Specialties, such as cardiology, are particularly susceptible to the ongoing transformations and diminishing reimbursements of the U.S. healthcare landscape. In fact, American College of Cardiology's (ACC) CEO Jack Lewin, MD, advised the cardiology community to begin preparing now for a move away from the current fee-for-service model  at last month's 60th annual ACC scientific sessions.

The current model is "unsustainable," Lewin says. It is a national imperative to start seeking out better ways to organize healthcare with an improved payment model and delivery approach that also enhances quality and health status with lower costs.

If cardiologists preempt the implementation of these changes by beginning to alter their practices now toward a shared savings model, such as with accountable care organizations (ACOs), they could potentially reap the incentives, rather than face forthcoming penalties.

Under ACOs, luminaries have suggested that healthcare providers will be encouraged to embrace value over volume. However, how that model will ultimately materialize is less clear.

Regardless, payment reform is "essential in this evolution because if the incentives are not aligned correctly, then we will not get to a better endpoint in terms of ferreting out efficiencies," Lewin says.

Changes won't necessarily all originate from the government. Over the next five years, there will be many changes to the healthcare payment model with or without the federal healthcare reform process, Lewin predicts. "For specialties, including cardiology, the fee-for-service model is a comfortable process, but we are going to begin preparing for change," he adds.

Willingness to adhere to appropriate use criteria and publicly report patient outcomes is  another method for staying in front of the changes from the state and federal government, as well as from the payor. Transparency will be a key aspect of this process.

At ACC.11, outgoing ACC President Ralph Brindis, MD, MPH, told Cardiovascular Business that cardiovascular medicine is "under attack" by being accused of performing inappropriate angioplasties. "The appropriate use criteria allow providers to assess whether they are properly performing these procedures, including assisting with patient selection," Brindis said. Also, he said that "public reporting is here to stay." Thus, cardiologists need to be on the forefront of this movement due to the national scrutiny.

Despite the uncertainty, the energy at ACC.11 was incredibly positive, which was encapsulated by Brindis' outgoing president perspective: "Whether it is through registries, clinical documents, relationships with lawmakers or educational programs, we are making a difference and paving the way for future generations of cardiovascular professionals and saving the lives of countless patients in the process."