Value-based care gives cardiology practices an opportunity to thrive

Wasfy emphasized the potential benefits of this transition for both physicians and patients, forecasting a promising shift in cardiology care. Traditional fee-for-service payments in medicine reward the quantity of care, but not the quality. The transition will shift the risk from the Medicare to the doctors and hospitals to provide optimal care with the least amount of resources in na value-based model. This will be based on episodes of care, such as heart failure, or heart attack with percutaneous coronary intervention. If a patient can be diagnosed, treated and discharged without readmissions quickly and with the least number of tests, the hospital and physicians will end up making more money. If they are inefficient and require multiple tests and procedures and readmissions, the providers may lose money.

"We will be incentivized to limit the total cost of care and improve quality, moving away from traditional fee-for-service medicine," Wasfy explained. 

He acknowledged the anxiety among physicians regarding this shift, but highlighted the potential upside. This includes giving physicians more say in how patients are treated and how their care is managed. 

Value-based care payments offer opportunities to access new technology faster

"It's so important that clinicians are involved in how policies are implemented and in how we respond to them," Wasfy said. "This is an opportunity to identify care gaps and implement services that may not be on a fee schedule, but are essential for patient care."

The potential benefits of value-based care include the integration of advanced technologies such as artificial intelligence (AI), remote monitoring and new technologies, which often are not covered by insurance payers.

"AI can help with workflow and speed diagnostics, and remote monitoring can ensure patients receive timely care," Wasfy noted. "In a fee-for-service system, these advancements are often underutilized because they aren't directly reimbursed. Value-based payments can make these innovations more viable."

The shift to value-based care could also reduce administrative burdens such as prior authorizations. "No one likes dealing with prior authorizations. This change could allow hospitals and physicians to focus more on patient care rather than navigating bureaucratic hurdles," Wasfy said.

He also explored the potential impact of this trend on the economy. 

"In America, healthcare constitutes 18% of the economy, and cardiology alone accounts for an estimated 3%," he said. "Policymakers will always scrutinize these costs. The opportunity here is to transfer decision-making to clinicians and hospitals, who know what patients need, rather than leaving it to nonclinical decision-makers."

Value-based care is already being introduced in medicine

Value-based payment models, such as accountable care organizations (ACOs), bundled payments, and Medicare Advantage, represent a variety of mechanisms that are already partially shifting the payment models away from fee-for-service. 

"There's often retrospective reconciliation of payments based on the total cost of care incurred by specific beneficiaries," Wasfy explained. "These models include penalties for hospital readmissions and other mechanisms that transfer financial risk to healthcare providers, prompting them to make more cost-effective decisions."

As CMS moves to implement new value based policies in the next few years, he said cardiologists should get involved and offer feedback when CMS asks for public feedback.

"This is an opportunity for clinicians and patients to be centrally involved in shaping the future of healthcare," he said. "Engagement from my colleagues is crucial for this transition to be successful."