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(Circulation. 2007;116:e60-e63.)
© 2007 American Heart Association, Inc.

AHA Conference Proceedings

Development of Systems of Care for ST-Elevation Myocardial Infarction Patients

The Payer Perspective

Thomas Fenter, MD; Terry Golash, MD; Neil Jensen, MHA, MBA

Key Words: AHA Conference Proceedings • myocardial infarction • point-of-care systems • angioplasty • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Extending revascularization to all ST-elevation myocardial infarction (STEMI) patients who could benefit from it requires both the rethinking of significant aspects of what is being done now and the development of new thinking for patients for whom such care requires system innovations. Such rethinking and restructuring involves how services are purchased, how payments are made, and how accountability is met. This article focuses on the role of purchasers and payers^* in providing primary percutaneous coronary intervention (PCI) for STEMI patients.

	The Current System

 
Data
No current national data exist on the percentage of STEMI patients receiving revascularization or the percentage of STEMI patients who are transferred from the hospital where they are initially examined to another hospital that is better able to provide revascularization.

Emergency Services
Because essentially all patients with STEMI present as emergencies, commercial insurers who contract selectively with hospitals have less influence over data collection and referrals than they have over more elective procedures or even less emergent medical admissions.

Community Structures
Community structures and networks for STEMI care are extremely variable and relatively uncommon. We are unaware of any survey of what the existing structures look like or how frequently they occur.

Payment
The complex aspect of payment is payment for transferred patients. It may be that no 2 payers have the same rules, but for Medicare,^1,2 the preponderant payer, the following protocol is followed: (1) The initial (transferring) hospital receives (a) payment only for emergency department services if the patient is not admitted before discharge or (b) per diem payment for inpatient services at . . . [Full Text of this Article]

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