HRS: EP-only practices provide better cost saving and control
DENVER—In 1996, Rodney P. Horton, MD, formed an electrophysiology (EP)-only practice--Texas Cardiac Arrhythmia Research, based in Austin, Texas. Since then, Horton and his colleagues have gone back and forth from being an EP-only practice to collaborating with cardiology practices in the state.

When comparing and contrasting both entities, Horton said EP-only practices provide better control of revenue, produce cost savings and form an abundance of outreach opportunities, during a presentation at the 31st annual Heart Rhythm Society scientific session Thursday.

The road to success for Texas Cardiac Arrhythmia, an independent EP-only, non-profit practice employing nine electrophysiologists, was a bumpy one, Horton said.

A big enticement to being part of a general cardiology practice is “knowing that you have a built-in referral base,” said Horton.

During the time that Texas Cardiac Arrhythmia was part of the cardiology practice, it stayed separated by keeping its own brand name, he said. “We tried to be as pod-like as possible and separate ourselves from the cardiologists."

While Horton said that collaboration with a cardiologist practice can be fulfilling if the cardiologists carefully refer patients to EP or mine records for patients who have chronic depressed ejection fraction,  from his “jaded experience,” this was not the case. “From our personal experience it just wasn’t nearly enough for what we gave up.”

From any clinical practice standpoint, Horton said that there are four aspects a practice must focus on: referral volumes, revenue, research and coverage.

When part of the cardiology practice, Horton said the group was sent only 32 percent of the EP volume that they received. Most of the patient volume was formed from outreach gained from other resources and other EPs throughout Texas.

“We were giving up a lot financially,” he said. “Now this might not be true everywhere, but I guess we picked the wrong practice.”

After becoming independent from the group, while Horton said the practice still sends referrals, he and colleagues have been able to build a large referral base of over 19 hospitals and one million people.

“For us to have grown this big, it really required a lot of outreach growth and developing relationships in towns outside of our main hub,” said Horton.

At a typical research site, two to three EPs from the practice are rotated from site to site. According to Horton, a typical week consists of one full day in the clinic, outreach for one day—a half day in the clinic and a half day of cases—and three days in Austin doing complex ablation procedures.

When first starting out, Horton said that the practice went from “absolutely nothing to something.” At this time he said the practice began receiving calls from towns that did not have EPs in the area to perform procedures. “Our practice kind of blossomed from these referrals.”

Today, Horton said that 50 percent of the practice's volume comes from outreach sites across the state. “This is valuable and may have more value than just volume.”

Horton said that EP-only practices produce far less overhead costs compared to the collaboration with cardiology practices. EP-only practice revenue comes mostly from hospital-based billings.

Comparatively, because cardiology practices have evolved into practices that are clinically- and imaged-based and largely outpatient, a large proportion of their revenue comes from these sources.

“When we were affiliated with the cardiology group, no matter how carefully people tried to manage the overhead allocation in a fair way, EPs always seemed to get the short end of the stick,” said Horton.

When affiliated with the cardiology group, Horton said that overhead costs for the practice were 54 percent, currently these numbers are down to below 35 percent.

“You have to remember that you want revenue to be as high as possible and the overhead to be as low as possible,” he said. “Frankly you just don’t want to have to pay for a thing that you are not benefiting from directly and that was one of the major problems with the general cardiology group.”

Horton said that the practice has also been able to focus on research and is able to control its large referral base while benefiting from it.

Additionally, the group has formed a non-profit research foundation to institute teaching on-site, which industry pays for, where cardiologists are trained to perform EP, enhancing physician training.

“I think you can do all of these things if you are creative and it all starts with clinical revenue and volume,” Horton concluded.