DON’T BET THE FARM ON IMAGING
As indicated above, many cardiology integration transactions have been largely based on the enhanced revenues hospital systems realize when outpatient cardiac imaging is performed under the Hospital Outpatient Prospective Payment System in comparison with the grossly undervalued Physician Fee Schedule (PFS) (currently an echocardiogram performed in a hospital outpatient department is reimbursed about 2.5 times higher than an echocardiogram performed in a physician office practice). In fact, in recent years, many cardiologists were in effect forced to close their private practices due to draconian cuts in physician office practice reimbursement for echocardiography services. In June, the Medicare Payment Advisory Commission (MedPAC) (an independent congressional agency) in their Report to Congress (available at http://www.medpac.gov/documents/ Jun13_EntireReport.pdf) issued a scathing indictment of this reimbursement disparity, and essentially called for a regression of HOPPS reimbursement to PFS rates. This of course ignores the much higher costs associated with imaging in the hospital setting. Although the ASE has vehemently opposed the MedPAC recommendations, it is likely that there will be some erosion in HOPPS imaging reimbursement in the coming years. The main point here – integration with a hospital system should not be based solely on enhanced imaging reimbursement, which may change over time. Instead consider this as one piece of the “physician investment analysis.”
PREPARE FOR POPULATION HEALTH MANAGEMENT Although most cardiologists still work in a “fee for service” environment, passage of the Patient Protection and Affordable Care Act has heightened interest in novel reimbursement schemes which will likely be characterized by payment for value (value=quality/cost), instead of simply payment for volume. I believe echocardiography has distinct advantages over competing modalities and is best equipped for success in the coming age of population health management. How do we enhance the quality side of the value equation? Intersocietal Accreditation Commission (IAC) accreditation of echocardiography laboratories, physician certification by the National Board of Echocardiography (NBE), and sonographer registration by the American Registry for Diagnostic Medical Sonography (ARDMS) or the Cardiovascular Credentialing International (CCI) are all important metrics which indicate a
Although most cardiologists still work in a “fee for service” environment, passage of the Patient Protection and Affordable Care Act has heightened interest in novel reimbursement schemes which will likely be characterized by payment for value (value=quality/cost), instead of simply payment for volume.
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