Patient care and procedure trends in cardiology by type of facility

Shift to ambulatory care

As depicted in the table above, there is a fairly dramatic distribution of growth, particularly in renal dialysis facilities and federally qualified health centers. The following section will address possible explanations for this.

Six organization types had growth in cardiology procedures in the last five years. Interestingly, the top five organization types are in ambulatory settings, which is consistent with the macro trend of patient care shifting to ambulatory settings. Ambulatory care can have several benefits for patients, payors, and providers, including faster access, shorter stays, and lower costs. There is also more opportunity for shared-equity ownership models for physicians in ambulatory sites. For some specific procedures, we are seeing cardiology patients seek care in ambulatory settings. In a recent webinar, we examined the trend in pacemaker placement procedures from 2018-2022 and saw a 37% increase in ambulatory surgery centers (ASCs) while there was a 12% decline in hospitals.

Which organization types have the highest percentage of cardiology procedure growth?

First on the list are renal dialysis facilities with a dramatic 190% growth in the last five years—3x more than the second-place facility type. Exploring some of the drivers to such growth, a contributing factor to this increase may be that cardiovascular disease is a common complication in patients with end-stage renal disease on hemodialysis. Procedures such as implantable, insertable, and wearable cardiac device evaluations (CPT codes 93294, 93298, 92278, 92396) and myocardial perfusion imaging (CPT 78452) are increasingly being billed through renal dialysis centers. An important note: While the growth trend is high for cardiology procedures at renal dialysis facilities, the overall cardiology procedure volumes are lower than the other facility types.

In second place are federally qualified health centers (FQHC) with 65% growth. The top codes billed were evaluation and management, electrocardiograms, echocardiography, and blood pressure. FQHCs are community-based organizations that receive funds from the Health Resources & Services Administration (HRSA) to provide primary care services to underserved and rural communities.

One driver contributing to the growth in FQHCs may be social determinants of health (SDOH). According to a research letter published in the Journals of the American College of Cardiology (JACC), racial and socioeconomic disparities in cardiovascular access significantly contribute to negative clinical outcomes. There has been a growing focus on addressing SDOH and health equity because SDOH has been shown to have a greater impact on health than genetic or access factors. The five-year growth trend in cardiology procedures at FQHCs may suggest some progress toward providing more cardiology services to these underserved populations.

For example, the JACC research letter shares a retrospective study on a collaborative model between a FQHC and an academic medical center where a cardiology clinic was staffed on a volunteer basis by University of North Carolina (UNC) faculty cardiologists and medical students. The study found this collaboration was effective at reaching underserved cardiovascular patients.

In third place are imaging centers with 30% growth. According to an article published in the Journal of the American Heart Association, the growth in cardiac imaging is due to advancements in technology and minimally invasive interventions. The top procedures being done at imaging centers are electrocardiograms, echocardiography, cardiovascular stress tests, and myocardial perfusion imaging.

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