NYU’s Natalia Eberhardt, PhD after finding that COVID directly infects coronary arteries and induces plaque inflammation.

Cardiology

MedAxiom on the State of Cardiovascular Providers

MedAxiom just released its 11th annual Cardiovascular Provider Compensation and Production Report, providing more data on these subjects than most of us could ever imagine, while revealing general stability in 2022 after years of significant change.

Within this massive 58-page report (n=5,806 providers, 198 programs) are six core trends that reveal how cardiovascular provider jobs are evolving:

Compensation Going Up – Cardiologist compensation continued its upward trend since 2018, while hospital-integrated physicians’ expanded their earnings lead (integrated system: $581k to $645k; private practice: $517k to $588k).

• EPs and interventional cardiologists remained the top-earning subspecialists ($715k & $710k), followed by invasive, general, and advanced HF cardiologists ($662k, $585k, $575k).

Production Stable – Despite notable CMS changes, cardiology’s wRVU production was relatively stable, with most subspecialties falling within 3% of 2021’s levels.

• Advanced HF cardiologists saw wRVU production jump 9% to 5,494 wRVUs per FT cardiologist (they still had the lowest production), while EPs overcame CMS’ significant ablation reductions and only saw a 2.1% decline to 13,118 wRVUs per FT cardiologist (they still had the highest production).

Hospital Integrated Cardiologists – Back in 2008, 90% of cardiology groups were privately owned, but private practices plummeted to just 11% of groups in 2021 and 2022.

• However, the number of private practice-employed cardiologists and cardiac surgeons both increased slightly from 2021 to 2022 (16% to 18%; 2% to 7%).

More New Patients – New patients per full time cardiologist reached a median of 632 in 2022 (a MedAxiom survey record), while cardiologists’ median patient panel reached 1,711 (second highest in survey history).

• Much of that trend was driven by ambulatory care, where median new patient office visits reached 376 per FT cardiologist (another survey record), up by over 30% since 2014.

Aging Cardiologists – Back in 2014 just 19.2% of cardiologists were 61 or older, but that jumped to 26.4% in 2021 and 2022… and another 5% are 71 or older.

• Although not yet retired, 61-70 and over-70 cardiologists are far less likely to participate in full call (72% & 44%), creating a greater labor deficit than overall headcount might suggest.

APPs on the Rise – Unsurprisingly given the above trends, cardiology’s advanced practice provider-to-physician ratio continued to rise since 2018 (per-cardiologist: 0.50 to 0.62; per-cardiac surgeon: 1.05 to 1.65).

• APPs also saw notable increases in production (wRVUs per APP: 894 to 1,693) and compensation (cardiology: $104k to $121k; cardiac surgery: $131k to $149k) since 2018. 

The Takeaway

MedAxiom firmly positioned this year’s data as a sign of increased stability within cardiology, although it’s hard not to focus on the greater longer-term changes to the cardiovascular workforce, patient volumes, and cardiologist pay and production. Those trends are almost certain to influence cardiology in 2023 and beyond.

Preparing for the Future of Cardiovascular Data and Analytics

There’s plenty of short term benefits to cardiology data analytics, but it’s just as important for providers to make sure they’re ready for the future of cardiology analytics. This Change Healthcare article with Dr. Jennifer Hall, chief of data science at the American Heart Association, examines what technology leaders can do today to facilitate their future advancements in cardiovascular data and analytics.

Relying on Echo AI for Heart Failure Management

The ESC has updated its heart failure guidelines, for the first time including a guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF). See how cardiologists are trusting echo AI to find these cases earlier in this video from Us2.ai.

The Wire

• COVID’s Arterial Plaque Impact: NYU researchers found that COVID directly infects coronary arteries, “inducing plaque inflammation that could trigger acute cardiovascular complications and increase the long-term cardiovascular risk.” Using coronary autopsy specimens from eight deceased severe COVID patients with CAD and at least three CVD risk factors, the researchers found that COVID targeted plaque macrophages and showed a stronger attraction to arterial lesions, while potentially contributing to acute CVD events such as myocardial infarction.

• Etripamil Nasal Spray Success: Milestone Pharmaceuticals’ self-administered etripamil nasal spray proved safe and effective for paroxysmal supraventricular tachycardia (PVST) in a new long-term study, just ahead of its planned FDA regulatory filing. Out of 169 patients, 155 used the spray for at least one episode and the drug was associated with a 60% conversion rate to sinus rhythm within 30 minutes. About 63% had treatment-related adverse events, which were generally mild/moderate. This study builds upon previous positive results for etripamil.

• Shockwave’s Inpatient PCI Reimbursements: CMS’s new reimbursements went live on October 1st, and now pay between $18.5k and $29k for inpatient PCI procedures performed utilizing coronary intravascular lithotripsy (IVL), a product category that’s currently dominated by Shockwave Medical. That’s roughly $4k more than inpatient PCIs not utilizing coronary IVL. The new Medicare Severity Diagnosis Related Group (MS-DRG) codes replace temporary NTAP reimbursements that were previously available for inpatient PCI IVL procedures, and further expand Shockwave’s reimbursement value proposition.

• LDL-C Vaccine: A new study in npj Vaccines highlighted a vaccine-based approach for lowering LDL-C, suggesting that it “may fill a niche as a long-lasting, inexpensive strategy for targeting PCSK9.” The study followed up on previous research into PCSK9-targeted vaccines, this time showing how a new approach could produce “strong and durable antibody responses and lowered cholesterol levels” in mice and monkeys, even when not combined with statins.

• Nattokinase Explodes: Trendwatcher Exploding Topics covered the skyrocketing interest in nattokinase, a soybean and bacteria-based supplement that’s believed to support cardiovascular health, reduce blood clotting, and have anti-inflammatory properties. News of these benefits and recent social media buzz has driven an 886% increase in “nattokinase supplement” search volumes over the last two years, while TikTok videos mentioning nattokinase supplements have generated over 5.4M views.

• Multimorbidity on the Rise: A study of NHANES data highlighted the growing number of Americans with overlapping cardiac, renal, and metabolic conditions. Researchers compared data from 11,067 adults in two time periods (1999-2002 & 2017-2020), finding that the ratio of people with all three comorbidities increased from 0.7% to 1.5% and participants with more than one condition rose from 5.3% to 8%. More than a quarter of participants had at least one cardiac, renal, and metabolic condition.

• Anumana’s First FDA: Anumana’s ECG-AI LEF became its first FDA-cleared product this week. ECG-AI LEF uses AI to screen 12-lead ECG data and identify patients who have low ejection fraction and are at greater risk of heart failure. The nference portfolio company and Mayo Clinic spinoff developed ECG-AI LEF using over 100k ECG and echocardiogram data pairs, and earned its FDA clearance after showing that the solution identified LEF with 83.6% specificity, 84.5% sensitivity, and a 0.932 AUROC.

• ACC/AHA Risk Equation Accuracy: A new JACC study confirmed that the ACC/AHA pooled cohort cardiovascular risk equations (PCEs) accurately predict ASCVD risk in real-world community settings. In the analysis of 30k adults in Minnesota who experienced 1,555 events and had a 5.6% mean ASCVD risk over 10 years, the ACC/AHA PCE achieved good overall performance (c-statistic 0.78) regardless of statin use.

• Boston Scientific Launches LUX-Dx II+ ICM: Boston Scientific announced the launch of its LUX-Dx II+ Insertable Cardiac Monitor (ICM) System. The next-generation insertable arrhythmia monitor is highlighted by its dual-stage algorithms that detect and then verify potential arrhythmias before alerting clinicians. The LUX-Dx II also allows clinicians to remotely adjust detection settings and record symptoms without requiring in-person appointments.

• Kaiser Permanente Strike: The largest healthcare labor strike in US history is underway after Kaiser Permanente and a coalition of eight unions failed to reach common ground on appropriate wages and staffing levels. Over 75,000 employees traded their scrubs for picket signs on Wednesday, kicking off a four-day strike for 40% of KP’s total staff and highlighting one of the industry’s most-pressing debates. KP leaders argue there isn’t enough staff to fill needed positions, while unions insist that the reason there isn’t enough staff is because cutbacks are causing them to leave.

• Employment Remains Strong: Speaking of staffing… Healthcare employment just saw its best two-month stretch since the start of the pandemic, with Altarum Institute data showing that the sector added 71k jobs in August and 73k in July. Ambulatory care (39,900) and hospitals (14,500) led the pack, bringing healthcare employment to 3.2% above where it was prior to COVID (vs. 2.6% across all industries). Despite the strong job market, year-over-year wage growth clocked in at 3.3% in July, trailing the overall private sector (+4.4%).

Measuring True Cardiac Risk

How can AI help physicians “see” beyond conventional lipid profiles? Tune in to this on-demand webinar showcasing how Cleerly’s AI-QCT solution complements conventional approaches to evaluating heart disease risk factors, and improves coronary artery disease diagnosis and heart attack risk assessments.

PIA Medical Processes It All

Need an analysis like calcium scoring, strain or even FFR? PIA Medical began as a Core Lab and can handle creative cardiac research and clinical trials along with the full breadth of clinical analyses available today.

The Resource Wire

• Do you know how many patients with high CVD risks are in your chest CT archive? See how the Stanford Health Care System used Bunkerhill Health’s Incidental CAC algorithm to screen its previous non-gated chest CTs, identify patients with coronary calcium, and get them on statins.

• Gain in-depth knowledge of fluoroscopic anatomy and cutting-edge imaging techniques with renowned expert, Dr. Nicolo Piazza. This five-session master class is happening now through November. Register now!

• How are interventional cardiologists using CCTA & FFRCT to guide revascularization? Tune-in to this 30-minute webinar to see how experts from Atrium Health, Yale Heart & Vascular, and St. Francis Hospital are using CCTA & FFRCT to inform their patient selection, cath lab planning, and treatment.

• QRS detection is essential for any ECG algorithm, and Monebo’s Kinetic QRS ECG Algorithm sets the standard for accuracy. Kinetic QRS accurately detects the QRS complex, no matter the amplitude, waveform, or noise levels.