According to a 2024 report from the American Heart Association, cardiovascular disease accounted for 12% of total U.S. healthcare spending in 2019-20, more than any other major diagnostic group. Between 2017 and 2020, 127.9 million U.S. adults (48.6%) had some form of cardiovascular disease. Between 2019 and 2020, total direct and indirect costs for cardiovascular disease 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 are setting their budgets for world-class cardiac care at a time when medical reimbursements are being cut.

“There are numerous advances in cardiac care that span the spectrum from early diagnosis to comprehensive treatment,” said Dr. Himanshu Gupta, director of cardiac imaging at Valley Health System.

“Advances in approaches such as machine learning and artificial intelligence are improving the efficiency and accuracy of diagnostics,” he said. “This is leading to improvements in triage (the preliminary assessment of patients to determine the urgency of their treatment needs and the type of treatment required) and treatment.”

He also pointed to new types of medical “wearables” like the Apple Watch, “which can track how frequently a wearer’s heart shows signs of atrial fibrillation (a type of irregular heart rhythm in which the upper chambers of the heart beat out of sync with the lower chambers) – which will help make healthcare more democratic or accessible. I expect this trend toward wearable devices to continue.”

Advances in connectivity, “such as 5G and other developments in telecommunications, are important for healthcare teams,” Gupta added. “As connectivity speeds continue to improve, we will be able to perform more diagnostics on our smartphones, which means entire healthcare teams will be able to work even more efficiently.”

Refund clamp

At the same time, health care providers are trying to balance the high cost of cardiac care with pressure on reimbursement rates from public and private insurers, said Nisha Sikder, vice president of payer strategies at Valley Health System.

“Unfortunately, as in many medical specialties, reimbursement incentives for preventing heart problems have declined and some relatively standard diagnostic tests, such as coronary calcium scans, are still not covered by insurers,” she said. “This dynamic leads device manufacturers, pharmaceutical companies and other industry participants to focus their investment and research on procedural and acute care rather than prevention, even though both are equally important.”

As a health system with employed physicians and active participation in multiple value-based programs that look at the total cost of caring for a population, “we try to take a more balanced approach by focusing on providing both cutting-edge preventive and acute care to our cardiology patients,” Sikder added. “The other big challenge with the economics of cardiovascular care is that many of the latest technologies also have significant costs that most insurers and Medicare will not cover unless they believe the device provides clinical value demonstrated by improved outcomes without a significant increase in the cost of treating a disease. Unfortunately, sometimes the physician and patient learn about a new technology before the insurer even updates its 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 the high costs associated with it remain a challenge.

“Both AI and robotic cardiac surgery are increasingly being used to improve the treatment of cardiovascular disease,” he said. “AI helps identify high-risk patients and predict cardiovascular events, and it improves imaging techniques such as echocardiograms and angiograms for better diagnosis.”

AI also helps tailor treatment plans to patients “based on their individual characteristics and risk factors,” he added. “And AI-powered virtual assistants help patients with medication management, lifestyle changes and follow-up care.”

Advances in robotic surgery can now “reduce trauma, scarring and recovery time, and provide improved dexterity, visualization and control during complex procedures,” Admani explained. “Robotic surgery can reduce the risk of complications such as bleeding, infection and stroke. Patients who undergo robotic surgery also often experience shorter hospital stays and faster recovery, which helps reduce costs.”

But the costs associated with cardiovascular care make it “a challenging time for healthcare providers,” he noted. “The cost of providing quality care has been increasing, and since the COVID pandemic, the increase has been exponential.”

To cope, “most providers have merged with larger networks to reduce the cost of running a practice,” he explained. “Solo physicians now make up a very small percentage of all providers. Controlling costs has been a challenge for private physicians, and trying to maintain smaller practices has helped some solo physicians.”

Admani is concerned about the impact of these developments on access to health care, “particularly in rural areas, where declining reimbursement could lead to the extinction of individual or private physicians.”

To avert this grim scenario, he wants state and federal agencies to increase funding for cardiovascular disease research, treatment and prevention. “Implementing policies to reduce health care costs and administrative burdens” would help, he added, as would measures such as “investing in health care infrastructure, including upgrading facilities and equipment, and supporting workforce development and training programs for health care professionals.”

Innovative measures such as “promoting public-private partnerships to improve care and innovation in cardiovascular disease and investing in digital health technologies such as telemedicine and AI to improve care in cardiovascular disease” could lead to better and more equitable health care, especially for underserved populations, Admani added. Another suggestion: “Recognizing that private practices need to exist and supporting them with programs to help them compete in this challenging health environment.”