Feature: More cardiac patients seen, less Medicare reimbursement

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As the baby boomer population begins to age and demand more care, cardiologists are seeing a surge in patients, but are getting reimbursed less and less for their services, according to a survey conducted by MedAxiom, a subscription-based resource provider for cardiology practices.

Cardiologists reported seeing an average of 343 new patients in 2009 and saw an average of 1,700 return appointments with existing patients last year, what MedAxiom said is the highest yearly number ever reported. This indicates "an ongoing commitment to providing consistent, high quality healthcare," said Patrick White, president of Neptune Beach, Fla.-based MedAxiom.

Additionally, the survey showed that the number of nuclear studies performed by cardiologists rose by 5 percent compared to those performed in 2008—the highest number in the last three years.

“This is largely due to the growth in the total number of patients being seen by cardiologists,” said White.

And while the survey found that the number of treadmill tests cardiologists administered was at their lowest levels last year, rates of stress echocardiograms reached their highest levels. The company reported that an estimated 4 percent of all patients underwent stress testing.

While Medicare reimbursements for these tests are slim, MedAxiom said that cardiologists have begun cutting down on overall operating costs to minimize their losses.

"We've done what Medicare wanted us to do. We've moved patient care from inside the hospital to outside the hospital. And the proportion of diagnostic testing grows only in proportion to the number of patients seen. Yet, it is becoming increasingly difficult for cardiology practices to deliver efficient care with the increasing financial pressures," White said in an interview.

"Unlike previous generations, the baby boomer generation understands the importance of being seen immediately for health concerns. We're better educated, better informed and we're putting more pressure on the system, especially when you consider the number of cardiologists who will potentially retire in the next decade," White said. "Not only do cardiologists see more new patients, but because treatments are effective, they continue to treat current patients longer. There's a lot of pressure for cardiologists to meet this demand."
To help further reduce cost, the survey found that a majority of cardiologists have begun merging practices and revising operations to account for the dwindling economy and to ensure long-term financial stability.

Virtually all practices surveyed indicated that financial concerns were the main reason for integrating with hospital systems. Every practice that integrated said it would recommend integration to others, White said.

"The level of satisfaction surprised us," he said. "It suggests that if you keep cardiologists happy, they will practice medicine longer. That could be a benefit we'll see in the next five to 10 years."

One of the main differences between this spate of integrations compared with those in the early 1990s is that practices and hospitals are both wiser about the negotiation process. While economics might drive practices to integrate, once they get to the table, they also are concerned with governance, quality and lifestyle.

"Smaller and midsized firms will face economic pressures to merge with larger firms or hospital practices. All practices will have to address the best ways to balance providing more personalized service to a growing number of patients seeking cardiac care in a cost-effective fashion," White said.

The survey found that 14 percent of practices have integrated with nearly 50 percent considering it. White anticipates that 70 percent of his members will have integrated by the end of the year.

One of the difficulties faced by cardiologists is the uncertainty of the sustainable growth rate, or SGR. Congress has postponed the 21 percent cut in payment called for in the SGR, but it's a temporary fix without any clear indication the fix will become permanent.

"How do you create a budget today if you don't know whether you'll be making 21 percent less in six to 12 months?" White asked.