Navigating value-based medicine helpful for interventional cardiology careers

NEW ORLEANS — Excelling at value-based medicine will be the key to navigating the increasingly challenging interventional cardiology job market, according to a presenter at the Society for Cardiovascular Angiography and Interventions Annual Meeting.

“There’s no good way to navigate these waters and I believe that health care reform for interventional cardiology offers several difficult choices that we need to make,” Christopher J. White, MD, MSCAI, FACC, FAHA, FESC, a member of the Cardiology Today’s Intervention Editorial Board and chairman of the department of medicine and cardiology and chief of medical services at Ochsner Medical Center in New Orleans, said during the presentation. “In our community of interventional cardiology, there are winners and there are losers. And you’re going to need to figure out which group you’re going to be in.”

Current job market

A 2009 survey from the American College of Cardiology reported a workforce crisis, in the form of a shortage of 1,941 interventional cardiologists. The survey recommended increasing the number of CV specialists based on the projected increase in U.S. adults with CVD.

Instead, since the survey, the number of patients needing interventionalists has gone down, according to White. Additionally, expanded training programs have left a surplus of graduated fellows, with limited jobs available.

“We’ve quickly moved from an area where many openings were unfilled and there was concern of a lack of providers for patients who needed to see us to a time when jobs are tight, compensation is under a lot of pressure and there’s frankly oversupply of graduated trainees,” White said. “We expanded the programs but decreased the volumes, and what does that mean to us? It means about two-thirds of interventionalists are doing less than one PCI per month. Those data were from 2013, so I think the figure is actually lower today. The vast majority of our providers are not doing high-volume intervention.”

Also of note, White said, was a 2014 ACC survey in which fewer than 25% of cardiology job openings were for interventionalists.

Costs and v alue-based payment

A troubling trend, White said, is “that the U.S. is way far above other developed nations in the cost it takes us to provide health care.” In this climate, value-based payment is being adopted to address both rising costs and quality, he said.

“We know that for men and for women, incidence of CVD increases with aging, and we have an aging population,” he said. “The baby boomers are coming through. What are we going to do about taking care of all of these people, when at the same time we have to get control of these costs?”

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White said the transition to value-based care is occurring now.

“Bundle payments are another way we’re doing the transition from volume to value,” he said. “Make no mistake that if you’re waiting to be told when is it time to make the conversion or to think about a strategy to position yourself and your organization, it’s time. It’s maybe even a little late. It’s not too late but you do not have the luxury of waiting another year or two before you figure out how to do this.”

White encouraged interventional cardiologists to be adaptive to change and highlighted the trend of employment away from independent physicians and toward employed physicians.

“There are people who are making alignments and there are people who are putting themselves in a position to benefit from strength and size,” White said. “So, are you on that bus or are you off that bus? Frankly, do the hospitals and health plans and the other providers of health care, do they want you on that team? Are you attractive to them? Or are you unattractive?”

In this job market, White said, setting oneself apart, particularly by being an engaged doctor, is important.

Solutions

In his presentation, White highlighted a formula that should govern the decisions physicians are making in order to thrive in the value-based payment system. The formula determines value by quality plus service divided by cost.

“You can increase value by either affecting that numerator which is quality or outcomes or service, by increasing those things or by decreasing the cost of those services or by a combination of both, but when you make decisions that violate this equation, that won’t last. So, pay attention to this equation and make decisions that are consistent with it,” White said.

In a study of computerized physician order entry enabled with decision support in participants with ACS, physicians who used the system were more likely to achieve perfect care for their patients, and perfect care was linked to increased survival.

According to White, as outcomes improve, so does an operator’s reputation, and his or her patient population will increase. Additionally, these physicians will be more attractive candidates to hospitals and payers.

“You need to be a quality champion. You need to lead that fight and you need to be a safety leader. You need to be the guy who cares the most about safety in your hospital. The winners will be the early adopters of this value agenda. In other words, will reap huge benefits for this, even if the administrative change is slow,” White said. – by Cassie Homer

References:

White CJ. Founders' Lecture. Presented at: Society for Cardiovascular Angiography and Interventions Annual Meeting; May 10-13, 2017; New Orleans.

Milani RV, et al. Am Heart J. 2012;doi:10.1016/j.ahj.2012.04.004.

O’Gara PT, et al. J Am Coll Cardiol. 2014;doi:10.1016/j.jacc.2014.04.002.

Rodgers GP, et al. J Am Coll Cardiol. 2009;doi:10.1016/j.jacc.2009.08.001.

Disclosure: White reports no relevant financial disclosures.