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.

Practice Ownership Across the U.S.; Based on Number of CardiologistsAn ACC survey conducted in summer 2012 of more than 2,500 practices provides a comprehensive snapshot of the current cardiology practice climate. CV physicians and administrators from all 50 U.S. states and Puerto Rico provide valuable insight into the state of the cardiovascular practice and the continuing trend toward 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% of practices and hospitals owned 8%, the new data shows only 60% of practices are now physician-owned, while 24% are hospital-owned.

Larger practices are more likely to integrate and, as such, it is not surprising that the number of cardiovascular professionals working for hospitals has also increased. According to the census, an equal percentage of practitioners (35%) are now currently employed by hospitals or are physician-owned, compared to 2007 when 59% of practitioners were in private practice and only 11% were employed by hospitals.

The good news is that of the 556 practices that have merged or integrated, 68% reported the practice climate is either better or about the same as before. However, two out of 10 practices did report changes for the worse. Some of the biggest challenges facing hospital-owned practices, according to survey respondents, include workflow management (38%), hospital/practice alignment (40%), reimbursement (49%), Medicare cuts (56%) and health information technology implementation (36%).

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% 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.