[Summary in Progress]

Cardiology Literature

(213) Brush et al. American College of Cardiology 2006 Principles to Guide Physician Pay-for-Performance: A Report of the American College of Cardiology Work Group on Pay for Performance (A Joint Working Group of the ACC Quality Strategy Direction Committee and the ACC Advocacy Committee. Journal of the American College of Cardiology. 2006: 48 2603-2609.

PMID: 17174211


  • First official policy statement and position from the American College of Cardiology (ACC) about P4P.
  • Lists 12 guiding principles that P4P programs must embrace, including:
    • Measures based on evidence, and backed by specialty committees.
    • A business case must be made for widespread implementation.
    • Reward improvement and sustained high performance, and rewards must be positive, no negative punishments.
    • Risk-adjustment and benchmarking should be embraced concepts.
    • Encourage collaboration.
    • Audit data, and set targets through a national consensus process, and data should not be collected from claims data.
    • Incentives must be aligned to result in improvement.

Significance to Literature:

The ACC’s official P4P policy statement.


(451) Farmer et al. Existing and Emerging Payment and Delivery Reforms in Cardiology. JAMA Cardiol. 2017 Feb 1;2(2):210-217. doi: 10.1001/jamacardio.2016.3965.

PMID: 27851858


  • Authors summarize each of the existing payment model categories (as defined by the Department of Health and Human Surfaces) including: 1) Fee-for-service (FFS) 2)  FFS with links to quality 3) Alternative Payment Models (APMs) built on a FFS architecture 4) Population-based payments
  • Examples of 4 new payment models involving cardiology are used to illustrate the changing reimbursement landscape
    • Physician Group Incentive Model  (PGIP)
      • Blue Cross Blue Shield of Michigan came up with the PGIP in 2005 which provides periodic performance reporting while associating both primary care and specialty payment to population-level outcomes
    • Acute Myocardial Infarction Episode Payment Model
      • CMS announced this first mandatory APM for cardiac conditions in July 2016 and it includes an acute myocardial infarction bundled payment for all Medicare services in the 90 days following discharge
    • MD Value Care
      • This is a physician-led ACO initiated in 2014 because participants wished to remain independent and succeed in the rapidly changing payment landscape. The ACO, with its 14,000 beneficiaries and 5 PCP groups, participates in Medicare’s Shared Savings Program
    • Henry Ford Physician Network (HFPN)
      • The HFPN was started in 2010 as a commercial ACO which focuses on administratively driven value strategies. The group also participates in PGIP and was chosen to participate in Medicare’s Net Generation ACO program
  • Authors also note that the complexity and administrative burden of emerging payment models has resulted in accelerated hospital acquisition of cardiology practices, noting that hospital ownership tripled from 8% to 24% from 2007 to 2012

Significance to Literature:

Cardiologists must acknowledge FFS has generated perverse incentives, but early novel payment models have not performed as well as many had hoped. Participation in APMs will soon become unavoidable for cardiologists and early involvement will help clinicians “to develop expertise in new care pathways during a period of relatively low risk.”