As the cost of healthcare grows, and the demand for cost-control measures increases, those professionals coming into the field will need to figure out how to operate in the new healthcare system. Educators must also determine how to prepare residents and fellows for this future. McGraw-Hill Education spoke with Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief, The Mount Sinai Hospital; and cardiology fellows Hadi Halazun, Robert Kleiner, and Crystal Angstrom regarding healthcare costs and how medical education must address cost concerns.
Listen to Dr. Fuster’s full podcast here:
According to a 2015 announcement by the CDC Foundation, heart disease and stroke cost the United States nearly $1 billion a day due to medical costs and lost productivity. In 2011, the Department of Health and Human Services estimated the cost at $316.6 billion, with 1 in 3 U.S. deaths due to heart disease. Annually, about one in every six U.S. healthcare dollars is spent on cardiovascular disease. By 2030, annual direct medical costs associated with cardiovascular diseases are projected to rise to more than $818 billion, while lost productivity costs could exceed $275 billion.
“The trend in this industry, it’s obvious, it’s an economic one,” Dr. Fuster says.
In cardiac disease, treatment usually comes very late, and because of that, the cost is much higher. The American Heart Association, citing statistics from 2011, says the direct and indirect costs of heart disease in the United States were $215.6 billion, with hypertension being $46.4 billion, stroke being $33.6 billion, and other cardiovascular disease, $24.6 billion.
“It’s easy to talk about artificial hearts and all these devices and new technology and so forth, but when you put the cost in front of you, this country, just last year, the expenditure in treating cardiovascular diseases was $300 billion,” Dr. Fuster says.
The key to stemming this cost is to emphasize prevention and evaluate risks, Dr. Fuster says. “Genetics are going to play a very important role there, as well as imaging,” he says. “But we are going to be identifying people much earlier and the question, the challenge there, is how we are getting to these people to change their lifestyle. This is going to be a big challenge. It’s an economic issue, we can’t continue this burden, this economic burden, and be relaxed about it. So we’ll have to go back to much earlier ages, and identify things sub-clinically, or even promote health from the beginning, from children. And this to me is the medicine of the future.”
According to Dr. Kleiner, residents and fellows are already seeing this attitude in their training.
“Cardiovascular training is moving more from an in-patient setting to an outpatient setting, and moving more toward prevention,” he says. “And in the next 10 years, we’ll see improved access to these patients who are high risk or at immediate risk before they get admitted for these diseases, we’ll catch it before it happens.”
Dr. Angstrom says patients are also asking for more preventative care. “They’re demanding with these questions, “How do I prevent this from happening? How do I stay healthy?’”
Dr. Halazun believes that cardiac care will become more decentralized. “The hospital is no longer going to be the center of care,” he says. “People are going to receive their care at home more often than not, I think, in the next 20 years.
Dr. Fuster agrees, adding that home-based wireless monitoring systems will make such care much less expensive. “The hospitals will wind up with 100 beds, and will be for emergency, acute, etc.,” he says. “It’s going to be a huge revolution coming up, in the next 10 or 20 years.”
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