Benchmarking: Cardiologists’ Ally in Tough Times

It’s become fashionable to describe the healthcare system as hopelessly broken, and to indirectly blame providers as a key reason for the situation. For instance, a new report from the National Academy of Sciences (NAS) sums up what it terms as a “fundamental paradox” in U.S. healthcare. It warns that American healthcare “is falling short on basic dimensions of quality, outcomes, costs and equity.” It compares the current delivery system to other industries, and concludes that the U.S. system falls significantly short.  

The NAS report quotes a 2010 Institute of Medicine report that quantifies $855 billion in excess costs in just one year, and notes that amount is greater than the Department of Defense’s entire 2009 budget.

Is it any wonder that healthcare finds itself in the bull’s eye for those who are trying to cut government spending? Medical professionals are increasingly being challenged to show improvement in how they deliver high-quality healthcare to their patients, both on quantitative and qualitative bases. Increasingly, they are relying more on clinical and operational benchmarking and trending data to track progress and to set goals for improvement in critical areas.

Cardiologists are leading this initiative, with proof coming in a survey published this summer. The American Society of Nuclear Cardiology (ASNC) partnered with MedAxiom to provide a trend study that focused on the current state of nuclear cardiology practice.
The survey received responses from 111 practices in the U.S., representing more than 2,000 cardiologists. The lion’s share of practices (42 percent) had between 11 and 20 cardiologists; more than half of those responding (58 percent) belonged to privately held practices, with 40 percent in integrated settings; the remaining 2 percent were in academia.

The ASNC/MedAxiom Nuclear Survey found that cardiologists are among the leaders in the adoption of appropriate use criteria (AUC) in their practices, as evidenced by a leveling off of the number of nuclear studies they performed per patient, even as the number of patients seen by the average cardiologist continued its steady rise.

The number of office encounters rose again in 2011 to 2,044; that’s up 35 percent from 2004, and up more than 3 percent year-over-year. It is indicative of more baby boomers requiring the services of specialists such as cardiologists as they age.
Despite the continued rise, the median in the number of studies per patient dropped from one in every six patients (16 percent) in 2004 to one in nine (11 percent) last year. The survey’s results showed that, on average, 234 nuclear studies were performed last year; down almost 17 percent from the number they performed in 2004. The study cited five primary reasons for the decline in the number of nuclear studies:

• The increasing adoption of AUC by cardiologists;
• The economic downturn, which has resulted in higher unemployment and loss of insurance coverage among a larger segment of the population;
• Higher deductibles and copays for those who have insurance;
• An ongoing concern over radiation exposure from imaging exams among providers and patients; and
• The use of provider-based billing by integrated groups, which splits revenue between a professional group performing the tests, and the larger healthcare organization, which receives compensation for performing the study.

PET scans, the survey found, continue to grow slowly in adoption among practices that have invested in the technology; the study cited PET’s lower per-dose radiation levels and improved image quality among a subset of patients for whom SPECT tests do not usually produce usable images, as well as increased patient satisfaction.

It also noted that challenges in obtaining rubidium generators in 2011 dampened greater adoption. The FDA voluntarily recalled the isotope generator because of concerns over what the agency called “inadvertent, increased radiation exposure” and then reversed course earlier this year.

MedAxiom’s perspective is that there has never been a time when benchmarking performance is more important to the continued health of cardiology practices. As a key strategic planning and decision-making tool, it is vital to help practices understand how they are performing, especially with the greater financial and regulatory pressures they face.

Campaigns like Choosing Wisely help physicians decide which tests to administer when. Benchmarking how changes are implemented enables practices to remain efficient and profitable.

The survey found that privately held practices are far more likely to retain total control of testing procedures, and less likely to outsource, than integrated groups. For instance, the average private cardiology practice conducted more than three of every four SPECT studies last year, outsourcing the tests in less than 23 percent of the instances.

By contrast, integrated practices referred the administration of these tests to their healthcare organization two-thirds of the time. This is an about-face from the numbers as reported just four years ago.

So, what does it take to operate as effectively as possible in today’s cost- and results-conscious environment? MedAxiom surveyed several high-performing groups to better understand how they were able to achieve and maintain their high level of performance. They focused on areas such as:

• Staffing: Groups ensured they had the right number of staff and ensured each person had the appropriate skill set needed to do the job well;
• Efficiency: Several groups noted that physicians are assigned to the nuclear lab for supervision purposes; having access to the physician improved efficiency; and
• Scheduling: Patients are called two days in advance of appointments to ensure they have adequate transportation, thereby reducing cancellations and no shows.

Cardiologists, however, face a potential challenge, such as investing in improved technology over the next several years. More than half of the practices reporting (58 percent) said their SPECT cameras are between six and 10 years old and 22 percent said their cameras are more than a decade old. While the lifespan of SPECT cameras has not officially been determined, there are indications that with the anticipated growth in demand for cardiologists’ services as baby boomers get older, the need for SPECT- and PET-based studies will continue to grow as well. As a result, healthcare organizations may need to replace existing cameras, or even expand their inventory, concurrent with the focus on appropriate use criteria.

The NAS report states that the path to what it calls a “learning healthcare system” involves improved outcomes through “engaging patients, families and communities; achieving and rewarding high-value care; and creating a new culture of care.”

Cardiologists will play a critical role in that new culture. While the number of patients needing care will continue to grow, cardiologists will meet the demand and provide superior quality of healthcare.
Linville is the CEO of MedAxiom.