Is This the End of Private Cardiology Practice?

An article titled “Is This the End of Private Practice?” in the August issue of the American College of Cardiology CardioSurve newsletter features the results of several surveys that were sent to more than 350 cardiologists.

The surveys were designed to help cardiologists better understand “the impact that the changes to the CMS Fee Schedule would have on cardiovascular care.” According to the article, the results show that “the private practice model is, in fact, struggling to survive.”

In response to the question “Which of the following activities have you or your practice undertaken in the past 30 days?” nearly 57% of respondents said that they had “reduced staff to save expenses.” Seventeen percent of respondents said they had limited the services offered by their practices; 8% had reduced office hours and availability; 4% had retired; another 4% had decided to limit the number of new Medicare patients seen by their practice; and 1% had opted to close their practice. One-fifth (20%) marked “other” on the survey, while 28% had done “none of the above.”

According to the article, this “decay in private practice cardiology is largely the result of a financial burden that is more easily absorbed in other practice models.” When asked to rate their financial health, cardiologists working at private practices were less likely to be optimistic about it. Only 29% of cardiologists working at private practices responded that the financial health of their practice was “good;” nearly half (48%) of cardiologists practicing in non-private settings said that the financial health of their organization was “good” or better.

One cardiologist quoted in the piece said that “The death of private practice... is imminent. It is impossible to provide appropriate patient services facing markedly reduced reimbursements and 60% overhead.”

In addition to showing that private cardiology practices were more than twice as likely to have taken “some form of cost-cutting action” compared to other practices, these surveys also revealed that many private cardiology practices “have also been forced to re-evaluate their business model, which has resulted in a growing trend toward hospital integration.”

Indeed, nearly 30% of practices with “migration plans” were focusing on hospital systems, with only 8% responding that they were looking to “merge with another practice to help stem the financial burden.” One-quarter (25%) said that they were “in the consideration phase of hospital integration or practice merging and have not yet been moved to action.”

With nearly six in 10 cardiologists working in a private practice setting (defined in the article as “solo practitioner, cardiology group or multi-specialty group”), the CardioSurve authors are quite correct when they claim that “the migration by private practices to hospital systems represents a significant change in the cardiovascular practice landscape” that “has the potential to profoundly affect both patient care and costs.”

The ACC In Touch blog has more on this, and warns that although “cardiology is making changes to keep up with the current health care environment” it would be folly for healthcare policy makers in Congress and the Obama administration to think that private cardiology practices “can sustain the increasing reimbursement cuts” when in reality these changes are forcing cardiologists “to make real changes to the way [they] practice (cutting necessary staff, limiting services) that affect the patient experience.”

The In Touch blog also says that even more bad news may be on the way — the ACC is currently compiling “a larger, more robust survey of more than 2,000 cardiologists that appears to be even more damning.” Results are expected to be released in mid-September.