What happened to cardiology's private practices?

"We're starting to see that as the hospitals come under more significant pressures, there are some different alternatives people are looking at as it relates to how physicians are an employee. And actually we've even seen unionization of doctors in some of our hospitals across the country," Biga explained. 

Another notable trend Biga mentioned is the emergence of private equity firms specializing in cardiology, indicating a growing interest in the field from investors. She said cardiology is just the latest area of healthcare to see involvement with private equity, and private equity now owns large shares of dermatology, ophthalmologist and primary care.

While acknowledging the potential benefits of private equity involvement, such as allowing doctors to retain clinical autonomy, concerns have been raised about the influence of business management on medical decision-making, akin to insurance companies dictating care protocols.

"We see private equity firms that are solely looking at cardiology. Private equity in medicine is not new, it's something that's been around, but cardiology has caught their attention the last couple of years and we're seeing that continue to ramp up. I think what we really need to do is make sure our physicians have options. I think our physician-led teams really need to be in charge of their destiny. Most physicians are entrepreneurial. They want to do what's best for their patients and they want to take the barriers down. And sometimes what we're seeing in some of our employee situations is that's getting a little bit more difficult," Biga said.  

MSOs are a new cardiology business model

Biga said a relatively new model of multistate operators (MSOs) is also expanding in in cardiology. She said the MSO provides the back-office functions and administrative burden that have gotten very complicated for stand-alone practices. She said an MSO can help reduce the burdens on the physicians, which enables cardiologists to have more time to practice medicine and lead their group. 

"This allows your group to determine its own destiny and really look at where you want to go. A lot of that still hinges on how our payment models work, but I think as we continue to see the elements of site neutrality, we continue to look at that disparity in payment that exists in our current model, that all of those things over the next couple of years are going to come to fruition," Biga said.

She emphasized the importance of physician education and understanding the implications of various employment models, stressing that there is no one-size-fits-all solution.

Measuring quality as OBLs and ASCs expand in cardiology

OBLs and ASCs are also becoming increasingly popular due to incentives for operating outside traditional hospital settings, where costs are often lower. Biga underscored the ACC's commitment to ensuring quality standards across all care settings, with the college recently launching a registry specifically for outpatient procedures through the ACC's National Cardiovascular Data Registry (NCDR). By benchmarking data and prioritizing quality metrics, the ACC aims to uphold patient care standards regardless of the site of service.

"I think best practices are really what we're looking for. So no matter what the clinicians and the government decide can and can't be done in various sites of service, the incumbency on us is to make sure the quality doesn't waiver so that our patient outcome, no matter side of service, is always as high as it can be," Biga said.