A healthcare revolution is on the horizon. We know that change in healthcare is driven by change in payment. Though payment today still is largely based on volume—especially volume of high-tech procedures, we’re seeing a shift to payment that incentivizes the least costly, most effective care. As a result of payment shifts, healthcare delivery is transforming.
One specialty ripe for significant change is cardiovascular services.
Why are cardiovascular services changing? How will it impact your organization? Will it affect you in terms of how many catheterizations you perform, for example? Any change creates a host of unanswered questions; let's take a look at some of them.
Why Is Healthcare Delivery Transforming, Overall?
Simply put, we cannot afford healthcare the way it is delivered today. But that doesn’t mean we have to sacrifice our health. All too often, what providers or health systems perceive to be the standard of care may not be the least expensive, most efficacious form of treatment. We saw how healthcare delivery changed in the ‘80s with the shift to outpatient care and more recently with joint replacements moving to the freestanding setting. Healthcare delivery is transforming again, and cardiovascular services will not be exempt.
Healthcare transformation is built on four key factors:
- Delivering the right care – no more and no less than what the patient needs.
- Offering care in the right setting – the least costly place to achieve the best outcome.
- Offering care by the right provider – the least costly provider to deliver the best outcome.
- Providing care at the right time – when patients most need it, not when it's most convenient for the provider.
Essentially, transforming healthcare will include avoiding costly and/or invasive procedures that do not achieve a better outcome than less expensive or less risky treatment.
Paying for healthcare the way we do is unsustainable. Medicare Part A is projected to run out of funds by 2026. By the end of the decade, healthcare is going to be very different from what it is today.
Why Is Cardiovascular Care Transforming, Specifically?
New studies are delivering insights, which can lead to providing right care … if the payment system supports it.
For example, if a patient has a cardiac disease, today’s system is primed to provide what has long been thought of as the gold standard of care, supported by high dollar payments per procedure. However, recent studies show that medical therapy for many of these patients is just as effective and costs much less.
In 2019, The New York Times reported results from a federal study showing invasive intervention is often unwarranted for blocked arteries, bringing into question years of what was deemed the “right care.” Groups such as Cochrane provide collaborative, peer-reviewed studies that are free of commercial sponsorship or other conflicts of interest to better discern what “right care” really is — and it may differ from what most providers consider to be the standard of care.
Then there’s the NNT Group, which takes information from the Cochrane Collaborative and others to assess the cost-benefit of many forms of treatment and care. The NNT Group has long advocated against coronary stenting for non-acute coronary disease, finding it harmful compared with medical therapy for non-acute patients.
Needless to say, these are examples of factors that will change healthcare providers’ behavior regarding cardiovascular services, particularly once health systems are at greater risk for the costs and outcomes of their patients’ care.
Looking to the future, there likely won’t be the same demand for cardiac interventional procedures in 2030 as there is today. If you move forward under the assumption that you’ll continue to need the same resources — or get paid the same — for cardiovascular services in 2030 as today, you’re placing yourself in a dangerous position. Hence, you’ll need to be more strategic about investing in your cardiac program.
Timing these care delivery changes with payment changes is a delicate balance. Move too early, your financial position is threatened; move too late, you risk being left behind and irrelevant to your market. Some health systems are taking on large, at-risk contracts and pushing the envelope. Others are dabbling in a limited number of at-risk contracts to gain experience in this new payment world. And some, unfortunately, still believe that fee-for-service will remain the dominant payment methodology for the long-run.
Payors eventually will flip the switch, and those who aren’t prepared will find themselves in trouble.
How to Prepare for the Future of Cardiovascular Services?
What steps should you take to prepare for this coming revolution, especially if your bottom line is highly dependent on cardiovascular services? Ultimately, there is no one-size-fits-all solution; the right steps for you depend on what payors are doing in your market. For example, most rural areas will see a slower shift because payors there aren’t as proactive in shifting risk.
Your best solution is to understand your own organization’s position and what’s happening with payors in your market. Then, you can calibrate your strategy to align.
Scenario planning is an effective tool under these circumstances, as it helps you map out transition points along the way and include contingency planning if the future unfolds differently than expected. HealthytownTM is Ascendient's proprietary modeling tool that can help you plan for success. It’s proven effective, having correctly predicted, for example, that the majority of joint replacements would occur in the outpatient setting – precisely what we're seeing today.
Healthytown’s sources, such as Cochrane, the NNT Group, and others, permit hospitals and health systems to model specific assumptions – such as the foreshadowed decline in cardiac catheterization volume – to determine the future impact on their organization strategically, financially, and operationally (staff, facilities, and equipment).
Healthytown provides access to metrics and triggers to monitor your anticipated transformation journey. If your path is changing, it provides guidance to help you modify your strategy when necessary – if your payors speed up or slow down, you can alter your plan accordingly. Want to learn more and see the tool in action? Please click here.
