Healthcare costs remain on the chopping block and with the future of the industry up in the air, more private cardiology practices have moved toward integrating with hospitals to survive the impending Medicare physician cuts and decreasing revenues. While new patients drive the business of cardiology, it remains a question as to whether supply and demand will meet midway, Patrick White, president of MedAxiom, said during a June 28 webinar outlining procedure volumes, ratios and financials.

In outlining trends in cardiology, White called it surprising that volume continues to increase in the outpatient setting. While new patient office visits have spiked in the recent years, the number of office consults have declined, he noted.

Data also have shown a steady growth in return office visits, and average of 1,150 in 2000 to more than 2,000 in 2010. In addition, White reported that total cognitive encounters per cardiologist (meaning new patients, return visits and office consults) increased 50 percent in the last 10 years, from 1,632 in 2000 to 2,448 in 2010.

White reported that the average number of outpatient echocardiography exams per cardiologists was 194 in 2000 and 503 in 2010; however, nuclear outpatient imaging has stayed flat but declined on a per office encounter basis. In addition, while stress echo has increased, SPECT and PET imaging also have remained flat.

In the past 10 years, admissions have spiked on the inpatient side but consults have declined and hospital cognitive encounters have remained flat.

On the inpatient evaluation and management (E&M) side, White stated that:

• Catheterizations are flat per physician and flat per patient encounter;
• PCIs are increasing slightly per physician and per patient encounter; and
• Electrophysiology-related procedures are flat to slightly increasing.

The future of stenting and PCI is questionable, said White, adding: “Will this have a future impact on volumes? Will appropriate use criteria (AUC) have an impact on stenting?" he asked. While the answers to these questions remain unknown, due to the recent bad press associated with stenting and its overuse, White said it will be interesting to see what happens to these expensive procedures as hospitals must begin cutting costs while at the same time improving care.

In addition, White said that revenue is declining for integrated groups, adding that Medicare and Medicaid advantage has grown and that will continue to grow at a much faster pace. "For the next 19 years, it is estimated that 10,000 Medicare beneficiaries will be admitted per day," White noted. He called this news “striking” and said that “if there are 20,000 cardiologists in the U.S., it is half a Medicare enrollee per day. This will definitely put a strain on the system.

“When people look at all the healthcare dollars we spend and all the bad press, it’s very unfortunate that we get painted with a pretty broad brush,” said White.

If these trends continue in the direction they are going, White says that cardiologists will be seeing more patients but doing fewer procedures. “The mix of expertise that we will need might change,” says White. The question then becomes: “Will we have enough procedure volumes to feed interventionists, electrophysiologists and diagnostic staff?”

Revenue and income are decreasing, and physicians are working harder for less money. While he said that the government has turned its focus toward ACOs, it is still unknown how they will fit into the healthcare mix.

White did offer that practice integration increased 21 percent from six months ago, and he estimated that by the end of this year, 60 to 80 percent of practices will be integrated due to the changing healthcare landscape.

The webinar—Practice Trends: Procedure Volumes and Ratios, Financials, and Hospital Integration—is part of MedAxiom's Driving Practice Improvement webcast series. MedAxiom represents more than 3,000 practices and 5,400 physicians.