Lesson 2
2. PCM Demographics
 Why
do I need to know PCM demographics? Well, you need to know the scope
of the problem. Is this a big problem or a little problem? If it
is a big problem, we need a solution. PCM is a big problem. 65 million
Americans have cardiovascular disease. 600 thousand undergo cardiac
surgery each year in the United States with 100 thousand episodes
of PCM. 3.2% die. This 600 thousand operations per year is an important
number because if I suggest a therapy that leads to many more cardiac
surgeries, do we have enough surgeons? Operating rooms? Money to
pay for it? If I suggest using a therapy that has a 3.2% mortality
rate and costs $20,000+, there had better be some benefit to that
therapy.
Here is a really big number. There are 30 million
non-cardiac operations per year in the United States. Of these,
6 million have either known coronary artery disease or known vascular
disease, or risk factors for coronary artery disease. So what we
are talking about with BBAC is a quarter of all patients scheduled
for surgery. If I tell you to use some therapy, or some test, you
need to multiply the cost of that test or therapy by 6 million (6,000,000)
to see the real cost. Let's try this out. I suggest using a $1,500
test as a preoperative evaluation for patients at risk for cardiac
disease undergoing non-cardiac surgery. How much does my recommendation
cost the U.S. health care system? That's right $9 billion ($9,000,000,000).
Now, don't you hope it works? Nine billion dollars is real money
as they say in Washington, D.C..
There are 50,000 perioperative MI's and 20,000 perioperative
deaths each year in the U.S. You can imagine the scenario, "Yes,
Mrs. So and So, I have some good news and some bad news. We did
an excellent job with the surgery on your husband's XYZ. It is fixed.
Unfortunately, he has had a heart attack, and may die, but his XYZ
is fixed. We have all been in this situation. BBAC is designed to
reduce the risk.
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