Planning with an Uncertain Financial Future

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C.P. Kaiser, Editor

It can be difficult for cardiologists to adequately manage their practices when the state of reimbursement is either in flux or in a downward spiral. Earlier this month, the CMS received a recommendation from one of its advisory panels to boost payments to physicians and and hospital by 1 percent. While that might not seem like much, it could be a harbinger of things to come.

The pall hanging over medical reimbursement is a nearly 30 percent cut ready to take place in 2012 unless Congress acts to fix the sustainable growth rate (SGR), which many, including the American College of Cardiology (ACC), have argued is flawed and needs to be completely overhauled. In the meantime, Congress has applied stop-gap measures to delay the SGR reduction for nearly a decade.

The ACC argues that this state of uncertainty is not good for practice viability. How can practices set goals for the future in terms of personnel, expanding service lines and purchasing new equipment when their own financial outlook is not clear?

One thing they can do is pay attention to evidence-based medical practice. We are increasingly moving toward a pay-for-performance model of care and Cardiovascular Business News highlights when the evidence points to one technique or protocol over another.

For example, Curry et al found that while protocols are beneficial for optimizing outcomes in patients with acute MIs (AMIs), an organization's values and how those values are emphasized throughout the enterprise contribute a great deal to optimizing outcomes. This is not to say that standardized protocols should be abandoned. It emphasizes that protocols do not happen in a vacuum and leadership is just as important.

Researchers from Spain and Italy found an increase in hospital deaths among elderly patients who had high undiagnosed blood glucose levels. They suggest routine testing of these patients when they are admitted for acute illnesses.

This type of patient management is important as hospitals are increasingly being judged and reimbursed based on outcomes. If a patient population is at risk for death, it would be wise to minimize that risk. In this case, a simple fasting blood glucose test can identify those with high levels, therefore allowing clinicians to be more aggressive in specific treatment.

Cardiology practices are increasingly being integrated with larger hospital systems. In these cases, as well as with independent practices, it is important to maintain an edge on patient management, as more research identifies best practices, which might be linked to reimbursement. Maintaining solvency within a practice can be challenging, but it will help in the long term to tie patient management with practice management.

Let us know how you are weathering the practice management challenges.

C.P. Kaiser
Editor