Trends in Interventional Cardiology

Earlier this year, I had the pleasure of co-presenting with Dr. Arnold Seto, Cath Lab Director, Long Beach VA Medical Center, Private Practitioner, Cardiovascular Care Inc., Professor of Medicine, Charles Drew University, Associate Professor of Medicine, UC-Irvine, and Treasurer, SCAI at our spring conference in Scottsdale, AZ.???

We began our conversation with what’s in and what’s HOT in Interventional Cardiology trends and wow, what a great discussion! I could write a book on this session alone, but for the purposes of this blog, I will offer a summary of key takeaways from our presentation.???

So, to begin…..what’s HOT are Ambulatory Surgery Centers (ASCs) and an expansion of procedures that are now more widely accepted being performed within this outpatient care setting, and keep in mind the pandemic had certainly driven this shift!? We are seeing more and more procedures being performed within the ASC; total joints beyond total knees, device implants such as pacemakers and/or implantable cardio-defibrillators, not to mention cardiac interventions, such as angioplasty and stent procedures.? For years we have not only heard but have speculated that this trend will continue to increase. However, much of this depends upon individual state regulatory language and their tolerance to accept what we’ve known is happening across the country. And, to mention that CMS continues to expand its list of covered procedures within the outpatient settings of care, i.e., the ASCs.???

Private equity is another HOT trend we are seeing, especially within cardiology. Private equity should not be foreign to anyone as it has been in place for years in other specialties such as orthopedics, GI, and ophthalmology.? This is attractive to many physicians offering them a “stake in the game,” so stay tuned as this continues to heat up!??

Positive reimbursement changes are IN, happening, and HOT for Interventional Cardiology; specifically, complexity codes for coronary procedures including an FFR with Angio being performed in the ASC.? The utilization of intravascular lithotripsy fondly referred to as “shockwave” is now reimbursed when performed in the coronary vasculature from both the Medicare perspective as well as add-on codes for work RVUs specific to the performing physician. This has been a long time coming and exciting as many of our clients have been employing this technology in the peripheral vasculature.??

Physician employment models continue to change and evolve as well.? What once was a world of private practitioners continuing to evolve to physicians becoming, or even seeking employment. A nice summary from Dr. Seto’s presentation included the following:??

• Hospitals employing physicians grew 49% between 2012 – 2015.

• Healthcare services provided in the hospital outpatient (HOPD) settings are reimbursed at higher rates than when provided in physician offices.

• Physicians employed by hospitals perform a higher volume of services in HOPD settings than in physician offices.

• For certain, cardiology, orthopedic, and gastroenterology services, hospital employment of physicians results in up to 27% higher costs for Medicare and 21% higher costs for patients.

• The physician/administrator relationship was another HOT topic of discussion and varies depending on your hospital’s model.? There is no one model, however, the two most common we see are the DIAD, or at times a TRIAD model, however regardless of the reporting relationship one thing is for certain, and that is this relationship needs to have TRUST!? Trust in one another, trust in the executive leadership team, trust in the organization’s mission and vision, trust in the community, and trust in the services you are providing will far exceed all patient expectations.? Day-to-day cath lab scenarios were presented at the conference, and with audience participation came greater dialogue and shared experiences that “one size” in these relationships does not fit all.?I know I am simply stating what should be obvious, but many opportunities can simply be solved through communication. The following is just one sample scenario that was presented and discussed with the audience:

• Your facility has had to annually pay hundreds of thousands of dollars in overtime for your cath lab staff and has had significant turnover.? Your exit interviews reveal that staff are disgruntled because they are sitting around all day 7am-5pm, and repeatedly have to stay late as the physicians have added on late cases that go from 5pm into the evening.?
• The physicians state that they have clinic all day and only have time to do procedures either in the early morning or late afternoon.?

• How would you manage this??

I challenge each of you reading the above scenario to think about how you would manage this, and how you would partner with the physician to explore opportunities to successfully come up with a win-win solution.??

Let’s not forget that even though there are many HOT trends happening and new trends on the horizon, each of us bring a different perspective. Whether you are a physician, an executive leader, an industry partner, or a clinician, we need to trust each other, collaborate with each other, keep all lines of communication open, and most importantly never forget that the safety of the patient remains first and foremost!?

To learn more about the other topics discussed in May at Corazon’s 2024 Spring Conference, or to learn more about Corazon and the services we offer, do not hesitate to reach out directly to me via email at [email protected] or call us at (412) 364-8200.???