Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting
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Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting Heart House, Washington D.C. August 2010 Changing CV Practice Landscape
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Changing CV Practice Landscape. Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting Heart House, Washington D.C. August 2010. Methodology. Survey sent to physicians in each state from the Chapter Governors. - PowerPoint PPT Presentation
Transcript of Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting
Findings from ACC Cardiovascular Practice Census
Presented to:ACC Board of Governors Meeting
Heart House, Washington D.C.August 2010
Changing CV Practice Landscape
2
Methodology
• Survey sent to physicians in each state from the Chapter Governors.
• Initial invitation sent 5/5 with reminders on 5/19, 6/2, and 6/9. Telephone interviews were conducted 7/28 – 8/9 to solicit responses from those who did not initially respond to the survey.
• A total of 2,413 unique practices participated in this study after surveys were cleaned and duplicate practices eliminated.
• Survey sent to 6,738 practices with 2,046 practices responding for a response rate of 30%. Calls were made to 1,024 individuals that resulted in 367 completed surveys (36% response rate).
3
This research represents ….
• 2,413 unique cardiovascular practices that treat, on average, 389.34 patients per week (or a total of 800,486 patients/week).
• Includes representation across the U.S. – received responses from practices from 49 states and Puerto Rico
• Responses represent:• 13,898 cardiologists• 23,806 other physicians• 4,434 nurse practitioners• 2,469 physician assistants• 1,589 clinical nurse specialists• 16,247 registered nurses• 844 pharmacists• 35,599 administrative personnel
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Response to CMS CutsTotal
No new equipment 43%
Reduce staff to save expenses 39%
Reduce MD income/salaries 35%
Reduce benefits 30%
Reduce non-MD salaries 21%
Limit services 15%
Reduce office hours and availability 10%
Limit number of new Medicare patients 8%
Increase non-MD staff for clinical 9%
Opt out of Medicare 1%
Develop a physician-owned Accountable Care Organization
1%
Retire 2%
Close practice 1%
Other 11%
None of these activities were related to CMS fee schedule change
27%
CV Group* Practices
50%
50%
45%
40%
28%
18%
10%
9%
10%
1%
1%
2%
1%
11%
18%
* Excludes solo-practitioners
5
Staff Reductions
Total
Physician 1,489
Mid-level Practitioners (RN, NP, CV Tech, CNS, Pharmacist, etc)
2,620
Administrative Support 4,275
TOTAL LAYOFFS 8,384
Increase in non-physician clinical support
309
• 12,253 patients affected by limiting Medicare coverage
• Non-MD salaries reduced by 5.3%
• MD salaries reduced by 8.5%
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Benefits Reduced
• Reduce staff
• Frozen/decreased salaries
• Suspended bonus
•Reduce PTO/Vacation
• Reduce 401 K contributions
• Changed insurance coverage
• Terminated short term disabilities
7
Services Eliminated • Limiting Medicare patients
• Urgent care appointments
• Charity care
• Outpatient clinic availability
• Non-billable services – callbacks, refills, precertifications
• Blood drawing / free blood pressure checks
• MD interpretation of CT scans
• Non-invasive imaging storage/retrieval
• Nuclear medicine
• Courtesy unreimbursed Coumadin management
50%
10%
4%
8%
8%
21%
0% 10% 20% 30% 40% 50%
Nothing
Other
Consider merger
Practice merger activity
Consider hospital integration
Hospital integration activity
Total
Private Group Practices
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Changing Practice Landscape
40%
8%
4%
10%
9%
29%
50%
10%
4%
8%
8%
21%
0% 10% 20% 30% 40% 50%
Nothing
Other
Consider merger
Practice merger activity
Consider hospital integration
Hospital integration activity
Total
Private Group Practices
38%
* Excludes solo-practitioners
*
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Changing CV Practice Landscape
4%6%
8%2%
9%
60%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Solo 2-4 Cards 5-10Cards
11-29Cards
30+ Cards
No merge/integration plans
Other
Considering merge
Merge discussions
Already merged
Considering integration
Integration discussions
Already integrated
10%16%
13%
18%9%
10%4%
5%7%
8%
48%34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Solo 2-4 Cards 5-10Cards
11-29Cards
30+ Cards
No merge/integration plans
Other
Considering merge
Merge discussions
Already merged
Considering integration
Integration discussions
Already integrated
31%40%
22%
17%
10% 4%
9%8%
5% 17%
21%15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Solo 2-4 Cards 5-10Cards
11-29Cards
30+ Cards
No merge/integration plans
Other
Considering merge
Merge discussions
Already merged
Considering integration
Integration discussions
Already integrated
19% 17% 20%
16% 21% 19%
24%23%
13%
1%
10%
8%
41%29%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct/Nov 2009 Feb/Mar 2010 May/June/July2010
No merge/integration plans
Other
Within next 2+ years
Within next year
Already merged/integrated
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Changing CV Practice* Landscape Over Time
19%
16%
24%
1%
41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct/Nov 2009 Feb/Mar 2010 May/June/July2010
No merge/integration plans
Other
Within next 2+ years
Within next year
Already merged/integrated
* Excludes solo-practitioners
19% 17%
16% 21%
24%23%
1%
10%
41%29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct/Nov 2009 Feb/Mar 2010 May/June/July2010
No merge/integration plans
Other
Within next 2+ years
Within next year
Already merged/integrated
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Changes in Practice Type
2%
0%
1%
1%
2%
14%
10%
9%
24%
37%
2%
0%
1%
1%
2%
5%
10%
11%
24%
44%
0% 10% 20% 30% 40% 50%
Other
HMO
Govt Hosp-Military
Govt Hosp-Other
Govt Hosp- VA
Non Govt Hosp
Medical School/Univ
Multi-Specialty
Solo
Cardiovascular Group
Pre Integration
Post Integration
12
A lot of activity among private practices* …
* Includes solo practitioners
222 private practices (representing 2,455 cardiologists) have integrated into a hospital system
220 (1,680 cardiologists) are in discussions about hospital integration
70 private practices (738 cardiologists) have merged with another practice
93 (278 cardiologists) are in discussions about practice merger
13
State of Practice Post Integration
Better, 37%
About The Same, 50%
Worse, 13%
Q: You indicated that your practice has merged with another practice or integrated into a hospital system. Would you say your changed practice setting is better, worse or about the same as it was before the merger/integration?
n=365
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Changing Private Practice* Landscape – Practice vs. Practitioner
47%
8%
4%
9%
9%
23%
0% 10% 20% 30% 40% 50%
Nothing
Other
Consider merger
Practice merger activity
Consider hospital integration
Hospital integration activity
Practice
Practitioner
31%
9%
2%
11%
8%
40%
47%
8%
4%
9%
9%
23%
0% 10% 20% 30% 40% 50%
Nothing
Other
Consider merger
Practice merger activity
Consider hospital integration
Hospital integration activity
Practice
Practitioner
48%
* Includes solo practitioners
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Practice Alignment Evolution Across The U.S.based on # of cardiologists
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Key Highlights • CV practices have been forced to engage in cost-cutting activities as a
result of the CMS fee schedule change. The first and largest wave of activity is directed toward staff (salary/benefits) and the second toward patients (services, hours, Medicare coverage). Private group practices are significantly more likely to have initiated cost cutting activities. If the pocketbook continues to be tightened, practices will be forced to further limit patient services.
• 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.
• Private practices are being forced to re-examine their business model with larger practices are integrating into hospital systems while smaller practices are merging with other practices, affecting half of all cardiologists. Solo practitioners seem to be the only private practice type immune to these waves of change.
• The changing practice structure has the potential to profoundly affect patient care and costs.
