The debate over the future of physician practices is often framed as a binary: hospital employment or full independence.
In cardiology specifically, hospital employment of cardiologists climbed from roughly 26% in 2008 to 63% in 2019, according to an American Journal of Managed Care analysis, and the groups that have since left have often walked away from their former employers entirely.
A newly combined cardiology platform is betting there is a third path.
Denver-based CardioOne, a technology-enabled management services organization that supports physician-owned cardiology practices, joined forces Oct. 8 with Warrenville, Ill.-based CardioSphere, a cardiovascular-focused MSO. As part of the deal, CardioOne added Midwest Cardiovascular Institute, an independent practice in Chicago’s western suburbs, bringing its network to more than 110 providers nationwide.
MCI President Mark Goodwin, MD, and former CEO Jacob Corbell, who co-founded CardioSphere in 2024, are joining CardioOne, along with Cathleen Biga, MSN, past president of the American College of Cardiology, as chief strategy officer.
CardioOne brings the technology and operating infrastructure to move employed cardiologists into independent practice. CardioSphere’s leaders, according to Alex Struck, co-founder and chief growth officer of CardioOne, “had spent their careers really crafting this unique partnership with the health system that aligns incentives across many different types of models and structures.”
“I think the future is really focused on the fact that cardiologists need hospitals and hospitals need cardiologists,” Mr. Struck told Becker’s. “So how do you create a new model that aligns incentives and creates a win-win for both of them?”
That question starts with what hospitals stand to lose when a group walks out, and what employment costs them if it stays.
Mr. Struck said that when cardiologists decide to leave employment for independent practice, it can come as a shock to health system leaders — cardiology service lines represent decades of investment, recruitment and training in some cases, as well as significant revenue streams.
“To maintain their salaries, benefits, and the administrative costs to support that group, you’re talking about $1 million to $2 million of cost per doctor,” Mr. Struck said. “What we’ve been able to prove also with MCI is you can do that without sacrificing the things that you care about as a hospital.”
Mr. Corbell, MCI’s former CEO, laid out the options.
“I think there’s a lot of different ways hospitals and doctors can work together without being employed. One is a co-management agreement. You can ask the doctors to help manage a component of your service line,” he said, adding that giving physicians this level of buy-in and responsibility can generate further engagement and better outcomes in the long run.
“Put a bucket of money in a pool that they can get by earning incentives or by improving quality, and instead of this a fixed flat rate,” as is the case with work relative value unit-based payment systems, Mr. Corbell said.
“There’s professional service agreements,” he continued. “There’s these group practice enterprises where the hospital and the doctors can create a new company governed by the doctors but owned by the hospital, so the doctors can actually run the company, but the company can benefit from some of the things the hospitals have in place: purchasing power, insurance rates with commercial payers, those types of things.”
MCI’s cardiologists were previously employed by a hospital now part of Evanston, Ill.-based Endeavor Health, according to Mr. Struck, and have modeled all three of these arrangements with notable success.
“I see the future as a combination of co-management agreements, where in partnership with an operating company like CardioOne, the physicians are managing the inpatient cath labs as well, and then joint venture surgery centers,” Mr. Struck said. “So if you think about that on the procedural side, both the hospital, the health system, and the physician group are very aligned and incentivized on the procedural side of the business.”
He added that in the Endeavor partnership, inpatient cath lab volume grew about 60% across the board once the physician went independent and began managing the cath lab. There was also a nearly 100% increase in new patient visit volume.
For Mr. Corbell, the shift is as much about the relationship as the contract.
“We are side by side in this solutioning of healthcare. Physicians need to be more empowered to help drive the change,” he said.
“There are models that I don’t think are as black and white as either you’re independent or you are employed,” Mr. Struck said. “The future of cardiology is independent, 100% physician-owned groups in partnership with a management company that partners with the hospital and realigns incentives in a way that everyone wins.”
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