ACADEMIC CARDIOLOGY DIVISION IN THE ERA OF MANAGED CARE - A PARADIGM FOR SURVIVAL

The ability of academic divisions of cardiology to pursue educational and research missions in an era of market-driven managed care is being increasingly jeopardized. Indeed, several academic medical centers ha ve been sold to for-profit entities, and many cardiology divisions hav e been forced to de crease staff and faculty reimbursements. Despite t hese threats, the academic division has unique strengths: (1) premium quality of care, (2) a single employer, (3) a somewhat uniform practic e culture, (4) high-volume operators performing interventional procedu res, (5) expertise in highly technical aspects of cardiology, and (6) the availability of physicians for outreach ventures. Therefore, we hy pothesized that the cardiology division could be strengthened by colla borating with the medical center in the development of an aggressive a nd proactive managed care strategy. To this end, we developed a cardio vascular network having the academic center as its central focus but i ncluding a group of high-quality and geographically dispersed communit y-based physicians. These physicians were attracted by an economic pac kage that provided protection from downside risk, participation in our managed care initiatives, and geographic exclusivity in an overcrowde d market. In turn, the community-based physicians increasingly used th e academic medical center for tertiary care, resulting in increased vo lumes and incremental profitability. Using this paradigm, we have now recruited approximate to 40 community cardiologists. The resulting net work provides access to a university cardiologist in most of the surro unding urban and rural counties and will allow us to compete effective ly for capitated contracts.