A New Hospital-Based Model for Growth in EP Procedural Volume

© 2023 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates. 

EP LAB DIGEST. 2023;23(8):6.

Dear Readers,

In the June 2023 issue of EP Lab Digest, my editorial focused on what hospitals can do to support their electrophysiologists after the recent major cuts in physician reimbursement for cardiac electrophysiology (EP) procedures.¹ The recommendation was to mitigate these extreme reductions by sharing 1% of the revenue generated from the procedures with the physicians. This month’s letter will expand on this idea by proposing a new growth model for hospitals to increase their EP procedural volume.

Like many internists, cardiologists spend much their time seeing outpatients in the office. However, cardiologists and electrophysiologists also spend a great deal of time performing complex cardiovascular procedures in the hospital. There is a growing push for EP procedures to be performed at ambulatory surgical centers (ASCs) rather than in traditional hospitals. However, unlike with orthopedic surgeons and other proceduralists, it is likely that electrophysiologists will continue to perform many complex cardiovascular procedures in the hospital setting where many of these sick patients are being cared for at the time the procedures are needed, and where there is immediate availability of cardiac surgical backup.

It is in the best interest of hospitals for the volume of most EP procedures to grow. The model for growth has historically been a flywheel (Figure 1) where growth in procedures results in physician expertise, which in turn increases reputation that leads to more growth in volume, and so on.

Two changes have occurred in EP that require the usual model for growth to be updated. First, as physician reimbursement for ablation procedures has decreased, hospital reimbursement has actually increased. This places the hospital in a position to support electrophysiologist’s compensation. Second, most electrophysiologists are now part of a large group practice and are hospital employees. The Stark law, which is intended to prevent self-referrals to hospitals where the physician has a financial interest, has exceptions. A bona fide employment exception applies to compensation arrangements between a hospital and a physician employee. The compensation must be reasonable and not related to the number of referrals made. A new model for growth takes into account the impact that the hospital could make by using part of the hospital procedural revenue to support physician productivity-based compensation and to provide competitive salaries to recruit and retain procedural experts (Figure 2).

If a hospital is willing and able to significantly contribute to EP physician compensation to allow for the targeted recruitment of procedural experts with the ability to substantially grow the volume of procedures associated with favorable hospital margins, great things could happen. 

Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies.

Reference

1. Knight BP. What can hospitals do to support their electrophysiologists after the Medicare reimbursement cuts? EP Lab Digest. 2023;23(6):4.