Dr. David Wolinsky

Q&A with Dr. David Wolinsky, president of ASNC

June 23, 2015
by Sean Ruck, Contributing Editor
Although the American Society of Nuclear Cardiology has existed for over twenty years and the organization is well-respected, this year was the first in which HealthCare Business News had an opportunity to speak with the society’s leadership. Dr. David Wolinsky, current president of the society, was very welcoming and shared a little bit of his history as well as news about ASNC in what HCBN predicts will be just the first of many interviews conducted in the years to come.

HCBN: What inspired you to get involved in medicine?
I loved pharmacology and physiology. But while in college, I also realized I loved the patient interaction and realized that pure science wasn’t going to be something that was satisfying in the long run. When I finished medical school, I thought I would become a gastroenterologist. But a cardiologist, Dr. Miles Schwartz became a personal mentor and got me excited about cardiology.

I’m a very clinically-focused person. I take the literature and apply it to determine what’s right for an individual. When you do a diagnostic test in your specialty, you can help define both long-term and short-term management. That is what attracted me to nuclear cardiology.

Today, though, this skill is also a lot harder to learn as clinicians get overwhelmed with computers and screens. So you have to be able to go from what’s high-tech to what’s right for the patient, and I continue to be able to do that in my field.

HCBN: How did you get involved and get to where you are today in the ASNC?
I was very involved with the New England Nuclear Cardiology Working Group. We’d get together about four times a year. From that, nuclear cardiology grew really in a relationship between academics and clinicians. Quality, research, and education were fostered within a lot of the private practices that often rivaled the academic centers. ASNC grew out of these regional working groups under the vision of regional and national leaders.

As president of ASNC I bring a slightly different perspective and focus from the last few presidents. The previous presidents were a nuclear medicine physician and before that an academic nuclear cardiologist and before that an imaging professional at an academic institution. Although we all have different visions, the strength of ASNC is its ability to continue these projects after a president completes his term.

HCBN: What have been the top accomplishments during your time as president?
We have developed the Image- Guide Registry. Along with others, I have been a champion for this initiative since the second half of last year. It’s the first sub-specialty registry to collect data on all aspects of its field. It delivers three key benefits. First and foremost, it helps with quality initiatives for labs. Second, it helps define the quality of the field as we deal with insurers, payors and government entities. Third, the data can form a foundation promoting research.

We’re ready to start collecting data by end of quarter two. The value of participating in ImageGuide has increased recently. We found out just this week that we were approved as a qualified clinical data registry. Participating in a QCDR will allow clinicians to fulfill government requirements for quality initiatives and value-based modifiers, and protect 5-10 percent of reimbursement.

The result is that clinicians will be able to validate the quality of their work and also get paid appropriately for the work we’re doing. Although we applied for the QCDR last fall, we weren’t sure we were going to get it, so the fact that it was accepted and announced this week, was a big thing. We are the only cardiology sub-specialty that has achieved this and one of the few registries overall accepted by the government this year.

HCBN: What other initiatives have you pushed during your presidency?
Bringing specialty groups together. There have been a lot of silos in cardiology and medicine. We talked to ourselves, developed statements, had appropriate use criteria. We figured if we built it, they’d come. We didn’t always do a good job of transmitting our message to the other groups that nuclear cardiology affects. We really have to clarify the relationship between the one that orders the test, the one that performs it and the others who will use those results. We’ve also worked at doing a better job of defining our value and how we fit into the big picture.

HCBN: What are the biggest challenges facing ASNC members today?
Nuclear cardiology was a test that was used a lot, but volume has gone down for a variety of reasons – some justified, some not. We have the ability to improve quality. We have cameras that are old, that won’t give us the highest quality, and we have technology that will improve quality beyond what we’ve ever had. The ability to incorporate these techniques is becoming increasingly difficult.

We have Cardiac PET that improves quality and provides more information, new software that will improve images, newer cameras that require less time for patients, at a lower radiation dose; but if reimbursement goes down, it is more difficult for health systems to agree to new purchases. In the past, when I was part of a smaller practice, there weren’t many people I had to talk to in order to get the new equipment.

But as more practices are owned by hospitals, it’s a challenge to go up against other technologies – maybe you can bring value, but if there are limited funds, you need to bring more value and marketability. So part of the problem is, how do we do this? It’s important to bring people together at national meetings to discuss these challenges. Yet the trend is online and web-based education. Unfortunately, when you don’t bring people together, it’s harder to grow leaders.

HCBN: Are there any recent advancements in nuclear cardiology you’re especially excited about?
Many of the things I have mentioned are cutting edge; we are excited about implementing them. There are new cameras that allow us to get far more information and better quality images. They have tremendous potential for research. PET is growing with new agents that may allow for new protocols. In the future we will have molecular imaging that will begin to identify disease at a very early stage. We’re also beginning to be disease-specific in our technology. These are all new areas where we believe there will be high visibility of nuclear cardiology, but we have to prove quality not just in a silo, but how it affects medicine as a whole.

HCBN: How do you think the nuclear cardiology field will have changed 10 years from now?
If you look at the evolution of nuclear cardiology, like any diagnostic test, once you’ve proved it is accurate the next question you should ask, from a prognostic point of view, is does it change my treatment? That’s a big question. It’s a risk assessment. One way to look at risk assessment - if you’re standing on your porch step, there’s not much risk in jumping down, but if you’re standing on the edge of the pool, how deep is it? Can you swim? Can you get out? Can you get out the other end? That’s the risk assessment. We’ll need to have nuclear cardiology as something that can guide therapy. Patients will need to be tested less often, and fewer will be tested, but there’s probably going to be better determinations on who needs to be tested and what the best test is and what the best treatment is for them.