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How Cardiology Groups are Maintaining Independence Amid a Changing Landscape
To care for a growing patient population while navigating staffing constraints and rising costs, independent cardiology groups must rely on innovative strategies without compromising on quality.
Heart disease is the leading cause of adult deaths in America, causing more deaths than all forms of cancer combined.
In men, the risk of a heart attack significantly increases after age 45. In women, this risk increases after age 50. In the United States, someone has a heart attack every 40 seconds. By 2030, The American Heart Association projects that 40% of US adults will have one or more forms of heart disease.
Will We Have Enough Physicians to Meet This Challenge?
By 2033, the Association of American Medical Colleges (AAMC) projects a shortfall of up to 139,000 physicians in the United States. This shortage dramatically impacts cardiology. Insufficient staffing means longer waitlists, decreased patient satisfaction, and increased provider burnout.
In this landscape, remaining an independent cardiologist is proving difficult as independent cardiology groups continue to attract private equity attention.
In the last two years alone, the number of private equity firms investing in the cardiology space has grown to over a dozen. But there is opportunity: site of care shifts (e.g. an expansion of CMS support of cardiac interventions in ambulatory settings) and regulatory changes prompting telehealth innovation. To maintain independence, cardiology groups must optimize staff time and relentlessly seek out efficiency.
4 Types of Virtual Care Commonly Used by Cardiology Groups:
- Evaluation/Management (E/M) Televisits: Two-way audio/visual encounters or phone-only encounters for E/M visits. Currently, phone-only encounters are permitted by CMS through the end of 2024. Typical revenue associated with E/M televisits is $46-$110 depending on length of encounter.
- Remote Patient Monitoring (RPM): Continuous monitoring and transmission of vital signs allow providers to monitor a patient’s condition from beyond the four walls of the practice. When data transmission occurs per program guidelines, providers can bill monthly for interpreting said data as well as interacting with the patient. With the end of the Public Health Emergency, RPM services are now limited to “established patients,” meaning if a patient has not been seen within the last year, an initiating office visit is required before RPM services can be ordered. Reimbursement per patient per month can vary based on time spent rendering monthly services (i.e. if additional sessions are delivered or additional devices are used), but the typical revenue associated with RPM is $100 - $160 per patient per month.
- Chronic Care Management (CCM): Care coordination services performed outside of regular office visits for patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient. Non-complex chronic care management requires a 20-minute monthly minimum of patient interaction with an average reimbursement of $62.69 per patient per month. Complex chronic care management demands a 60-minute monthly minimum and reimburses at an average of $133.18 per patient per month.
- Principal Care Management (PCM): While similar to CCM in that it is designed to address chronic illness, PCM places a unique focus on one, sole issue, e.g. heart failure. PCM is typically delivered through a combination of on-site and remote encounters. The average reimbursement for PCM is $61.34 per patient per month.
Virtual Cardiac Rehab Outperforms on Revenue.
Not included above is cardiac rehab, as it’s not widely adopted among cardiology groups due to physical space & staffing constraints. Instead, the traditional site of care for cardiac rehab is a hospital outpatient department, with nurses and exercise physiologists treating patients in a gym-like environment.
Virtual cardiac rehab, however, presents an opportunity for forward-thinking cardiology groups to better care for patients while retaining the revenue that they’re currently referring to local hospitals. In an intensive cardiac rehab program, patients can complete up to 72 sessions over the course of 12-18 weeks. Each session reimburses at an average of $120 (Medicare), bringing the total reimbursement opportunity per patient per course of rehab to $8,640.
To offer virtual programs, most cardiology groups partner with vendors to mitigate spend and expedite speed to launch.
Estimated costs of launching a virtual care program in-house are upwards of $300K, and implementation timelines can be 6-12 months in length. Virtual care programming often requires monitoring device procurement and shipment, time spent contacting & enrolling patients, and valuable clinical hours spent delivering and documenting care.
Recora partners with cardiology groups that use our program as an extension. They haven’t invested in additional staffing or facility, but are able to offer virtual cardiac rehab via the partnership. Groups provide medical directorship and work with Recora’s technology platform to identify eligible patients. Recora staff then provide the care under the clinical supervision and guidelines of the medical director appointed by the cardiology group. With a virtual cardiac rehab program, cardiologists are better able to manage heart disease in the home.
The medical groups that will navigate the obstacles ahead are those innovating alongside the healthcare landscape.
The cardiology groups winning their markets are prioritizing patient care growth, revenue generation, and operational efficiency.
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