Managed care is having an increasing impact on the administrative and
clinical practices of cardiovascular specialists including physicians
providing cardiac pacing and electrophysiology services. This article
provides an overview of the five key areas where managed care is affec
ting cardiovascular practices including the following: (1) administrat
ive burdens; (2) competitive/economic pressures; (3) cost/efficiency r
equirements; (4) interference in the physician-patient relationship; a
nd (5) disruption in physician-physician relationships. The issues ass
ociated with each of these areas of concern are discussed in detail wi
th specific examples that are relevant to cardiac pacing and electroph
ysiology.