Private Equity Firms Own Half of Cardiology Practices: MedAxiom Survey

Private equity is taking on a much larger role within cardiology, the 12th annual cardiovascular provider compensation and production survey from MedAxiom confirms.

Nearly half of private cardiology practices were owned by private equity firms in 2023, up from zero just a few years ago, according to a report released last month.

That finding is consistent with other data indicating that cardiology has become a growing area of focus for private equity firms, which have been acquiring medical practices across specialties for the past decade. Some experts have warned that an emphasis on maximizing profits may have detrimental effects on patient care.

“You can certainly start a fight among otherwise reasonable people when you start talking about private equity in medicine,” MedAxiom President and CEO Gerald Blackwell, MD, MBA, told TCTMD, adding that for cardiology, it’s too soon to tell what the implications of the shift are.

In its most favorable light, private equity is just another type of capital partner helping cardiovascular groups that are struggling, Blackwell said. On the other hand, some may say that this trend just represents the finance industry muscling into cardiovascular care.

But for now, “there are no really bad stories to tell in cardiology related to private equity because it’s all happened very recently,” he said, stressing that private equity has been involved in other areas of healthcare for many years. “There have been some [situations] that have gone very well and . . . several have been colossal failures. We have not seen that yet in cardiology, but it’s very early in the game.

“We all have to pay close attention,” Blackwell continued. “I think as long as organizations keep the patient front and center of all decisions, what happens behind the curtain is far less important.”

Compensation, Production, Practice Ownership, and More

For over a decade now, the survey from MedAxiom, an American College of Cardiology company focused on performance improvement in cardiovascular organizations across the country, has provided insights into the business of cardiology, including compensation, production, and practice ownership. This most recent iteration was based on 2023 survey data from 202 cardiovascular programs with a total of 5,663 physicians and advanced practice providers (APPs). Most (85%) came from cardiology practices, with 10% from cardiac surgery and 5% vascular surgery.

Compared with last year’s survey, compensation ticked up for cardiologists in both integrated and private practices, reaching $668,809 and $616,382, respectively. The difference in pay between integrated and private settings was less than 10% for the fourth year in a row.

For the first time, invasive cardiologists topped the compensation list for both integrated and private practices; in the year prior, electrophysiologists and interventional cardiologists earned more. In addition, there were three subspecialties within integrated practices for which median total compensation exceeded $700,000 per full-time physician—invasive cardiology ($775,000), interventional cardiology ($755,840), and electrophysiology ($746,444).

You can certainly start a fight among otherwise reasonable people when you start talking about private equity in medicine. Gerald Blackwell

In terms of how much work was done, cardiologists in private practice outpaced their colleagues in integrated practices when measured by median work relative value units (RVUs), with the difference greatest (by 40%) for general/noninvasive physicians and smallest (< 10%) for invasive full-time physicians. However, median work RVUs for both ownership categories were the highest ever recorded in the MedAxiom survey.

That increase in production from 2022 to 2023 was seen across all subspecialties, with the exception of advanced heart failure (HF), which saw a slight regression. Even so, total median compensation increased by nearly 8% in advanced HF because this subspecialty had the highest compensation per work RVU.

Additional noteworthy findings from this year’s survey were a continuation of the growing role of APPs within cardiology practices and increasing use of advanced imaging for diagnosis. The median ratio of advanced imaging to cardiac catheterization has doubled over the last 5 years, from 23% in 2019 to 44% in 2023.

What’s Happening in the Cath Lab

For interventional cardiology, the ratio of PCIs to catheterizations has declined slightly over time, from 41% in 2016 to 37% in 2023. “This drop has been expected as more definitive studies, such as cardiac CT, have replaced staple technologies like nuclear SPECT, sending fewer ‘false positives’ to the cath lab,” according to the report.

The field also has seen shifts in certain procedures. In 2023, for example, the number of left atrial appendage occlusion cases performed per 1,000 active patients nearly caught up with the number of PCIs performed for acute MI (3.3 vs 3.6). Back in 2019, the figures were 1.1 and 4.4 per 1,000 active patients, respectively.

There is also a hint that TAVI volumes may be reaching a plateau. Operators performed 2.7 TAVIs per 1,000 active patients in 2023, the same as in 2022 and only slightly higher than in 2021 (2.5).

“Based on the MedAxiom team’s insights into the market, this may have as much to do with facility and staffing capacity as with patient demand,” the authors write. “A single year’s worth of data does not form a trend, so future years will determine whether 2023 volumes have peaked or represent an oddity in the data.”

Postpandemic Recovery Continues

The latest data indicate that cardiology continues to recover well after the initial disruption of the COVID-19 pandemic. Both new cardiology patient visits and patient panel—which measures the number of unique patients seen by a physician or APP during an 18-month period—continued their upward trends following a bottoming out in 2020. Median total new patients and patient panel hit new highs of 680 and 1,851 per full-time equivalent cardiologist, respectively, in 2023.

“It’s remarkable, the resilience of the cardiovascular community,” Blackwell said, pointing to both the increases in production and the recovery of compensation since 2020. It “shows the resilience of both the patient population that seeks care and the providers that are able to provide the care. Those have been harmonized and the demand has been met adequately.”

To understand the bigger picture of cardiovascular care, it’s important to do these types of surveys that offer insights into patient access and benchmarks related to the types of work being performed, whether that’s outpatient visits, imaging, or procedures, Blackwell said. “We can drill down to a variety of things that matter greatly to the community and to the providers that are providing that care.”

Overall, these latest data indicate that “the cardiovascular specialty has been very blessed,” he said. “We’re very adequately compensated. We have responded to changes in the regulatory environment. We’ve responded to global pandemics. And the bottom line is [that] the system is quite resilient.”