In a session at the Becker's Hospital Review Annual Meeting in Chicago on May 18, Andrew Ziskind, MD, managing director of clinical solutions at Huron Healthcare, and James Palazzo, managing director at Navigant, discussed ideas and concepts to improve cardiovascular program profitability.
The session began with a discussion of trends in cardiologist reimbursement. According to Mr. Ziskind, decreasing reimbursement for cardiologists is stemming from the decreased utilization of cardiology procedures and limitations on hospital space capabilities for inpatient procedures. The use of stents, for example, is dramatically reducing the incidence of cardiovascular disease, he said. There is growing focus on healthcare value and the reduction of unnecessary services.
On the outpatient level, Mr. Ziskind said, physician groups are questioning whether they want to stay in freestanding facilities because of regulatory risk and reimbursement risk. "They're also hitting their capital replacement cycles with a lot of their equipment," he said. "So the question becomes, do you want to fork out what you need for new equipment or turn to a hospital or health system?"
When asked to discuss the future of cardiologists' salaries, Mr. Palazzo predicted that salaries will moderate rather than increase long-term. "Physician employment is increasing at a five to seven percent per year growth rate," he said. "In some markets, like Raleigh, there is a race to hire every available doctor, but in other markets, like Baltimore, that is happening less. Cardiologists are trying to monetize the value of ancillaries before reimbursement drops. Younger physicians want to be employed, but want a better work and life balance. In the end, cardiology salaries are going to moderate."
Though salaries will not necessarily increase, there is a high level of anticipated growth in cardiology services among older patients in the next decade, said Mr. Palazzo. This is largely due to the fact that cardiology patients are now living longer with chronic conditions. "Our analysts have suggested that 80 percent of direct cost growth in cardiology will be in the Medicare program," he said. "That's where the growth is. They're showing that the 65- to 79-year age group is going from $130 million to close to $500 million by 2030. It's therefore important to configure our programs so that we can profit off the Medicare program."
Cardiology costs associated with the 18 to 44 age group, on the other hand, will be very steady through 2030, Mr. Palazzo said.
Mr. Ziskind then discussed two cardiology procedures that will likely in volume in the next date. The first procedure, the use of terminal implantable device therapy for heart failure, is being used as a destination therapy as opposed to a bridge to a heart transplant, he said. "This is exploding in growth, and it's best reserved for a high-end tertiary center," Mr. Ziskind said. "There is also some possibility for a smaller center to have an inpatient unit for this."
The second area of growth centers on procedures to address aortic valve disease among the elderly. "As techniques get better, this will serve as an alternative to surgery," Mr. Ziskind said.
Mr. Palazzo concluded the session by discussing how to evaluate the success of a cardiology practice. "You automatically know that a cardiology practice is sick if the proportion of new office visits relative to return visits is bad," he said. "The ratio should be around one to six. A busy cardiologist should see 20 to 25 patients in a full day, and a midlevel provider can see 30 to 40 patents in a day."
The session began with a discussion of trends in cardiologist reimbursement. According to Mr. Ziskind, decreasing reimbursement for cardiologists is stemming from the decreased utilization of cardiology procedures and limitations on hospital space capabilities for inpatient procedures. The use of stents, for example, is dramatically reducing the incidence of cardiovascular disease, he said. There is growing focus on healthcare value and the reduction of unnecessary services.
On the outpatient level, Mr. Ziskind said, physician groups are questioning whether they want to stay in freestanding facilities because of regulatory risk and reimbursement risk. "They're also hitting their capital replacement cycles with a lot of their equipment," he said. "So the question becomes, do you want to fork out what you need for new equipment or turn to a hospital or health system?"
When asked to discuss the future of cardiologists' salaries, Mr. Palazzo predicted that salaries will moderate rather than increase long-term. "Physician employment is increasing at a five to seven percent per year growth rate," he said. "In some markets, like Raleigh, there is a race to hire every available doctor, but in other markets, like Baltimore, that is happening less. Cardiologists are trying to monetize the value of ancillaries before reimbursement drops. Younger physicians want to be employed, but want a better work and life balance. In the end, cardiology salaries are going to moderate."
Though salaries will not necessarily increase, there is a high level of anticipated growth in cardiology services among older patients in the next decade, said Mr. Palazzo. This is largely due to the fact that cardiology patients are now living longer with chronic conditions. "Our analysts have suggested that 80 percent of direct cost growth in cardiology will be in the Medicare program," he said. "That's where the growth is. They're showing that the 65- to 79-year age group is going from $130 million to close to $500 million by 2030. It's therefore important to configure our programs so that we can profit off the Medicare program."
Cardiology costs associated with the 18 to 44 age group, on the other hand, will be very steady through 2030, Mr. Palazzo said.
Mr. Ziskind then discussed two cardiology procedures that will likely in volume in the next date. The first procedure, the use of terminal implantable device therapy for heart failure, is being used as a destination therapy as opposed to a bridge to a heart transplant, he said. "This is exploding in growth, and it's best reserved for a high-end tertiary center," Mr. Ziskind said. "There is also some possibility for a smaller center to have an inpatient unit for this."
The second area of growth centers on procedures to address aortic valve disease among the elderly. "As techniques get better, this will serve as an alternative to surgery," Mr. Ziskind said.
Mr. Palazzo concluded the session by discussing how to evaluate the success of a cardiology practice. "You automatically know that a cardiology practice is sick if the proportion of new office visits relative to return visits is bad," he said. "The ratio should be around one to six. A busy cardiologist should see 20 to 25 patients in a full day, and a midlevel provider can see 30 to 40 patents in a day."
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