Survey: Private practices show skepticism about healthcare reform

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"Private practice cardiology will not survive the 2010 CMS Physician Fee Schedule cuts regardless of the healthcare reform legislation, but the passage of this legislation adds the final nail to the coffin." This is just one of the many comments from participants in a survey of more than 300 cardiologists and cardiology professionals conducted in March by MedAxiom, a subscription-based resource provider for cardiology practices.

Out of the 310 MedAxiom members who were sent the survey, 225 responded. Of those, 71 percent indicated the newly-enacted healthcare reform legislation will hurt their ability to serve their patients; 81 percent said they believe the law will hurt their overall practice; and 83 percent predicted that their revenue will decrease.

The numbers are statistically significant, because 68 percent said they were opposed to the healthcare reform bill prior to its passage by Congress, according to MedAxiom.

"These numbers have less to do with the individual elements of the healthcare reform bill and more to do with skepticism within the cardiology community regarding the government's ability to manage something it may not do correctly," Patrick White, president of MedAxiom, told Cardiovascular Business News.

The average size of MedAxiom member practices is 19 cardiologists per group, ranging from one to 90 cardiologists. Part of the skepticism of private practice cardiologists also rises from the trend of practices increasingly merging with their hospital partners.

In the last several years, 15 percent of member groups have integrated with hospitals and 45 percent are currently working on integration deals, mainly driven by financial concerns. While all different sizes of groups have merged with hospitals, the trend favors mid- to large-sized groups, White said

One survey respondent commented: "We felt we needed to sell our practice to the hospital because of healthcare reform. The jury is out as to the effect on our practice."

"We know that the majority of our private practice members will no longer be in private practice in years to come. It's not only the cuts to reimbursement that have affected us greatly, but there are issues on the regulatory side as well," White added. "Congress and MedPAC and CMS seem to feel that anytime you give physicians a piece of equipment they will overutilize it. We are losing site of the benefit of medical imaging and how it can decrease downstream costs associated with cardiac caths and hospitalization."

Many participants expressed a concern about the increasing use of preauthorization by private payors to approve imaging tests. In fact, many believe that Medicare will follow the private payor lead and enact its own preauthorization program. "Once a patient walks out the door because he or she can't have an imaging test done promptly, there is no guarantee that the patient will return for the test," White said.

One survey participant wrote: "[O]ur revenue will increase, but currently our costs are pacing and in some cases, outpacing our revenue—especially where Medicare is the payor..[O]ur net profit will decline on a per patient basis, but due to the large influx of patients, that loss may be mitigated. At this point, it is hard to predict the impact on the business-side of our practice. I am most concerned with the impact to our patients. We are just under capacity now with mid-to-high patient satisfaction. We already use electronic medical records, and physician extenders. I can't imagine how we will service so many more patients with the same or better quality care."

The MedAxiom survey found that a majority (55 percent) believe their patient loads will increase under the new law, with 79 percent of those responding saying the legislation will be detrimental to the field of cardiology.

Anecdotally, White has been hearing that more and more older cardiologists want to retire earlier than they had originally planned because of their frustration with the healthcare system. As the baby boomer generation ages, the demands on cardiologists will increase. This could pose a problem with an already projected shortage of cardiologists in years to come, he said.

"We will be unable to meet the influx of patients into the system," wrote a participant. "We already are unable to meet primary care needs. There has never been in the history of the country a government program that hasn't far exceeded its costs. There is no reason to think this one will not do the