New device indications: impact on the individual electrophysiology (EP) practitioner in a predominantly managed care...

The high penetration of managed care as a payment source in cardiology practice is a fact of life in many areas of the country. Understanding the system of reimbursement used by managed care is helpful in order to maximize physician payment for work done, to minimize practice overhead, and to reduce physician and managerial frustration. The key ingredient for success in any cardiology practice environment is high quality procedural outcomes and good communication with patients and referring physicians. This is true in both a managed care and fee for service environment. This article describes the relationship between an indicated electrophysiology procedure (e.g., an implantable cardioverter defibrillator in a low ejection fraction coronary patient) at one end and its reimbursement by a local managed care payer to an electrophysiologist at the other end.