As top U.S. blockbuster drugs' patents begin expiring, healthcare may see a dip in bills through the purchase of cheaper, generic drugs. Pharmaceutical companies will undergo tough times when patent expiries occur for big brand name drugs like Plavix (clopidogrel) and Lipitor (atorvastatin), and patents on branded drugs valued at $133 billion expire within the next six years, according to EvaluatePharma, a London-based research firm.

In some practices, particularly larger ones, management professionals saw pay increases last year. However, most compensation for these professionals remained static, according to this years "Management Compensation Survey" put forth by the Medical Group Management Association (MGMA).

By 2015, 30 to 50 percent of hospitals will face extreme budget shortfalls and have limited access to capital. Cardiology already has endured multiple cuts, including a 36 percent slash in SPECT imaging reimbursement for independent cardiovascular practices, which have forced many private practices to merge with hospitals, creating strain and resistance. Meanwhile, hospitals will need to restructure payment models and care delivery to survive (and possibly thrive) in this increasingly challenging landscape.

As Medicare and third-party payor reimbursement are likely to continue to declineespecially with value-based purchasing slated to begin in 2013 under healthcare reformhospitals will need to become more financially accountable, as well as take responsibility for patient satisfaction and quality.

Thomas M. Tu, MD, an interventional cardiologist, and John M. Mandrola, MD, an electrophysiologist with Baptist Medical Associates in Louisville, Ky., discuss the complex relationships that medical societies and physician specialists form with the cardiac device and pharmaceutical manufacturers that provide the products to support their specialties.

U.S. healthcare is undergoing massive changes. While its often easy to focus on the negative side-effects of this transformation, healthcare professionals should not lose sight of its many opportunities. One of the biggest opportunities, particularly for cardiology, is a movement towards team-based care, which involves using non-physician practitioners and clinical staff to participate in the decision-making, coordination of care and shared responsibility for quality.

As physicians face tighter scrutiny from consumers and public health experts, a survey conducted by Jackson Healthcare reveals that physician salary accounts for approximately 8 percent of total U.S. spending on medical care, while only a minority of physicians receive additional earnings for ordering imaging or other tests.

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.