Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting

1. Changing CV Practice Landscape Findings from ACC Cardiovascular Practice Census Presented to: ACC Board of Governors Meeting Heart House, Washington D.C. August 2010

2. Methodology • Survey sent to physicians in each state from the Chapter Governors. • Initial invitation sent 5/5 with reminders on 5/19, 6/2, and 6/9. Telephone interviews were conducted 7/28 – 8/9 to solicit responses from those who did not initially respond to the survey. • A total of 2,413 unique practices participated in this study after surveys were cleaned and duplicate practices eliminated. • Survey sent to 6,738 practices with 2,046 practices responding for a response rate of 30%. Calls were made to 1,024 individuals that resulted in 367 completed surveys (36% response rate).

3. This research represents …. • 2,413 unique cardiovascular practices that treat, on average, 389.34 patients per week (or a total of 800,486 patients/week). • Includes representation across the U.S. – received responses from practices from 49 states and Puerto Rico • Responses represent: • 13,898 cardiologists • 23,806 other physicians • 4,434 nurse practitioners • 2,469 physician assistants • 1,589 clinical nurse specialists • 16,247 registered nurses • 844 pharmacists • 35,599 administrative personnel

4. Response to CMS Cuts * Excludes solo-practitioners

5. Staff Reductions • 12,253 patients affected by limiting Medicare coverage • Non-MD salaries reduced by 5.3% • MD salaries reduced by 8.5%

6. Benefits Reduced • Reduce staff • Frozen/decreased salaries • Suspended bonus • Reduce PTO/Vacation • Reduce 401 K contributions • Changed insurance coverage • Terminated short term disabilities

7. Services Eliminated • Limiting Medicare patients • Urgent care appointments • Charity care • Outpatient clinic availability • Non-billable services – callbacks, refills, precertifications • Blood drawing / free blood pressure checks • MD interpretation of CT scans • Non-invasive imaging storage/retrieval • Nuclear medicine • Courtesy unreimbursed Coumadin management

8. Changing Practice Landscape 38% * * Excludes solo-practitioners

9. Changing CV Practice Landscape 9

10. Changing CV Practice* Landscape Over Time 10 * Excludes solo-practitioners

11. Changes in Practice Type

12. A lot of activity among private practices* … 222 private practices (representing 2,455 cardiologists) have integrated into a hospital system 220 (1,680 cardiologists) are in discussions about hospital integration 70 private practices (738 cardiologists) have merged with another practice 93 (278 cardiologists) are in discussions about practice merger * Includes solo practitioners

13. State of Practice Post Integration n=365 Q: You indicated that your practice has merged with another practice or integrated into a hospital system. Would you say your changed practice setting is better, worse or about the same as it was before the merger/integration? 13

14. Changing Private Practice* Landscape – Practice vs. Practitioner 48% * Includes solo practitioners

15. Practice Alignment Evolution Across The U.S.based on # of cardiologists 15

16. Key Highlights • CV practices have been forced to engage in cost-cutting activities as a result of the CMS fee schedule change. The first and largest wave of activity is directed toward staff (salary/benefits) and the second toward patients (services, hours, Medicare coverage). Private group practices are significantly more likely to have initiated cost cutting activities. If the pocketbook continues to be tightened, practices will be forced to further limit patient services. • Patients are being pushed to hospitals to receive services which results in higher co-pays, longer turn-around in treatment, and increased costs of care. • Private practices are being forced to re-examine their business model with larger practices are integrating into hospital systems while smaller practices are merging with other practices, affecting half of all cardiologists. Solo practitioners seem to be the only private practice type immune to these waves of change. • The changing practice structure has the potential to profoundly affect patient care and costs. 16

17. For questions please contact Anne Rzeszut (arzeszut@acc.org) or 202.375.6434