It is true that guidelines backed by the American College of Cardiology and the AHA establish that when caring for STEMI patients, the clock should start ticking upon the patient encounter with a paramedic or first medical contact (FMC). However, the Centers for Medicare & Medicaid Services (CMS) has not yet moved its goal posts on this measure, relying instead on door-to-balloon times, essentially starting the clock when patients first arrive at the hospital.

“Most hospitals now, at least 75% of the time, can get their door-to-balloon times within 90 minutes,” Christopher Granger, MD, observes. “But most hospitals cannot get FMC-to-balloon times within 90 minutes, and that is what we are after.”

Why hasn’t CMS adopted the more aggressive indicator? Because it requires coordination between various elements of the healthcare system, and since CMS pays for individual elements, it is difficult for the agency to incentivize or penalize a region, Granger offers. “The other challenge is if people aren’t measuring [FMC-to-balloon times], then CMS can’t penalize them for an indicator that is not being measured.”

However, given that most hospitals already meet the door-to-balloon time standard, Granger maintains that it is time to aim for the more aggressive indicator.

“We should be moving to where this is expected, where regions measure it, and where it is a shared responsibility,” he says. “We are not there yet for CMS.”

Nonetheless, the Mission: Lifeline program holds participating organizations to the tougher standard along with recognition criteria for high performers. Granger would like to see more hospitals and regions establish these higher expectations without regulatory pressure.

“The best things that we do are not because government tells us to do them; it is because we get together as healthcare providers and leaders and say that this is the best thing for our patients, and we convince hospital administrations and paramedics and interventional cardiologists to do this, not because they will get paid more or less, but because it is the right thing to do,” he says. “Fundamentally, if we convince people that this is the case, they will do it.”