Medaxiom Blog

Aligned? Not so Much The historical divide between CV physicians and hospitals/health systems is still alive and well in most programs despite contemporary trends in employment and contracted “alignment” models. We encounter it nearly every day and we often reside in one of two “camps” – the physician camp or the hospital/system camp. We can see how distrust, whether subtle or intense, can influence parallel decision-making processes and leadership structures. Differences are often years, or even decades old – management, infrastructure, compensation, call coverage or all of the above. Although it’s unintentional, this divided culture may cause our work to be more about our needs and managing margins and less about our patients.

MedAxiom’s recently released 2019 Cardiovascular Provider Compensation and Production Survey report unveiled heart failure insights for the first time. Heart failure physicians are still very rare in the cardiology workforce, making up just 2 percent of the total (Figure 1). For our survey, the designation of heart failure as the subspecialty type is made by the group responding. However, the Heart Failure Society of America corroborates how small this population of physicians still is, listing around 200 total fellows among its membership. Likewise, the American College of Cardiology includes 792 cardiologists who have received fellowships through its certification process, with another 105 currently in training.

Regardless of your role in your organization, you are likely intimately familiar with the administrative burden that accompanies documentation and coding and the crucial role it plays in a practice’s success. Because the process is complex and can be frustrating, mastering the art of documentation and coding requires “lifelong learning” and a team effort by all stakeholders.

What does “Patient Access” really mean in my Program? Patient access has become one of the hottest topics across the country in the majority of CV Programs. It seems so simple to “fix” however it remains a challenge. I have experienced that the definition of access has many meanings based on the individual’s interpretation in relation to their needs, schedule, organization, etc. Access has over time become synonymous with “value” care.

A common challenge in CV programs today is the cost/resource requirements of quality registry involvement such as NCDR-PCI and others. Due to several payer requirements for registry utilization, I’ve not yet been to a program that has not engaged with at least one registry in the CV program or service line. The challenge typically lies in the resource requirements for abstraction and registry data management. Although this is an important and real challenge, the bigger challenge I see is the utilization of the registry data in a meaningful way. Whether the registry is STS, NCDR-PCI, ICD, Action or others, there is a wealth of quality data that can provide feedback on patient outcomes, processes, clinical decision making and patient throughput. All of these can be tied to clinical outcomes, patient experience and the economics of your CV program. The key is using the data in a meaningful way to drive and support quality and process improvement within your organization. There are three areas that need to be managed in order to promote effective utilization of quality data - abstraction, data management, and program performance.

When you walk into a business that’s a great place for employees to work, you just know it. You can tell by the behavior, attitude, and loyalty of the employees.

It seems as though every day I hear about the next big thing. Sometimes there is merit, and sometimes there isn’t. There is undoubtedly merit to the coming changes in Transcatheter Aortic Valve Replacement (TAVR), and they are exciting. The changes are going to revolutionize how we use TAVR and how we contract to provide TAVR services. By contracting for TAVR, I’m referring to ways in which TAVR services are sold, which can mean negotiating with private payers, participating in bundles with CMS via BPCI-A, or working with jumbo employers to create bundles for TAVR procedures.

Trends in the Data For the fifth year in a row and for the seventh year out 10 overall cardiology compensation increased from the previous year, with the median now sitting at $586,888 (see Figure 1). This despite many predicting that incomes would come down, including my audience at the Spring CV Transforum where data from the 2019 MedAxiom survey were first debuted. When polled nearly 70 percent predicted that total compensation for cardiologists went down in 2019 (based on 2018 data), with nearly identical results whether considering employed cardiologists or those in private practice.

At the start of last week’s conference, I asked attendees to fire up the conference app by answering a few polling questions. When I asked people to choose their top three concerns from a list of eleven, “staff/operational efficiency” came out far and away as everyone’s biggest issue. 58 of you, in fact, put it in your top three. And when we asked people to rate their number one challenge, staff/operational efficiency was again at the top.

Last month, the long-awaited dream of patients being able to access all their medical and insurance information from any device, and take it with them to another provider or healthcare organization, got a major boost toward becoming reality.