“We've had our own subspecialty since the 1980s and we called ourselves 'angioplasty doctors' back then,” said Ramee, medical director of the heart valve program at the Ochsner Health System in New Orleans. “For the last 15 years, we've been a distinct subspecialty with distinct training.”
The American Board of Internal Medicine began certifying interventional cardiologists in 1999, and the American Board of Medical Specialties reports that there are 5,884 doctors with active certification in the subspecialty.
The ABIM started certifying cardiac electrophysiologists in 1992 and heart-failure-transplant cardiologists in 2010. Ramee said CMS needs to complete the cardiology subspecialty-recognition circuit and designate heart failure-transplant cardiology as a distinct subspecialty.
According to SCAI, the new CMS designation for interventional cardiology will result in fewer claims denials, improved evaluation of performances and outcomes, and fairer comparisons in resource utilization.
The interventional cardiologists generally treated patients with more complex conditions than general cardiologists and often did not compare as well in terms of resource utilization or outcome measures such as length of stay.
“We're all for quality reporting and performance measures,” Duffy said. “But now, when quality metrics come down the line, it won't look like interventional cardiologists are outliers because our resource use is higher.”
Ramee agreed that interventional cardiologists welcome public reporting as long as it's placed in the right context. He added that interventional cardiology is “probably the most studied field in all of medicine.”
Most cardiologists may still operate in a fee-for-service environment, but most also know that volume-based payment is being phased out and recognize that future compensation will be linked to quality metrics, Ramee said.
This trend is being accelerated as more cardiologists move toward hospital employment and away from private practice, Ramee said. But he predicted more change was yet to come.
Ramee said reimbursement policies have already pushed cardiologists out of private practice and into hospital employment, but cardiology services were delivered at a lower cost when they were performed in physician offices rather than in hospital settings
So, more reforms are on their way, in part because “it's easier to control 5,000 hospitals than 20,000 cardiologists,” Ramee said. He added that he could see subspecialty board certification of CMS recognition being tied to hospital credentialing or employment.
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