With that, I'm going to turn it over to Patrick Bridges. Patrick is actually the cardiac service line director for Advent Health here in Florida, I think close to Orlando. Is that right, Patrick? Right downtown. Yeah, so Patrick is going to talk to us a little bit from the perspective of the hospital and their leadership. So I'm going to turn it over to Patrick. Accountable care organizations come in a variety of shapes and formats, as we've seen. The private sector generally interacts with these organizations either through payer contracting, affordable care networks, employer arrangements, or other existing ACOs. Specifically, private health care organizations, including hospitals, physician groups, and integrated health care systems participate within this group. Of interest most recently, many of the private equity companies that are getting involved in this space have taken particular interest in really seeing this as an opportunity to drive value in return for their members. They're particularly interested in the number of lives covered and the number of lives covered in an ACO. Each of us, as we've seen throughout this, has got some sort of a familiarity with an ACO. However, Medicare has stated with the stated goal of getting everybody by 2030 to participate in a value-based care product. In addition, with new products, such as the REACH product that actually allows for greater return with a little bit more risk, one thing's for sure, that change is about and change needs to be paid attention to. Riders generally, there's essentially eight different aspects of a successful ACO. And interventionalists specifically interact by adding value to these individual subgroups, providing intellectual expertise, infrastructure support, administrative capabilities, care coordination, data and leadership mining, patient engagement, disease population skills, managed care pathways, and implementing and aligning payment models within the ACO that are successful. Cardiology leadership within every phase of this programmatic development will ensure that interventional cardiologists are not only at the seat of the table, but are involved in the intricacies without. With this change, culture is incumbent. It's got to have a high degree of accountability and transparency. Obviously, this will take time. And with the stated goal, really, for all parties involved to come to a win-win situation. It's well documented within the literature that ACOs that have cardiologists participating within their ACO actually had higher savings in this space rather than ACOs that did not have cardiologists participating. Cardiologists must lead this integration in the cardiovascular patient, either be by leading committees in primary care condition pathways, a de-shared decision government, care transition teams, chronic conditions such as hypertension or arrhythmias, or helping reduce unnecessary admissions or low-value testing. It's worth pointing out that low-value screening and testing increases the likelihood of subsequent subspecialty visits. Diagnostic testing procedures, the literature points out that patients undergoing low-value stress testing generally equate to $200 to $1.2 billion to the US health care system annually. Cardiologists leading these defined workflows, either through electronic clinical decision support and directing the hospital care throughout programs such as virtual care and remote patient monitoring for chronic conditions, is key. Of particular interest, if you simply rely upon your EMR and your hospital's financial data, it is a recipe for disaster. With all of these different subspecialties making up an ACO, I think the thing that comes most strikingly is setting up the ACO structure is easy. However, creating a culture where accountability and transparency is key is the difficult part. Commitment to this from the cardiologist standpoint can't be understated. Finding the right provider within your group or yourself with a leading vision and multi-specialty team approach ensures that the interventionalists will be well-represented. The amount of time and effort of such effort is difficult in the current fee-for-service agreements. However, the foresight and the structure to compensate physicians for their time and their intellectual capabilities must be achieved in the near term to provide you the resources and the compensation to participate. This is no small task. Meaningful incentives that are correctly aligned must be achieved. With the majority of the cardiologists throughout the nation being employed, we all know that employment does not mean alignment. And from a healthcare organization standpoint, it's really incumbent upon the healthcare organization to engage not only employed physicians, but also non-employed physicians. Pressures in the health system, as we all know, are a real challenge. Limited resources, staff shortages, inflation, supply chain shortages, and access constraints create a very strong headwind for this kind of change to occur. These challenges will not resolve themselves in the short term. And we should expect such headwinds near future all the way to 2030. As mentioned previously, simply relying upon your EMR and your coded data will ensure your failure. Cardiologists that failed to engage throughout the process run the risk of having themselves self-selected out whether they know it or not. Having top-decile NCDR data, low procedural costs are simply not enough. Whether you're the champion for your group or your organization, facilitating the education for your colleagues or taking part in the benchmarking initiatives, investing your greatest resource, your time, is key to this long-term success. In conclusion, interventionists must be engaged at every level in a historic manner. Access to analytics, costs, perceived process barriers, elimination of low-value testing are a must. Leadership of the organizational and department level committees are with great transparency and trust is key. One must be highly engaged within the entirety of the cardiovascular patient care, whether that be in the clinic, procedure areas throughout wellness and education, remote patient monitoring, patient satisfaction, are all areas that need to be paid particularly attention to. The tasks outlined simply present a broad brush. They undoubtedly will have difficult challenges with the headwinds as mentioned, but one thing's for sure, the way you practice medicine and the way the organizations are reimbursed in the future is going to change. Fully embracing this value-based care will ensure that providers have the tools necessary to be successful. And quite honestly, who better than you all to help facilitate that change? Thank you. Thanks, Patrick, for that perspective. I think your experience is particularly valuable because I know that you've been in the middle of this with your own organization. I think one of the most difficult aspects for the practitioner is most organizations are not going to be 100% accountable care, at least not during this transition phase. And the reference is always made to low value care, inappropriate procedures. And I think that's something that I like to think most of our members are already steering clear of. And then there's the things that you definitely should do in the guidelines, the class one recommendations and twos and two As. But a lot of what's assumed in some of these models is the, in my mind, oversimplified idea that there's a right answer for every clinical scenario that's a single answer. And with a lot of patients, when we're talking to them, there's more than one right answer in certain scenarios. And sometimes, I'm talking to patients and I walk them through it. And my patient population, I say, well, we could order this test or we could wait and see how you do. And you could come back. And I think it's reasonable to go either way. And the patient looks at me and says, well, what should I do? And you tell me, what would you do? And that's very typical of some of my patients. And so I think in that scenario, these types of models become very challenging because depending on your schedule, you may be seeing a patient at one o'clock where you're incentivized to tell the patient, no, you should not have the test. You should call me back if you feel bad. And then you see a patient right after that and you're being incentivized to order the test. And at the same time, you have some hospital administrator that wants to make sure that, pick on you guys, Patrick, to make sure you're working hard enough so they're tracking your RBUs even if you're not getting paid on RBUs. So it's a lot of, I think, confusion. And at the end of the day, there's not always an algorithm to follow. We're humans practicing medicine and there are gray areas and that's where a lot of this gets messy. Yeah, I'll give you a specific example that sometimes we currently are struggling with. Depending upon who's discharging the interventional patient, a lot of areas, it's a hospitalist. You have multiple hospital groups, have varying practices. Once that patient hits the floor and you turn them over to the hospitalist, all of that is perhaps defined, maybe not well-defined. There's varying degrees of acceptance of electronic medical alerts in terms of best practice. So most of the things that I find most challenging are centered around processes, access to data, transparency, and trust. Interventional cardiology, and I hope I'm not offensive in saying this, but for the most part, it's a commodity type business in terms of being in the lab and using balloon stents, wires, and catheters. That cost has been taken out of the system long ago and it's really incumbent upon us to look where else can we get cost out. And in general, it's through processes, duplication of tests, long length of stays, poor process preoperatively, and then managing those patients once they're outside of the hospital in all the different variety of ways that they present themselves. So thank you.

interventional cardiologists

ACOs

value-based care

patient engagement

private healthcare organizations