ACC: Reimbursement woes pain hospitals/private practices
CHICAGO—Reimbursement cuts have been detrimental to healthcare providers, but private practice physicians and hospitals still can get ahead. During a presentation March 25 at the 61st annual American College of Cardiology (ACC) scientific session, Gregory S. Thomas, MD, MPH, practicing cardiologist at Mission Internal Medical Group in Mission Viejo, Calif., offered strategies to help both private and public sectors.

“Today many specialties are doing double what the primary care physicians [PCPs] are doing,” Thomas offered. “As specialists, we believe we should be getting paid more for performing a TEE [transesophageal echocardiogram], but there are many people who would like to pay us much less for the procedure.”

However, the hopes of many cardiologists to get more for their services may not be realized, especially as reimbursements keep decreasing at a fast and steady pace. To help curb these cuts, MedPAC has gone to Congress calling for a compromise between physicians and Washington. In their plea, the commission urged Congress to help to reduce overpriced, overused healthcare services, like imaging, Thomas noted.  

He added, “Public opinion is certainly not on our [cardiologists'] side in terms of increasing the amount we will get for the fee-for-service work that we do.” This may be because many believe that PCPs and their assistants may be the key to coordinating patient care in a disjointed healthcare system.

“What can we do?” he asked. Thomas noted that a strategy should be implemented to allow physicians to “obtain other income from the healthcare system to continue practicing medicine like we’d like to.”

Thomas offered the following suggestions for this model:
  • Implement gain sharing and co-management opportunities: This can provide opportunities for physicians not partnering with a local hospital where they can make or lose money based on certain DRGs, patients coming into the emergency room and Recovery Audit Contractor audits. “We need to find out how physicians can partner with local hospitals so when hospitals gain money you can share some of that”;
  • Collaborate with other medical groups and discuss opportunities to partner;
  • Focus on clinical research: Recruiting well can be a significant source of income; and
  • Practice “hybrid concierge cardiology."

“Physicians are getting about half of what hospitals get in terms of Medicare expenditures,” Thomas noted. “How can we work with hospitals to see possibly increases in revenue?”

Thomas said that integration could be key. He said that practices will need to look at ways to work with the hospitals, without being employed by them. “Are there ways to become more integrated without becoming fully integrated and losing your independence?

“The pendulum is moving toward hospitals practice vs. private practice, but will it continue like this?” he asked.

“Medicare should seek to pay similar amounts for similar services taking into account differences in the quality of care and in the relative risks of patient populations,” Thomas said.

If these reimbursement cuts continue, private practices will be forced to merge with hospitals and patients could see triple the co-pays, he said.

Some other ways that could up the ante for private physicians could be: shared savings opportunities; utilizing the EMR in physician offices; connecting to the hospitals’ PACS to get access to the hospitals’ EMR; nurse practitioner support and joint marketing initiatives.