ACC's 2012 Practice Census Shows Continued Changes in Practice Landscape

The intersection of health reform implementation, ongoing cuts to Medicare reimbursement and a growing population living with or at risk of heart disease continues to test the limits of the U.S. health care system and physician practice models as we currently know them.

A new ACC survey of more than 2,500 practices provides a comprehensive snapshot of the current state of cardiology. Respondents from all 50 U.S. states and Puerto Rico provide valuable insight into the state of the cardiovascular practice today and the continuing trend towards hospital integration. 


According to the survey, while physicians remain the primary owner for the majority of cardiovascular practices, the number of physician-owned practices continues to decline, while hospital ownership is on the rise. Compared to 2007 when physicians owned 73 percent of practices and hospitals owned 8 percent, the new data show only 60 percent of practices are now physician-owned, while 24 percent are hospital-owned. As such, it’s not surprising that the number of cardiovascular professionals working for hospitals has also increased. According to the census, an equal percentage of practitioners (35 percent) are now currently employed by hospitals or are physician-owned, compared to 2007 when 59 percent of practitioners were in private practice and only 11 percent were employed by hospitals.

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The good news is that of the 556 practices that have merged or integrated, 68 percent report the practice climate is either better or about the same as before. However, two out of ten practices did report changes for the worse. Some of the biggest challenges facing hospital-owned practices, according to survey respondents, include workflow management (38 percent), hospital/practice alignment (40 percent), reimbursement (49 percent), Medicare cuts (56 percent) and health information technology implementation (36 percent).

The remaining private practices continue to look for options that improve the quality and efficiency of their practices, while also providing additional revenue. Continued cuts to Medicare physician payments, as well as reimbursement in general, are by far the top two issues keeping more than 70 percent of private practitioners awake at night. As a result, coding and billing and expense management are also major challenges highlighted by private practice providers.

The continued challenges and changes to the cardiovascular practice landscape highlighted by the survey results demand that cardiovascular professionals, as well as organizations like the ACC, move forward with creative and workable solutions to meet the needs of new practice models, as well as help current private practices maintain their viability. This includes looking at new payment models, outside of the current fee-for-service system; continuing with education around evolving models of cardiovascular care; developing and/or using quality tools to improve upon and/or ensure appropriate care; and helping patients take a more active role in their care.

*The ACC’s 2012 Practice Census was conducted from June 26 through August 17 by e-mail and telephone. A total of 2,520 unique practices from 50 states and Puerto Rico participated in the study. The response rate was 42 percent.


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