Heart Rhythm Society (HRS) Chair of Health Policy Richard I. Fogel, MD, echoed the thoughts of many during the 32nd annual HRS meeting: This is a very dynamic healthcare environment with a lot of unknowns. While I am not sure what the picture will look like in the next five years, one thing is for certain, healthcare in the U.S. will be forever different.

Specialties, such as cardiology, are particularly susceptible to the ongoing transformations and diminishing reimbursements of the U.S. healthcare landscape. In fact, American College of Cardiologys (ACC) CEO Jack Lewin, MD, advised the cardiology community to begin preparing now for a move away from the current fee-for-service model at last months 60th annual ACC scientific sessions.

As Congress and other policymakers seek to lower costs, improve access and ensure quality in the U.S. healthcare system, there are increasing opportunities for collaboration between healthcare providers and payors.

On Oct. 1, 2013, physician practices and hospitals will be required by CMS to have transitioned from the 30-year-old ICD-9-CM codes to the ICD-10-CM (clinical modification) and ICD-10-PCS (procedural coding system) codes. The switch will cost time and money because ICD-10 has nearly nine-times more codes. Many practices and facilities, however, have not even begun a preliminary assessment of what the transition will require, which could negatively impact their bottom line.

Based on surveys distributed throughout 2009, the ACC estimates that nearly half of private practice members have sold their practices to become employees of hospital systems, with many more heading in that direction. The cuts in payment for cardiovascular services included in the final 2010 Medicare Physician Fee Schedule (MPFS) have forced the hands of many practices struggling to remain viable.

Since the clinical benefits of fractional flow reserve (FFR) were confirmed with the release of the FAME study in January 2009, the technology has gained wider adoption. To assess its impact on contemporary cath labs, five interventionalists came together from across the U.S. to discuss the economic considerations.

The U.S. healthcare reform law makes significant headway in expanding access to care for millions of uninsured Americans. It extends Medicaid qualifications, increases the age limit for young adults on family plans and eliminates pre-existing condition exclusions for insurance. The legislation also addresses congenital heart disease, chronic disease management, prevention and wellness, as well as funding for Medicare and Medicaid pilot programs.

Cardiology practices have always faced fairly distinctive coding and billing challenges. Rapidly declining reimbursement for key servicesincluding nuclear medicine, cath labs and consultationsnow makes it imperative for cardiology practices to capture and collect every legitimate charge.