How economic forces are reshaping the future of cardiac care

Changing cardiologist employment models

On the economic front, Joynt Maddox pointed to industry consolidation as another growing issue. Lower Medicare physician payments have forced many private practices to consolidate into large health systems or under large corporations.

"These mega health systems, mega insurers, mega everything have kind of become the way that the health system works, and that creates a lot of very different economic pressures. No one's going to go in and break that up ... instead, we need to think about how to work more in these systems as cardiovascular practitioners," Joynt Maddox explained.

In addition, the emergence of private equity in cardiology, though still small, is beginning to reshape and disrupt local markets. She said that change, and especially what happens when these firms leave the market, needs to be watched as time goes on.

The shift toward Medicare Advantage

The Centers for Medicare and Medicaid Services (CMS) has been attempting to shift more patients to Medicare Advantage plans that are managed by private insurance companies. The move is aimed at increasing efficiency and giving patients more options and benefits, but it has come with much more administrative burden in the form of rapidly rising numbers for prior authorizations.

"Particularly under this administration, we're going to have more Medicare Advantage," she said. "With policy change, it creates a whole different set of pressures on the business of practice."

Growing cardiology staffing shortages

The ongoing shortage of cardiologists is exacerbating the strain on the health system. 

“We see problems of staffing everywhere that are particularly problematic in rural areas,” Joynt Maddox said. “Hospitals aren't only competing with each other, they're competing with industry … where clinicians are growing increasingly unhappy with the practice environment.”

To address the clinician shortfall while at the same time working top improve care quality, she advocates for expanded team-based care models.

"We need to be thinking about ways that we can use team-based care and other approaches to really kind of multiply our presence, if you will, because we can't increase the number of clinicians with the same speed with which people are aging into needing care," she said.

Technology, particularly artificial intelligence, also offers potential solutions to augment the staff that is available to make them more efficient and speed workflows, but AI needs to be implemented thoughtfully.

"We're going to need to get a little smarter about how we use technology. It's obviously a whole new era of technology and of AI and of prediction, and we're just starting to figure out how to use it. That's going to be key, because if you've got clinicians who don't have to write notes because AI is doing it for them, and don't have to do follow up in basket requests, a lot of it can be handled. That does free up more time to be able to actually interact with patients and try to keep them healthy. But we are not at prime time for using all that stuff just yet," Joynt Maddox explained.

Making cardiovascular prevention a priority

She stressed that healthcare payment models must shift toward more prevention. While cardiology has gotten pretty good at treating advanced disease, it would make a lot more sense and save a lot more money and lives to prevent cardiovascular disease before it can even develop.

"We've neglected all of the other stuff that gets people there in the first place, and so therefore we don't impact health outcomes. And that's the point of population health and ultimately the point of changing these payment models," Joynt Maddox said.

This is the goal of the CMS plan to transition to a value-based payment system, rather than fee-for-service.

“We don't really pay for health, we pay for visits. But if we could move more toward paying for health, I think it would make care even more valuable.” Joynt Maddox said. "I don't think population health is going away. I think there's too much recognition now that with the demographic changes, with the economic pressures, we have to rethink how we do this."

She is not sure where payment reform will go under the current administration, but historically these types of efforts have had bipartisan support.