Improving Patient Outcomes While Reducing Healthcare Cost  


In 2001, after practicing traditional clinical and non-invasive cardiology for 20 years, I decided to create a new approach to cardiology that also prevents most heart attacks and strokes. This lead to the development of the first atherosclerosis clinic with its unique and proven approach, two published performance data and significant healthcare cost savings to the Centers for Medicare and Medicaid Services. It is hard to believe that even up to now with the rising healthcare cost that impacts us all and the ACO’s financial incentives to provide higher quality care at a lower cost, most medical centers are still reluctant to eliminate preventable heart attacks and strokes in their own communities. 

My journey to prevention was partly inspired by the result of the L-TAP study, a nationwide survey in 2000 to determine what percentage of very high risk patients - those who already suffered a heart attack, were treated to the recommended LDL-cholesterol goal which was less than 100 mg/dL at that time. A wide treatment gap was discovered. Only 18% were treated adequately; 82% were not treated or treated inadequately.

Wide Treatment Gap
Advanced Cholesterol Therapy is the Cornerstone

In 2004, the STENO-2 Trial showed that lowering LDL-cholesterol accounted for over 70% of the cardiovascular risk reduction while diabetic and blood pressure control about 20% each.

I created a clinical management system to close the treatment gap in my practice and after 5 years, published our performance data which was the best at that time. Also at about that time, I could see that incorporating aggressive prevention had paid off with clearly fewer heart attacks and strokes, less need for stents and heart bypass surgeries. I became among the first 50 physicians to become a specialist in Clinical Lipidology in 2015.

In 2016, a follow up publication showed that using PaKS and ACCEPT system, high level of treatment success can be sustained and even improved upon. 89% had LDL-cholesterol below 100 mg/dL while 51% had LDL cholesterol below 70 mg/dL. Cardiovascular events that used to be common and expected became more and more uncommon and unexpected.

Clinical outcomes improved very significantly. What about healthcare cost? The answer is shown below.  

These data are from CMS (Center for Medicare and Medicaid Services) comparing the significant cost savings for Medicare among patients with diabetes ($11,921 versus $18,420, a savings of $6,499 per beneficiary per year) and among patients with coronary heart disease ($13,327 versus $22,117, a savings of $8,790 per beneficiary per year) under the care of Dr. R. deGoma compared to the national average for all cardiologists. Medicare has not given back any shares of their savings. 

For those with CHD, there is a 40% cost reduction, a saving of $8,790 per beneficiary. For those with diabetes, there is a 36% cost reduction, a saving of $6,499 per beneficiary.  

These cost savings are due to the high quality of care the our patients receive which results in much fewer cardiac hospitalizations, stents, heart bypass surgeries and other expensive procedures. What is not included in these data is the reduction in premature deaths and disabilities. 


Heart disease death rates have increased for the first time in decades and stroke death rates also have gone up, according to new federal statistics that show a drop in U.S. life expectancy.

The number of Americans dying of heart disease increased last year for the first time in more than a decade, delivering a wake-up call to the medical and scientific communities. After nearly 40 years of victories in the battle against heart disease — from the development of medications to control blood pressure and cholesterol to the public campaign against smoking — heart health experts are now facing a stark truth: Progress has stalled.

Heart disease is the No. 1 killer in America, responsible for about 1 in every 4 deaths. New data released by the National Center for Health Statistics shows it took more than 633,000 lives in 2015. 

The rise in heart disease deaths is a surprising change, since they had been declining rapidly since 1969. The last time there was an uptick was between 1992 and 1993. The latest data reinforces another troubling trend: the annual number of heart disease deaths hasn’t gone down since 2011.

It is time to turn off the faucet instead of just mopping the floor.

CDC Chief Dr. Tom Friedan: “How can the healthcare system save the most lives? We can save the most lives by preventing heart disease and stroke.

Most of the 525,000 Americans who will suffer their first heart attack this year are not aware they have a silent heart disease that is medically treatable and their heart attack could have been prevented. 

AHA Statistics Oct2017
2015 AHA MI Statistics-2

The slide highlights a serious national health problem that is begging to be solved. There is a real urgency to find a solution for several reasons: it touches the lives of nearly every American family; heart attacks are largely preventable and the cost to the nation is in the hundreds of billions every year. 

Previous attempts to reduce heart attacks failed:  1) Emergency stenting during a major heart attack is not a solution since shorter door-to-time time failed to show benefit - it did not reduce 30 day mortality. 2) Even intensive lifestyle intervention (Look AHEAD Trial) did not prevent heart attack. 3) The landmark COURAGE Trial showed that in stable patients with advanced multi-vessel CHD, the addition of stent therapy to optimal medical therapy did not prevent heart attack or cardiac death. Because these interventions are as effective as originally thought,  elevates the role of aggressive medical prevention to a more prominent position - there is a lot of science behind it, it is highly effective, alters the progressive course of atherosclerosis, saves lives and reduces healthcare cost. 

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