Procedural shift: Cardiac care refocuses on less-invasive processes

Advances in technology have meant better outcomes for patients. But they also can move business toward a new specialty, forcing physicians to adapt.

By Mike Norbut, AMNews staff. Dec. 1, 2003.

There was a time -- just a few years ago, actually -- when the heart surgeons affiliated with one of Southern California's largest cardiology groups got all the referrals they needed internally.

Business waned, however, as patients who used to be candidates for bypass surgery instead were undergoing less invasive catheterization procedures. Suddenly, being affiliated with one cardiology group was no longer profitable for the surgeons, and after 4½ years of association, they recently decided to break away in an effort to secure more referrals and keep their volumes high.

"We all keep saying, 'Life used to be a whole lot simpler,' " said Ali Gheissari, MD, a cardiothoracic surgeon and president of the new three-surgeon group. "The way I see it, things are tougher now than they were 10 years ago."

Technology, it seems, is what's changing those physicians' lives as their patients' lives change, too. New advances and improved equipment mean better outcomes and the ability to treat patients with more complicated health problems. But they also can blur the lines between doctors who in years past had clearly defined roles -- and revenue streams.

"Technology clearly is a very real plus-and-minus factor, depending on what side you're on," said Rick Kunnes, MD, vice president for clinical and operations consulting for VHA Inc., a national health care cooperative based in Irving, Texas. Cardiology is the latest and best example of this phenomenon, with the development of better catheterization technology and drug-eluting stents shifting more work from surgeons to interventional cardiologists. The market for drug-eluting stents, for example, is expected to triple from $2.1 billion in 2003 to $6.3 billion in 2008 as it becomes the treatment of choice, according to Front Line Strategic Consulting Inc., a San Mateo, Calif.-based life science market analysis company.