Value-based care gives cardiology practices an opportunity to thrive

 

The Centers for Medicare and Medicaid Services (CMS) aims to transition completely to value-based payments by 2030. This has some physicians and health system executives feeling concerned, but others see the change as something positive. 

"It's an opportunity for cardiologists to determine what patients need and to listen to them. We can think deeply about the services our patients need, whether or not those services are on a fee schedule," explained Jason Wasfy, MD, an associate professor at Harvard Medical School and director of quality and outcomes research at Massachusetts General Hospital Heart Center. He spoke in the business of cardiology sessions at Heart Rhythm 2024, the Heart Rhythm Society annual meeting, and expressed a lot of optimism. 

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."

Dave Fornell is a digital editor with Cardiovascular Business and Radiology Business magazines. He has been covering healthcare for more than 16 years.

Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com

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