The CFA Perspective

2017: What a Year It Was and What the New Year May Bring!

Posted by Peter Spiers

1/3/18 7:50 AM

 

2017 – A Look Back

 

Year End 2017 - New Year 2018.jpgBy all accounts 2017 was an exceptionally change-driven year both nationally and on a global scale!  Most prominent being the effect of the 2016 election which unleashed a massive convergence of governmental, socio-cultural and business environmental dynamics driving change.  As is always the case, this created new challenges and opportunities.  

The healthcare landscape was not immune to these forces either including these following outcomes and impacts:

  • While the Congress failed to repeal and replace the ACA, the Trump administration did re-direct CMS’s approach to the healthcare marketplace.  This was done through a return to a more market-driven, competition based philosophy resulting in the cancellation of the mandatory cardiac and expanded ortho bundled payment initiatives (with a promise to take another “bite at the apple” on healthcare reform in 2018.)
  • The recently passed sweeping federal tax cut and reform bill coupled with the executive branch unleashing a significant reduction in and reform of the regulatory environment stimulated growing business optimism, increasing profitability, a booming stock market and renewed capital investment!
  • While reimbursement challenges continued to impact healthcare providers, many hospital and health systems saw non-patient care revenues (investment income) grow significantly in 2017 which better positions many providers to explore growth opportunities in the coming fiscal year.
  • 2017 was a tumultuous, yet eventful year for sure!

Throughout 2017 The CFA Perspective continued its mission to provide strategic insights and useful information for our colleagues within the national and international cardiovascular community.  Our outreach and subscription numbers grew exponentially in 2017 and for that we are truly grateful.  Our top 5 blogs by readership for the year centered upon the:

1) The long and winding road of the mandatory cardiac bundled payment initiative; and

2) Its eventual cancellation,

3) The national low-volume cardiac surgery conundrum,

4) The growing evidence for and means to achieve and maintain low-volume cardiac surgery program excellence; and

5) The growing optimism for cardiac services start-ups and program expansion.

In the clinical arena, TAVR use and program expansion continued to be a significant topic of interest.  We are finding a wide variety of heart programs are struggling to figure out how to accurately assess TAVR feasibility and build a successful TAVR program.  We plan to blog more on this topic in 2018.

2018 – Moving Forward

In this brave new world of digital marketing, predictive analytics and business intelligence driven strategic positioning, we are keenly aware of the tsunami of information flooding your personal and work-related digital platforms on a daily basis!  So, our promise to you in 2018 is to continue to strive to bring you needed information and meaningful insights and trends emerging or extant within the cardiovascular enterprise, coupled with practical “go forward” strategies, as you operate within your personal context in cardiovascular services communities.  Here are some key trends and issues we see unfolding in 2018:

Strategic Trends:

  • Cardiac Center of Excellence (COE) accreditation/certification will continue to grow as insurers, third-party purchasers of healthcare and consumers seek objective, demonstrable evidence of exceptional service excellence, quality and value validated by objective experts.
  • CMS will seek to incentivize market-based innovation in healthcare delivery.  Cardiovascular payment models will likely include new incentives for efficiency, quality, administrative burden reduction, patient and physician satisfaction through new pay-for-performance compensation models.
  • CMS may begin to re-visit new physician-hospital ownership models.
  • Cardiac program expansion will continue to increase in smaller and/or underserved markets as previously cash strapped small and medium sized hospital providers see an increase in their capital budgets and seek to re-direct outmigration through new and expanded cardiovascular program market entry and capabilities.
  • Medium and large sized health systems in urban and suburban markets will continue seeking to merge and re-configure their cardiovascular programs across the system, particularly on a regional basis.  This will re-set delivery models and cost structures with the goal of improved efficiency, profitability and user satisfaction.
  • Low and declining volume cardiac surgery programs in select markets will increasingly seek to re-structure and/or grow new cardiac surgical volumes.
  • Many cardiologists and hospitals will continue re-thinking and re-structuring current physician employment models.

Operations:

  • Despite the plethora of vendor-based cardiovascular information systems (CVIS), IT performance will continue to underperform and challenge cardiovascular programs.
  • Many CV programs will re-structure and/or transition to a CV service line management/operating model(s) as a means to engage physicians, align operating incentives and position themselves for CV COE accreditation.
  • Many CV programs will continue to struggle with TAVR program implementation, growth and development, while low-volume cardiac valve programs will continue to lose business to local and regional TAVR centers.
  • CV nursing and technical staff shortages will continue to challenge heart programs across the country and there will be a persistent use of travelers and contract staffing in many facilities.
  • The consistent, high quality, comprehensive and patient-centered delivery of cardiovascular services in the USA will continue to be one of, if not the best care provided on the planet!

In summary, while the above lists are neither all-inclusive nor exhaustive (and, in reality, no prospective and predictive list could be for us mere mortals!) these are the key trends and issues we see emerging in the near-term planning horizon.  Which of these will take precedence?  Only time will tell and, as history teaches us, many unforeseen challenges and opportunities are likely to emerge as well.

All of us at CFA want to wish you all the best in the New Year.  And if we can be of service to you and your colleagues next year, please give us a call.  If the day is calm, without enough wind for a good sail, we will be here.  Otherwise, leave a message and we will get back to you very soon!

Happy New Year 2018!