Cardiology care in the U.S. is undergoing a period of transformation, shaped by regulatory shifts, evolving reimbursement models and mounting pressures on both private practice and hospital-employed physicians.
From the rise of outpatient procedures to the resurgence of private cardiology groups, here’s what five cardiology leaders have told Becker’s recently about the state of care:
David Konur. CEO of Cardiovascular Logistics: As we see site-of-service differential go away in diagnostic imaging between the HOPD rates and the outpatient world, and as Medicare continues to shift its focus on cardiovascular care being treated more in the outpatient arena than the inpatient arena, we’re going to see more and more hospitals looking for alternatives to how they’re going to deal with their cardiology programs. If site-of-service differential goes away, there is going to be a huge influx of cardiologists looking to join platforms like ours, and we’re already talking to almost a dozen groups that are very interested in what that would look like, because as they read the tea leaves, they see that coming as well.
That pendulum that swung all the way over to hospital employment, we see that starting to swing back the other way. I would expect to see an increase in consolidation in the specialty. I think this partnership is a great example of the leaders within cardiovascular medicine coming together. Our platform is not a roll-up play where we’re trying to roll up a bunch of small practices from all over the place. We’re bringing together the true thought leaders that have been thought leaders for decades to fundamentally change how we deliver care in our country.
Sarang Mangalmurti, MD. Interventional Cardiologist and Endovascular Specialist of BMMSA Heart and Vascular Center of the Main Line (Bryn Mawr, Pa.): Reimbursement for peripheral vascular interventions is being denied more readily by insurance companies for spurious reasons. This places our most vulnerable PAD patients, those with CLTI, at risk for suboptimal vascular care and an increased risk for amputations.
Mahesh Mulumudi, MD. CEO of CardioNow: The biggest challenge and [one of the] biggest things that I’ve seen change in the healthcare landscape in the last 20 years is that care delivery is not smooth anymore. It’s not what it used to be. In my opinion, patients could get in to see the providers promptly, get the tests that they need to be done promptly and then get the procedures. That’s a classic world that I used to live in, and that’s gone.
Paula Reisdorfer. Senior Director of Cardiovascular Services at Surgery Partners (Dallas-Forth Worth, Texas): Although the shift of cardiology procedures to the outpatient space may have been slower than predicted five to 10 years ago, it has become more widely accepted in most states. Honestly, physicians who work in states where cardiology is still prohibited in ASCs are in an unfortunate position, as they see colleagues across the country safely providing care for patients in the ambulatory setting. It’s encouraging however that states such as Ohio and New York are now considering the approval of cardiology procedures in ASCs. Providing this lower-cost site of service while increasing the satisfaction of patients and physicians is of benefit to everyone. Also within the next five years, certainly we should see the approval of EP ablations in the outpatient environment by CMS. Implementing ablations safely in ASCs will take diligent planning of care pathways with careful patient selection, but I am optimistic this is achievable.
Rajesh Sharma, MD. Interventional Cardiologist of Advanced Heart And Vein Center (Thornton, Colo.): I am concerned about significant delays in cardiovascular care across the country. Most cardiologists are now employed by big systems and bureaucracy is getting in the way. We have seen this in our community as patients are waiting up to two months to see a cardiologist with symptoms of chest pain. Private practice has eroded and I feel that now there may be a migration back to private practice to provide more timely service and cost-effective quality cardiac care.
