This post was authored by Kathy Blake, MD, FACC, member of the ACC’s Advocacy Steering Committee.

A recent article in the Wall Street Journal, “Same Doctor Visit, Double the Cost” (subscription required) detailed the shift we have seen across the country of hospital systems acquiring private practices, often leading to higher prices of services. The article notes that “as physicians are subsumed into hospital systems, they can get paid for services at the systems’ rates, which are typically more generous than what insurers pay independent doctors. What’s more, some services that physicians previously performed at independent facilities, such as imaging scans, may start to be billed as hospital outpatient procedures, sometimes more than doubling the cost. The result is that the same service, even sometimes provided in the same location, can cost more once a practice signs on with a hospital.”

The article lays the groundwork for much of what the College has been advocating for over the past few years: the need for payment reform. The payers have noticed. The patients have noticed. The Centers for Medicare & Medicaid Services (CMS), as the article suggests, may have its hands (somewhat) tied by statute. The love affair with independent practice ended a long time ago. The infatuation of business with private payers and HMOs died awhile back. The current love affair, with integrated systems, is looking a bit tattered. The reality suggests that a variety of offerings across the full spectrum probably leads to a healthier delivery ecosystem, especially if there is transparency about cost and quality, and real competition based on accurate determination of value.

The article is timely as the 2012 Legislative Conference is right around the corner and will be touching on issues such as the College’s ongoing payment reform efforts, including advocating for the repeal of the sustainable growth rate (SGR) and instead focusing on quality-based delivery and payment models. Also at Legislative Conference Dr. Zoghbi will give an update on the “State of Cardiology” with results from this year’s Practice Census (we remember the results from two years ago that started documenting this shift in private practice).

The current fee-for-service system in integrated models is not sustainable, and it is up to us to steer the payment reform decisions in the right direction.

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