A new ACC survey of more than 2,400 practices was presented today during the 2010 Legislative Conference. The survey provides a comprehensive snapshot of the current state of cardiology given the changing health care landscape. Respondents from 49 states and Puerto Rico provided valuable insight into the various ways the changes are forcing many private practices to take drastic actions to remain viable. 

Over the last year, the survey found that more than half of all practices have taken some form of cost-cutting action as a direct result of the cuts in reimbursement for cardiovascular services included in the 2010 Medicare Physician Fee Schedule. The first and largest wave of activity is directed at the staff level, with half (50 percent) of cardiovascular group practices reporting a reduction in staff to save expenses. In addition, 40 percent of survey respondents said they have reduced staff benefits, while 45 percent have reduced salaries for physicians and clinical staff (28 percent). The second wave of actions more directly impacts patients. Survey participants reported limiting services (18 percent), reducing hours and availability (10 percent), and limiting the number of new Medicare patients (9 percent).

Private group practices are significantly more likely to have initiated cost cutting activities. Patients are being pushed to hospitals to receive services which results in higher co-pays, longer turn-around in treatment, and increased costs of care. If the pocketbook continues to be tightened, practices will be forced to further limit patient services.

Private practices have also been forced to re-evaluate their business models and look for options that improve the quality and efficiency of their practices, while also providing additional revenue. This has resulted in a trend toward hospital integration or practice mergers. According to the survey, nearly 40 percent of private group practices are currently integrating with hospitals or merging with other practices. Meanwhile, 13 percent of all cardiovascular practices are considering hospital integration or a merger in the next three years to help stem the financial burden.

The ACC will be using the survey data to help determine next steps in terms of meeting member needs in terms of team-based care, quality improvement tools, educational tools and other resources. The survey results will also help inform advocacy efforts related to payment reform and health care reform implementation.

The changing practice structure has the potential to profoundly affect the physician/patient relationship, patient care and costs. These changes also will have impacts on professional societies like the ACC. Our job will be to continue to track the changes in cardiovascular practice and use the results to have in place the needed support and tools for our FACC constituency to ensure patient access to quality, evidence-based care.

* The ACC’s 2010 Practice Census was conducted from May 5 through August 9 by email and telephone. A total of 2,413 unique practices from 49 states and Puerto Rico participated in the study. The response rate was 31 percent.