Cardiovascular disease accounted for 12% of total U.S. health expenditures in 2019 to 2020, more than any major diagnostic group, according to a 2024 report from the American Heart Association. Between 2017 and 2020, 127.9 million U.S. adults (48.6%) had some form of CVD. Between 2019 and 2020, direct and indirect costs of total CVD were $422.3 billion ($254.3 billion in direct costs and $168.0 billion in lost productivity/mortality). NJBIZ spoke with some hospitals about how they’re budgeting for top quality cardiac care at a time when medical reimbursements are being squeezed.

“Multiple advances in cardiac care are being made, spanning the full spectrum from early diagnostics to comprehensive management” according to Valley Health System Director of Cardiac Imaging Dr. Himanshu Gupta.

“Progress in approaches like machine learning and artificial intelligence are improving efficiency and accuracy in diagnostics,” he said. “This is leading to improvements in triaging [the preliminary assessment of patients to determine the urgency of their need for treatment and the nature of treatment required] and management.”

He also pointed to new kinds of medical “wearables,” like the Apple Watch, “which can track how frequently a wearer’s heart shows signs of AFib [atrial fibrillation, a type of irregular heart rhythm where the upper chambers of the heart beat out of sync with the lower chambers] — which will help to expand the democratization, or accessibility, of health care. I expect this wearable trend to continue.”

Connectivity advances, “like 5G and other telecommunication developments, are important for health care delivery teams,” added Gupta. “As connectivity speeds continue to improve, we will be able to get more diagnostics on our smartphones, which means that complete health care teams will be even more efficient.”

Reimbursement squeeze

At the same time, health care providers are working to balance the high costs of cardiac care with the squeeze on reimbursement rates from government and private insurers, according to Valley Health System Vice President of Payer Strategies Nisha Sikder.

“Unfortunately, like many medical specialties, the reimbursement incentives around prevention of cardiac issues have dwindled and some fairly standard diagnostic tests, such as coronary artery calcium scans, are still not covered by insurers,” she said. “This dynamic results in device manufacturers, pharmaceutical, and other industry stakeholders focusing their investments and research on procedural and acute care rather than prevention, although both are equally important.”

As a health system with employed physicians and active participation in several value-based programs, which look at the total cost of care for a population, “we try to have a more balanced approach in terms of focusing on providing both state-of-the-art preventative and acute care for our cardiology patients,” Sikder added. “The other significant challenge with the economics of cardiovascular care is that many of the latest new technologies also have a significant cost, which most insurers and Medicare will not cover unless they feel that the device provides clinical value demonstrated by yielding better outcomes without a significant increase in cost to care for a condition. Unfortunately, sometimes the physician and patients become aware of a new technology before the insurer even updates their coverage and reimbursement policies leaving the patient with limited options for optimal care.”

Dr. Irfan Admani, chief of cardiology at Bergen New Bridge Medical Center, noted that cardiovascular care continues to improve, but high costs associated with it continue to be a challenge.

“Both AI and robotic-assisted heart surgery are being increasingly used to improve cardiovascular disease treatment,” he said. “AI helps to identify high-risk patients and predict cardiovascular events, and it enhances imaging techniques like echocardiograms and angiograms for better diagnosis.”

AI also helps to tailor treatment plans to individual patients, “based on their unique characteristics and risk factors,” he added. “And AI-powered virtual assistants support patients in managing medications, lifestyle modifications, and follow-up care.”

Meanwhile, advances in robotic-assisted surgery can “reduce trauma, scarring, and recovery time, and provide improved dexterity, visualization, and control during complex procedures,” explained Admani. “Robotic-assisted surgery may lower the risk of complications, such as bleeding, infection, and stroke. Patients undergoing robotic-assisted surgery also often experience shorter hospital stays and faster recovery, which helps to reduce costs.”

But the expense associated with cardiovascular care makes it “a challenging time for health care providers,” he noted. “Expenses of providing quality care have been increasing, and the increase has been exponential since the COVID pandemic.”

To cope, “Most providers have partnered with larger networks to offload the cost of running a practice,” he detailed. “Solo practitioners now account for a very small percentage of total providers. Controlling cost has been challenging for private practitioners, and trying to maintain smaller practices has helped some solo practitioners.”

Admani is worried about the way these developments may affect access to health care, “Especially in rural areas, where decreasing reimbursement may lead to the extinction of solo/private practitioners.”

To stave off this doom-and-gloom scenario, he’d like to see state and federal authorities increase funding for CVD research, treatment and prevention programs. “Implementing policies to reduce health care costs and administrative burdens,” would help, he added, along with such actions as, “Investing in health care infrastructure, including modernizing facilities and equipment, and supporting workforce development and training programs for health care professionals.”

Taking innovative steps such as, “Encouraging public-private partnerships to enhance CVD care and innovation, and investing in digital health technologies, like telemedicine and AI, to enhance CVD care,” could lead to better and more equitable health care delivery, especially to underserved populations, Admani added. Another suggestion: “Recognizing that private practices do need to exist and assisting them with programs so they can sustain in this challenging health care environment.”