Prepare for pay-for-performance

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Candace Stuart - FOR LEAD ONLY - 157.40 Kb
Candace Stuart, Editor, Cardiovascular Business

Cardiologists may be fleeing the practice of medicine over the next decade, according to one poll, and healthcare reform may be fueling the exodus. One looming challenge is pay-for-performance. Are you ready?

Results from a recent poll found that 45 percent of cardiologists plan to retire or otherwise hang up their stethoscopes by 2022. The number does not seem far-fetched, given that the American College of Cardiology reported in 2009 that 40 percent of cardiologists were 55 years old or older.

This could be interpreted in many ways. Economists have pointed out that some retirement-age employees have remained in the workforce because they lost savings in the recession and needed to rebuild nest eggs while other older workers are fiscally capable of retirement but reluctant to forgo an income in this economy. This trend has contributed to a logjam that has exacerbated already high unemployment.

Cardiologists—who have salaries ranging from the low $400,000s to $500,000 and higher, according to the Medical Group Management Association—may be better positioned to make the leap than other employees. Perhaps this is a sign that the logjam is beginning to loosen, at least at the top of the pay scale.

Jackson Healthcare, which conducted the survey, suggested that healthcare reform may be serving as an unintended pry bar; given the changes mandated under the Patient Protection and Affordable Care Act, some physicians say they prefer to leave medicine rather than experience what some anticipate will be a difficult adjustment.

There is cause for anxiety. The clock is ticking on several pay-for-performance initiatives, which include mortality and 30-day readmission rates for acute MI and heart failure. One recent study in the Journal of the American College of Cardiology found that hospitals implement only half of evidence-based recommended practices for reducing readmissions. The authors observed that it has yet to be proven that following these practices actually reduces readmissions, or which recommendations have the biggest impact.

That finding follows another analysis published in the Journal of the American Medical Association that found a proposed measure on 30-day mortality outcomes for acute ischemic stroke missed the mark by a wide margin. The proposed measure is under public review. Adding a score for stroke severity greatly improved the measure model’s accuracy, the authors contended.  

Given these uncertainties, many physicians and administrators worry about the effect of pay-for-performance on patient care and reimbursement. Beginning in fiscal year 2013, hospitals that perform below expectations will be financially penalized by the Centers for Medicare & Medicaid Services (CMS). But be prepared: CMS is expected to begin tracking data for these measurements in October.  

The September issue of Cardiovascular Business will explore strategies for dealing with the acute MI and heart failure performance measures. Be sure to check it out, either online or by signing up for the electronic or print edition.

Feel free to contact me about this topic and other issues.

Candace Stuart
Cardiovascular Business, editor