Growing costs, cutbacks & changes
Justine Cadet, Executive Editor
During the 32nd annual meeting of Heart Rhythm Society (HRS), HRS Chair of Health Policy Richard I. Fogel, MD, echoed the thoughts of many other specialists in the audience. “This is a very dynamic healthcare environment with a lot of unknowns. While I am not sure what the picture will look like in the next five years, one thing is for certain, healthcare in the U.S. will be forever different.”

As a result of these inevitable changes–which no one can clearly define–certain providers have decided to pre-empt government mandates and third-party payor cutbacks through novel initiatives within their practices, while some practices have caved to the trend of hospital integration.

While this trend has seen a drastic increase over the past few years, mainly due to CMS reimbursement cutbacks for private practices, a recent JACC editorial questioned the prudence of this tactic from the perspective of the patient. Editorialist Alexander A. Stratienko, MD, from the Chattanooga Heart, Lung and Vascular Center in Chattanooga, Tenn., suggested that if hospital administrators “appropriately protect” the profitability of the hospital, “who will protect the medical interest of the patient when the two are in conflict?” He proposes that the physician has traditionally protected the patient, and questioned if he or she will have the liberty to do so as a hospital employee.

While there are growing efforts by the government and administrators to reduce costs, the expenses associated with certain disease states, such as atrial fibrillation continue to rise. In fact, one recent study found that U.S. healthcare expenditures for atrial fibrillation could reach $26 billion per year. The researchers reported inpatient and outpatient medical services and pharmacy prescriptions for each patient.

Two studies presented at HRS had similar findings: Patients with atrial fibrillation and atrial flutter, especially those who are similar to the ATHENA trial patient population, have high readmission rates and inpatient costs, which lead to greater overall costs. In an interview with Cardiovascular Business, lead study author Alpesh N. Amin, MD, MBA, from the University of California, Irvine, asked: “How can we tackle such a large quality and cost burden under the current fee-for-service model? We are still rewarding or reimbursing providers for volume and not value, but it’s important that focus get shifted if any changes will occur.”

If you or your colleagues have new methods of dealing with these burgeoning costs, cutbacks and changes within the practice of cardiology, please share them with us.

Justine Cadet