A New Day: Interim Thoughts on the 2012 Heart Rhythm Society Scientific Sessions

I woke this morning to sunshine pouring through my hotel window as the heavy clouds of the last several days in Boston have disappeared.  A whole new day has arrived.

It has been interesting to take a 50,000-foot view of our scientific proceedings in Boston so far, especially since I carry with me many memories of former scientific sessions, including those of the American College of Cardiology sessions earlier this year.

What is clear is that my field of cardiac electrophysiology, like a dividing amoeba, has nearly completely divorced itself from its former professional and scientific kin, the ACC.  While many similarities of the two meetings' format are similar, many differences are apparent, too.

As Bruce Wilkoff, MD, President of the Heart Rhythm Society, read the teleprompter at the opening plenary session Wednesday, we heard that the Center for Medicare and Medicaid Services (CMS) has officially sanctioned the field of cardiac electrophysiology as its own separate billable specialty.   I wondered (ever-so-briefly) why this mattered.  But a quick reality check reminded me that up until now, thanks to a convoluted and ever-changing set of governmental billing rules, CMS would not pay electrophysiologists for their expertise in patient care because (not uncommonly) the patient had already been seen by a cardiologist from the same practice group on the same day.  Never mind that the two specialties really are different.  That's the way it had stood electronically according to CMS until this year.

But this divorce from our general cardiology colleagues comes with mixed feelings to this older clinical cardiac electrophysiologist.

You see we miss important connections to our general cardiology colleagues when we separate ourselves from them for billing purposes.  The irony in all of this (and part of my concern) is that cardiac electrophysiologists still must maintain general cardiology board certification as a prerequisite to remaining board-certified in cardiac electrohysiology according to our certification overlords, the American Board of Internal Medicine.  Obviously, the separation of specialties makes staying current in both fields even MORE expensive and time-consuming now.  For the leadership of our professional societies who are nearing the end of their productive clinical careers, there is little concern about this issue.  But for our younger specialists facing recertification in two separate specialties every ten years, the ability to stay current in both fields so we may remain certified is now officially a costly and burdensome full time job that encroaches significantly on our time with patients.

Beyond this regulatory concern, we also now see that very few electrophysiology posters hang at the ACC meeting any longer.  Likewise, there was not a single coronary stenting poster anywhere at these HRS Scientific Sessions.  No doubt many will applaud this.  But at the ACC meeting, general cardiologists' concern about maintaining skill at complex EKG reading and pacemaker management is forgotten.  So too is my basic understanding of new, powerful antiplatelet agents commonly used after coronary revascularization procedures.  We lose something when we divorce ourselves intellectually from our general cardiology colleagues.  But perhaps this is part of the plan, since dividing the two fields makes us more manageable for hospital administrators, too.

But it's a new day in medicine, isn't it?  Despite all that's happening, the sun still shines bright some days.  There is tremendous value in attending meetings like this for those of us relegated to the dark confines of the EP lab or office much of our existence.  Seeing the original innovators in this field who have grown to become close friends, like Ben Scherlag, MD and Mel Scheinman, MD, totally clears the air for me.  Connecting with EP social media pals Jay Schloss, MD (aka Edwin Janszen Schloss, MD on Cardioexchange) and theHeart.org's John Mandrola, MD (whom I have never met in person until yesterday and who secured a press pass to scoop me, damn it) was fantastic and forever seals our friendship. 

And while many of the posters I have seen are strikingly similar to posters that were there years ago, there are still remarkable insights to our field that are occurring.  The work on mapping rotors in atrial fibrillation may have promise.  The improvements in 3D mapping systems, while expensive, seems to be making our job safer.  And although there are still too many company reps for too few doctors here, getting back to the basics of sharing science and professional connections, rather than tracking our every movement with RFID tags (yes, they are no longer on our name badges!), still gives me hope that as a professional society, we're getting somewhere.

And yes, I'm looking forward to my last day here.

-Wes