As endovascular approaches evolve and technology brings more specialties into this arena, there will be increased cross-specialty competition. However, research presented at the American College of Cardiology Administrators (ACCA) conference this week in Atlanta suggested that finding a financial model that works to decrease the competition among physicians providing the same services while ensuring that the patient receives the optimal care could translate to many providers.
According to lead study author Steve Maxwell, MSM, from the University of Michigan Health System in Ann Arbor, procedures that were historically done as open procedures by surgeons are now performed endovascularly by interventional cardiologists, radiologists and surgeons.
“As these specialties move their practices to more catheter-based procedures, there are increased opportunities for competition among proceduralists,” he said. “This competition stems from the economic incentives of the specialties to perform the procedures on these patients to ensure the flow of revenue to their practice if they are in private practice or to their department if in an academic institution or health system employed physicians.”
For the study, an interdisciplinary team composed of physicians, administrators and staff determined what types of procedures were driving competition among specialists. The administrators then decided on procedures where all specialists should collaborate in the treatment of patients. The administrators made a proposal of allocating revenues based on time contributed to a collaborative clinic.
For the study, the administration funded nurse practitioners to facilitate clinic operations and patient management, and medical school departments agreed to share revenues on a trial basis to see if the competition could be eliminated.
Cardiology, interventional radiology and the cardiovascular surgery departments agreed to share revenues for the sake of the study.
The study’s revenue-sharing model redistributed professional revenues based on the time that physicians invest into the program. The model worked “similar to a RVU- [relative value units] based model but replaces the RVU’s with time,” according to Maxwell. “The advantages of this type of model relative to RVU-based models are that physicians will not be incentivized to seek out higher RVU-based work to the detriment of a lower valued task.”
The researchers found that participation in the collaborative clinic was relatively equal across departments, relative to the amount of revenue generated.
“There was a small exchange of funds across departments. This sharing of funds is a demonstration of the commitment from the departments, institution and participating faculty in the belief that this method will reduce internal competition.”
Specifically, over the study period, the cardiology department invested 190.75 hours, and collected $41,920 in revenue due to the program. The interventional radiology department invested 97.75 hours, and collected $21,482 in revenue due to the program. Also, the cardiovascular surgery department invested 170 hours, and collected $37,470.
Across all three departments, the percentage collected was 26.5 percent and the percentage revenue outstanding was 9.2 percent, leading Maxwell to say that the “program revenue has exceeded projections.”
The researchers also reported that the demand for the interdisciplinary clinics has “exceeded capacity without any advertising.” Also, they reported decreased return visits to see different specialists.
Their findings lead them to conclude that partnering efforts across disciplines in the treatment of patients requiring endovascular procedures is an issue which all healthcare providers should address.