Preparing for change

Happy New Year! As we usher in 2014, it is a safe bet that the next 12 months will be busy and bumpy for cardiovascular specialists and administrators.

First, we can anticipate pent up demand for cardiologists’ services from people who put off seeking care because of lack of insurance. Two days into 2014, anecdotally there are signs supporting that trend.

One likely group of patients will be those who previously were denied coverage because of pre-existing conditions such as cancer. Some cancer survivors may well need care for cardiovascular complications from their chemotherapy and radiation therapy. These treatments save lives but some also damage the heart and cardiovascular system, as detailed in “Surviving Cancer, but at a Cost.”

The unemployed and under-employed, now insured under the Affordable Care Act, also might be knocking on cardiologists’ doors over the next months. One study found that even short-term unemployment put people between the ages of 51 and 61 years old at risk of acute MI.

Analysts have predicted that the demand for cardiologists will increase by 20 percent by 2025. The projection took into account the many millions of Americans who will receive coverage under the Affordable Care Act combined with data on the prevalence of cardiovascular conditions in the U.S.

The next few months may prove fitful as payers and providers give these new insurance programs a test drive. To date, most reports have focused on sticker shock for some patients from premiums and co-pays but delays and challenges in reimbursement would not be surprising.     

On another front, Congress now has three months to try to resolve differences over legislation designed to repeal and replace the sustainable growth rate (SGR) formula. This may be the magic year when the SGR gets mothballed for an approach that emphasizes value.

Common sense dictates that this flawed formula that has sown uncertainty for many years needs replacing. There is a reasonable chance that the SGR may be repealed, but—pardon my skepticism—not because Washington saw the light. Instead, the three-month patch coincides with a pivotal election year for some lawmakers who have been criticized for political gridlock in the past.

The next year will be interesting, albeit probably rocky. We welcome hearing from you as these changes affect your practices and patients.   

Candace Stuart

Cardiovascular Business, editor