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Acute Coronary Syndrome Pathways: Alignment With a Bundled Care Reimbursement Model

Fong, Pete P. MD; Jackson, Emily Blake MBA; Churchwell, Keith B. MD; Steaban, Robin RN, MSN; Starmer, John M. MD, MMHC; Johnson, Daniel C. PharmD, BCPS; McNeil, Julie D. MBA; Klint, Zachary W. MS; Scalf, Sonia L. RN, BSN; Parsons, Carol M. RN, MSN; Cortez, Susan RN, MBA; Christensen, Donna RN; French, Tina RN; McPherson, John A. MD

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: March 2011 - Volume 10 - Issue 1 - p 1-8
doi: 10.1097/HPC.0b013e318211bb08
Original Article

Changes in public policy, population demographics, and market dynamics are spurring innovative approaches to value-based care. Annually, hospitalizations for Acute Coronary Syndromes (ACS) account for a substantial proportion of healthcare expenditures in the United States. Vanderbilt University Medical Center has developed a framework to deliver comprehensive care incorporating inpatient and outpatient care teams for patients with ACS under an episode-based, bundled reimbursement model for a term of 6 months. As such, a value-oriented pathway was created with the goals of (1) optimizing patient outcomes following ACS; (2) minimizing complications from the treatment of ACS; and (3) reducing costs of healthcare related to the treatment of ACS. In a tertiary care academic medical system receiving patients from multiple facilities involving multiple providers, standardization of care by using practice guidelines and evidence-based data coupled with a robust computerized provider order entry system provides a unique opportunity to produce a “best practice” algorithm for treating patients presenting with ACS. Presented in this study are in-hospital and postdischarge care pathways for treating a diverse group of patients presenting with ACS to our institution.

From the Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN.

Reprints: John A. McPherson, MD, Vanderbilt Heart and Vascular Institute, 1215 21st Ave. South, MCE Fifth Floor, Suite 5209, Nashville, TN, 37232. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.