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The New Cardio Service Line

Michael Zeis, for HealthLeaders Media, March 13, 2013
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Banner Heart's Robertson observes that population characteristics support such a long-term view. "There will always be cardio patients who need procedures," she says. "Cardiac disease isn't going away. Look at diabetes incidence, the aging population, obesity. The risk factors for cardiac disease are so prevalent."

If one examines the make-up of the revenue stream, one sees continuing revenue in imaging, mostly on an outpatient basis. Says Kirschner, "If you really track reimbursement, most of the volume is outpatient testing after the first visit. You do an initial MRI or CT scan and then there is appropriate follow-up." This may be why imaging is cited by 35% of respondents as a technology they expect to add to their cardio service line in the next three years. The appeal of imaging is even stronger among smaller enterprises: 42% of organizations with net patient revenue of less than $250 million expect to add imaging technology, while just 19% of organizations with NPR of more than $1 billion will be doing so, as they focus more on remote monitoring technology (60%) and hybrid rooms (55%).

Contribution: Mostly positive

For most, the cardio service line remains a leading service line in terms of financial contribution. The mean positive contribution margin reported by respondents is 19%. Nearly half of respondents (45%) expect a minor increase in contribution margins from cardio in the next three years. On top of that, 21% expect a major increase. No wonder 74% of healthcare leaders expect to expand their cardio service lines in the next three years.

While only 1% of respondents expect a major decrease in cardio service line margins, a notable share (11%) expects a minor decrease.

Collaboration and alignment

More attention to collaborative care means more attention to physician alignment. Many provide collaborative care through comanagement programs (31%) or joint ventures (17%), but the fully employed model is used in 33% of cardio service lines. Robertson notes the benefits of the medical staff model for cardiology. "More than ever, we are aligning with medical staff. For the cardio service line, you need cardiologists who are committed to your facility to bring business, ensure quality and service, and manage costs." And today, interventional cardiologists are in demand, especially with more procedures done in an outpatient setting. Nearly one-third of respondents (31%) plan to hire interventional cardiologists to drive business to their cardiology service line. "Interventional cardio is the real driver of reimbursement," Robertson says. "They'll do the procedures like catheters and stents. A noninterventional cardiologist can do a diagnostic catheterization, but they can't do any interventions."

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