Care
Given its large proportion of expenditures in relation to total healthcare costs, cardiology has a unique opportunity to cut unnecessary spending and drive revenue from value-based care simultaneously. With results available in minutes at the point of care, ECG has significant potential to drive down costs and improve patient care, as long as practitioners undergo the training required to read ECG correctly.
Every minute is precious in cardiac care, and as healthcare practices and patients continue to reel from the economic effects of COVID-19, managing costs remains a critical consideration as well.
