The U.S. healthcare reform law makes significant headway in expanding access to care for millions of uninsured Americans. It extends Medicaid qualifications, increases the age limit for young adults on family plans and eliminates pre-existing condition exclusions for insurance. The legislation also addresses congenital heart disease, chronic disease management, prevention and wellness, as well as funding for Medicare and Medicaid pilot programs.
While the bill is a start, it does include several onerous initiatives, including the creation of an “independent payment advisory board” and prohibitions on new physician-owned hospitals. It also fails to address several of the principles that the American College of Cardiology (ACC) has deemed essential for real reform. It does not include delivery and payment system reforms that provide incentives for improvement of quality and outcomes, nor does it repeal the flawed sustainable growth rate formula used to calculate Medicare physician payment. It also fails to implement medical liability reforms that reduce legal and defensive medicine costs.
In general, the new law does little to ease the unprecedented stress placed on the patient-cardiovascular specialist relationship. A recently completed survey of ACC members to gauge the current cardiovascular practice landscape shows the following:
- Nearly two-thirds of private practices indicate that they have considered, have already begun, or have completed integration of their practice into a hospital system.
- Nearly two-thirds of private practices have cut costs and eliminated staff as a direct result of the 2010 Medicare Physician Fee Schedule.
- Under financial pressures, some practices have closed satellite offices that serve inner-city, disadvantaged patients, further exacerbating the racial and socioeconomic disparities of care that unfortunately exist in the U.S.
- Despite known workforce shortages, many academic centers and private practices are now deferring the hiring of cardiovascular physicians.
These are sobering statistics. The situation is both unprecedented and untenable and threatens the core of our profession and our nation’s health. A significant challenge has been the devaluation of the superb services provided by cardiovascular specialists. The reductions in cardiovascular mortality and morbidity, and the unmatched impact we have on quality of life now seem to be reduced to a commodity traded back and forth by Congress, commercial payors and the public. What is the value of this accomplishment? What is our value as professionals and healers?
No patient doubts the value of a cardiovascular specialist at 3:30 in the morning when we are caring for an acute MI. No patient questions our value when plagued by a recurrent rapid heart rhythm that is then successfully ablated. Therefore, it would seem that what we value the most, and where our greatest value lies, is the direct relationship with our patients.
The real work begins now. The ACC and its membership need to adjust the sails and set the standard for healthcare delivery in this new healthcare environment. We need to focus on providing tools for practice survival and transformation. We need to lead the profession toward systematic and measured reductions in cardiovascular morbidity and mortality and in ongoing improvements in personal and population-based prevention and healthcare outcomes. We must continue to fight Medicare incursions and defend access to quality care. We also need to focus on patient value, including partnering with patients and promoting patient empowerment.
Through the promotion of professionalism and improved systems of care, the ACC is seeking to empower both cardiovascular care teams and their patients to participate in continuous system reform and innovation.
Dr. Brindis is the new president of the ACC.