No matter what size or type, running a practice hasn’t gotten any easier. Balancing the needs of patients, while also navigating changing federal and state regulatory requirements and addressing demands from payers, practice partners and/or hospital or health system executives, keeps many a cardiovascular professional up at night.

Practice integration has been one of the biggest stories over the last decade. Except for states like California, Arizona and Connecticut, integrated hospital- or health–system-owned practices have now become the norm. ACC’s latest survey of cardiovascular practices shows that between 2007 and 2017, the number of physician-owned practices declined from 64.1 percent to 34.2 percent.

Most practices are now hospital-owned, with 60 percent affiliated with a health system. This mass migration to integration has forced practices and providers to make significant shifts in operations and management structure. Understanding the “business of medicine” – contract negotiations, building an effective cardiovascular service line, dyad management, etc. – has become as essential as understanding the latest clinical research developments.

While the shift to hospital- or health system-owned (or at least tightly affiliated) practices has been the biggest story over the last 10 years, more recent changes related to reimbursement, with an emphasis on quality over quantity and population health is the new seismic shift underway, says Pamela S. Douglas, MD, MACC, co-director of ACC’s annual Cardiovascular Summit.

The Medicare Access and CHIP Reauthorization Act (MACRA) ushered in the new Quality Payment Program (QPP) and further cemented efforts to transition the U.S. health care system away from a fee-for-service model to one that is focused on improved outcomes and lower costs.

Cathleen Biga, MSN, RN, co-director of the Cardiovascular Summit, says all practices (integrated and physician-owned) need to understand the QPP and develop strategic plans to guide them going forward. ACC’s practice survey suggests there is room for improvement in this area. While more than half of practices surveyed report a QPP implementation plan at their practice, nearly 18 percent still do not have a plan and 27 percent are unsure.

“This is coming full steam,” Biga cautions. “All practices need to be thinking about this.”

Meanwhile, how do practices and providers balance the realities of the current health care environment with patient needs? Some of the most successful practices are those that find novel ways to ensure patient satisfaction, make the most of team-based care to manage and improve population health, and address workforce or provider well-being, says Andrew M. Freeman, MD, FACC, a member of the Cardiovascular Summit Planning Committee.

“In the past, the physician was responsible for managing a patient’s care and patient input mattered much less,” Freeman says. “However, our new reimbursement environment focuses heavily on patient satisfaction and has changed the patient/clinician dynamic. I now tell my patients: ‘You’re the captain of the ship, but I’m your navigator. Our job is to work together to avoid any icebergs.’”

It’s not just patients that need to be part of the care team. A 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers highlights the importance of advanced practice providers in helping cardiovascular practices meet the challenges of workforce shortages, an aging patient population and a payment system in transition.

While approximately two-thirds of participants in ACC’s practice survey noted they employ a team-based approach to care using advanced practice providers, nearly 30 percent still do not.

Check out ACC’s new audio podcast series “Practice Made Perfect,” hosted by C. Michael Valentine, MD, FACC. The series is dedicated to clinician career and leadership development through in-depth discussions on non-clinical competencies, skills and best practices. Visit ACC.org/Podcasts to learn more and to listen to the first episode on “Contracts 101.”

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session

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