Jason H. Wasfy, MD: Optimal Inpatient, Outpatient Heart Care

About 1 in 10 of every consult provided by the Massachusetts General Hospital’s (MGH) cardiology team is not face-to-face. This is less a symptom of burdened work, and more a mark of understanding that telehealth has a role to play in the future of cardiovascular care.

In an interview with MD Magazine® while at the American College of Cardiology (ACC) 2019 Annual Meeting in New Orleans, LA, Jason H. Wasfy, MD, director of Quality & Analytics at MGH, discussed the value of optimizing a patient’s setting for receiving care and consultation, as well as the value of patient-reported outcomes versus administrative data.

MD Mag: Is there an optimal metric for assessing a facility’s cardiovascular care?

Wasfy: I think it's a scientific question. I think the jury's still out, to some extent. But in general, I hope that we can understand how to design policies and payment systems that incentivize all kinds of providers, doctors, nurses, hospitals to improve the quality of care in ways that are meaningful to patients.

So clearly, things like improving reducing mortality rates would be a clear win. But also, really thinking deeply about how to integrate patient-reported outcomes into data sources that are useful. The problem is, anytime you change compensation or adjust a payment for hospitals or for physicians, you're using administrative data. And there's limitations to the use of that data—it's just a billing code that doesn't really encapsulate what's happening with a patient.

Patient-reported outcomes are a much more promising way to do it, but those aren't routinely collected in everyday practice. So we're far from an ideal learning healthcare system. I think that a lot of the discussion around the Hospital Readmission Reduction Program and a lot of these debates are important first steps.

The science of understanding how to design policies and payment systems in ways that provide optimal responses from providers, in ways that are meaningful to patients, is a relatively early science. And I think that it's important that we discuss these early lessons and push ahead.

How is cardiovascular telehealth being applied at your practice?

We’re very interested in understanding how to get outside of the traditional doctor's office visit. There are many ways in which the traditional doctor's office visit—in the office, with the physical exam—are good ways to deliver care. But there are lots of other ways to deliver care, and I think that we've probably underutilized those areas.

We have active, robust programs and telehealth—video-conferencing with patients instead of having them come into the office. We really have had a huge growth in electronic consultation. So, we'll be talking more about that at the health tech summit later this afternoon.

We are doing about 10% of all our cardiology consult as electronic consults now. So when a primary care doctor has a question about cardiology, in about 10% of cases, there's an exchange of information and documentation, and the chart will share the information with the patient without the patient having to go to the doctor.

We don't ever push patients to do this, and we ask patients if they want this. Of course, it has to be a clinically appropriate question. There's some questions for which you have to actually go see the cardiologist. But we want to offer patients the opportunity to receive care in the setting that they want—in ways that are safe and understanding—to sort of break this Gordian knot of doctors and hospitals doing things simply because they're compensated to do them, rather than not compensated, and understanding how to optimally provide care in ways that patients want to receive the care and are effective to give that care.

There's a lot of problems with a specialist-primary care provider interface, nationally. It's very hard to get in with the doctor. Doctor's appointments in general are not when people want to go to the doctor and use it. You know, I'm a parent of young children, and if the doctor was to bring our children to the doctor, it's often 3 o'clock on a Tuesday. It's a horribly inconvenient time for parents.

In some cases, it's important, because there's the vaccine or something that you have to get in person. But not every clinical question requires the patient to come in for a physical exam and history from a cardiologist. It's not consistent with our clinical best practices.