Cardiology practices must be more sustainable to survive

Rose outlined four imperatives for any practice looking to thrive in this changing environment:

   1. Create value in care. Applying proven interventions consistently is critical. For example, he pointed to the underutilization of cardiac rehab, which is well-supported by evidence, but unevenly implemented across the United States.

   2. Reduce unwarranted variation. Practices should avoid “nine ways of doing things” and instead develop playbooks tailored to their setting. Standardization, Rose argued, makes care more predictable, reduces costs and improves patient experience.

   3. Embrace team-based care. Cardiovascular medicine requires all clinicians—physicians, nurses, advanced practice providers, pharmacists and technologists—to work at the top of their license. “We need to be comfortable letting go of certain things that we know others can do reliably well,” he said, noting that shifting tasks such as hypertension follow-ups to trained team members can free physicians for more complex work.

   4. Commit to structured change management. Sustainable transformation requires more than inspiration. “There needs to be alignment of incentives, there needs to be an action plan,” Rose said, adding practices must establish clear decision-making pathways to avoid fragmentation.

The urgency is heightened by the projected loss of more than 500 cardiologists per year over the next five years due to retirements. Without new approaches, Rose warned, the system risks “rationing care, not by intent, but that’s what will happen in practice. Because if you can’t get in the door, you’re rationing care.”

Technology, particularly artificial intelligence, may help bridge some of the gaps by improving efficiency.

"We need something that is different. Technologies are emerging. AI is at the early steps of how it will make us more efficient if we're able to get real-time dictations and we're not on the computer at night finishing all of those reports," he said.

But Rose stressed that efficiency must not come at the expense of effectiveness.

“The output of healthcare should be effectiveness. Too often we get hung up on efficiency," Rose said. "The principal issue has to how we can be more effective, because effective care in the long run will be more efficient. If we're taking better care of that patient upfront, he or she is less likely to be readmitted, which is just waste."

National advocacy and resources through the ACC will also play a vital role. Rose highlighted the organization’s state-level chapters for policy engagement, 'best practice' guidelines presented in more digestible formats, and MedAxiom, which focuses on the business side of cardiology.

Ultimately, sustainability will require collaboration and compromise, Rose said. “We don’t need a faster horse. We need the horseless carriage. We need something that is different now.”