Cardiologists don't skip a beat as tighter regulations, difficult economy reign

At the heart of an evolving healthcare system, and any other competitive business model for that matter, is a value incentive. It’s the vein through which the essence of industry livelihood runs, and a vital the healthcare sector must maintain, now more than ever before, at all reasonable costs. 

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While specialists hailing from all categories of medicine are doing their part for cost-effective, quality care, certain sects have proven themselves ahead of the curve among medical experts and analysts. Perhaps it’s not surprising then, that in matters of the heart — organ and industry — cardiologists were the specialists to beat in a new survey measuring the field’s care volume and quality.

“If you talk to anybody that works across the spectrum of specialties, they’ll say that cardiology is not just leading the field, they’re way out ahead,” Patrick White, president of MedAxiom — one of the organizations that directed the survey — told PhysBizTech. “They’ve done a tremendous job from a scientific perspective of getting experts together to provide either evidence-based medicine or consensus-based medicine guidelines for folks to use.”

Conducted in part by MedAxiom and the American Society of Nuclear Cardiology (ASNC), the report found that U.S. cardiologists are seeing more patients than ever, yet they are performing, on average, fewer nuclear tests. Results relayed that in 2011, cardiologist recorded, on average, more than 2,100 patient visits — a 29 percent increase since 2004. In tandem with the heightened number of visits, specialists were performing 356 imaged stress studies (such as stress echo tests, single-photon emission computerized tomography [SPECT] tests, or positron emission tomography [PET] tests) on average last year, a statistic that remained largely flat over the eight-year period, up only 2 percent. More than 110 practices, representing more than 2,000 cardiologists, participated in the survey.

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Survey rationale dictates that this decline has occurred, in part, because of the ways in which cardiovascular care is now delivered as well as the heightened concerns surrounding the country’s current economic conditions.

“We know that the economic downturn has had an impact there [on depleted test volumes]; that patients have to pay more out-of-pocket; perhaps a little bit from the perspective of concern from both the provider and the patient on radiation exposure; and a few other topics,” White said.

Specifically, the study cited these primary reasons behind the inverse relationship between patient visits and test orders:

  • increasing adoption of Appropriate Use Criteria;
  • higher deductibles and copays for those with insurance;
  • increased awareness of radiation optimization
  • the use of Provider-Based billing by integrated cardiology practices; and
  • an intermittent shortage of Molybdenum-99, a key radioactive isotope in conducting the tests.

The results of the survey also indicate successful control over variability, and therein, a perpetuation of healthcare value for the specialty, White noted.

“What everyone is looking for is greater value — value being defined as high quality at a low cost. There’s a lot of pressure on everyone, not just cardiology, to deliver higher quality at a lower cost, so of course there are programs that are going to be measuring some of that value-based purchasing and others. We are definitely in the mode of switching from that fee-for-service mentality to providing population-based care, where we are responsible for the health of a population, where we no longer get paid for doing procedures, where we get paid for maintaining the health of a population.”

Cardiology, White added, has done “a great job of trying to put [its] arms around this issue of variability in the number of procedures done. It’s only a matter of time before the public, payers, and Medicare, etc., are probably going to demand that other specialties do the same.”

"In the face of increasing challenges, America's cardiologists have made a commitment of continuing to provide superior healthcare," added Jennifer Linville, MedAxiom's chief executive officer, in a news release. "At the same time, many recognize the advantages of nuclear cardiac imaging tests as an important tool to identify potential coronary disease among their patients. Balancing the two, cardiologists have committed to the selective and responsible administration of these tests in a way that contributes to the continued health of the people who depend on them."

The delicate balancing act being put on by cardiologists is indeed one to be lauded and replicated, especially given the dire economic climate consistently working against medical professionals in their quest to do right by patients, study experts said.

“We’re doing this in the face of severe cuts in reimbursement over the last several years, so even though we’re getting paid less, we’re doing less, we’re still doing the right thing for the patient,” White said. “We’re going to be incentivized to do the right thing, to be efficient because we know we have an unsustainable market right now, we can’t continue to service the Medicare population the way we are now.”

Despite cardiologist “doing less” on the nuclear testing front, John Mahmarian, M.D., president of ASNC, is still optimistic about the future of such procedures.

“Nuclear cardiology imaging plays, and will continue to play, an important role diagnosing and treating heart disease," he said. “Our doctors have been vigilant in prescribing the appropriate use of these tests as defined by our participation in the Choosing Wisely initiative. As healthcare evolves in the United States, we intend to continue clearly defining the patient-centered approach to cardiovascular imaging and optimizing the value received from it. Our goal is to continue to provide both quality and value to our patients."

Following the cardiologist beat by strengthening Appropriate Use Criteria across the medical continuum is one aspect that those related to the study hope will catch on.

“What the survey does is confirm what we’ve known for the some time and that is that the hard work of cardiology — and that’s the American College of Cardiology, American Society of Nuclear Cardiology, specifically in terms of nuclear — has done a great job in developing Appropriate Use Criteria, and physicians have embraced that over the past several years such that it has had an impact on volumes,” White said.


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