BUSINESS CONSULT
KATY REED
Senior Manager, ECG Management Consultants
TESSA KERBY
Senior Consultant, ECG Management Consultants
Cardiology And Quality Measurement
H
ealth care news headlines continue to be
peppered with stories related to quality
measurement. Many of these stories highlight
initiatives that are incorporating quality metrics to drive
improvements in the overall effectiveness and efficiency
of health care delivery. For cardiologists and organizations with cardiac service lines, the prevalence of these
programs means their income or revenue is increasingly tied to the achievement of performance standards.
Several of the initiatives advancing this agenda are Physician Quality Reporting System (PQRS), core measure
sets, MACRA legislation, and bundled payments.
As these quality metric programs become more
prevalent, they are redefining the economic dynamics
between health care organizations and cardiologists,
as well as between practices and payors. For instance,
hospitals are adding performance incentives into traditional compensation contracts with cardiologists. The
metrics are appearing in professional services agreements, hospital coverage or call coverage arrangements,
and comanagement agreements. Under these contracts,
some of a physician’s compensation is at risk based on
his/her performance relative to specific and prearranged metrics. To offer a bit of context, quality metrics
are commonly associated with several focus areas for
improvement, including the following (see TABLE).
The popularity of tying a portion of compensation
to performance is growing and will likely become commonplace in the future. For cardiologists and cardiology
service lines, this creates an opportunity to develop metrics that are applicable, are realistically achievable, and
can help improve the quality and coordination of patient
care. Having a clear approach to selecting metrics is important in positioning an organization for success. One
of ECG’s recent clients serves as an excellent example of
how to develop a strategy for improving patient revenue
under value-based contracts(see CHART).
By developing a structured methodology to evaluate, rank, and choose quality measures that were most
applicable to its strategic aims, this organization was
able to enter into payor negotiations with the understanding, background, and knowledge to negotiate
beneficial value-based contracts. For this practice and
others, success also hinges on the ability to effectively
manage the changing relationships with providers and
payors. Paying for value in care through performance
measurement is a trend that will likely define health
care for generations, and cardiology organizations that
determine strategies to navigate value-based contracts
and evolving dynamics will be better positioned to
manage their future revenue.
For more information or if you have any questions,
contact Katy Reed at [email protected]. ■
ACC.org/CSWN
TABLE
Focus Area
Key Questions/Strategic Engagements
Physician Level
Access
• Are patients able to obtain visits with specialists within a reasonable time frame?
• How long do patients have to wait in the office to see a cardiologist or have a procedure performed?
Cost of Care
• Are diagnostic ancillary tests being ordered appropriately?
• How are advanced care practitioners being used in offices?
Participation in National
Quality Programs
• Do cardiologists participate as individuals or as part of the broader group?
Care Coordination
• Are cardiologists communicating with their patients’ primary care physicians and sharing assessments?
Patient Experience
• How willing is a patient to recommend his/her cardiologist?
Communication and
Follow-up
• Are hospital patients with specific conditions (e.g., AMI, heart failure) seen for cardiologist follow-up
visits within a few days of discharge?
• How timely are readings and interpretations of ancillary tests?
Organization Level
Hospital Recognition or
Accreditation
• Obtaining organization or hospital recognition under specialty-specific programs, such as the American
Heart Association’s certification for stroke, heart failure, and STEMI or the Intersocietal Accreditation
Commission’s programs for echocardiography, cardiac electrophysiology, stenting, or i