Trends in PCI Utilization: Will there be a job for you?

Transcription

1 Trends in PCI Utilization: Will there be a job for you? David A. Cox, MD FSCAI Lehigh Valley Health Network Director, Interventional Cardiology Research Associate Director of Cardiac Catheterization Laboratory Allentown, PA Fall Fellows Course Las Vegas 2013

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3 Can I find a Job?

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7 Invasive/ Interventional Cardiologist Athens Heart Center Athens, Georgia JOB DETAILS Hippie life style, one month of vacation for 2 month of work, enjoy life with family and children or explore the world your choice Join a growing cardiology practice that combines the atmosphere of hard work and free time. Work 2 months on with 3 days on call a week, and 2 weekends a month, then relax and take 4 weeks of vacation and enjoy the vibrant college town, home of the Georgia Bulldogs or relax and enjoy the wonderful small town atmosphere for raising a family. Full time salary and benefits

8 Different World for YOU Hospital owned vs private practice Drop in PCI volume sustained: DES safety concerns Legal issues at public forefront AUC criteria fear of inappropriate use label by PCI docs Affordable Care Act impact

9 What may increase PCI volume We demonstrate value for PCI Baby boomers getting older! Epidemic of Diabetes

10 Storm coming

11 Evolution Practice Ownership by Practitioners Over the past 5 years, the number of cardiologist working for hospitals has more than tripled & now the number of cardiologist who are employed by hospitals and physician-owned is at parity % 1% 6% 15% 11% 4% 58% 1% 6% 17% 35% 5% Physicians Other Hospital Med school/univ Gov t HMO/insurance 34% 2012 MFMER

12 WW Stent Market (DES + BMS) Revenue 80% (% of WW Stent Revenue) 70% 60% 50% 40% 30% 51.3% 48.7% 57.5% 59.2% 59.4% 42.5% 40.8% 40.6% 64.0% 36.0% 20% US Total Stent OUS Total Stent Sources: MRG Synergy, MRG Marketrack, Earnings Calls, Industry sources

13 PCI Procedures ( ) US ROW 1,000,000-1% 5,000, ,000 4,000,000 +8% 600,000 3,000, ,000 2,000, ,000 1,000, Worldwide 6,000,000 5,000,000 +6% 4,000,000 3,000,000 2,000,000 1,000,

14 PCI Procedures Growth from (X 1,000) U.S. 18% of global in 2017 ~ 4.5 million by ,000 US ROW Multiple Industry Sources

15 We have been here before

16 i c a t i o n s t o h e l p h e a r t p a t i e n t s e x t e n d t h e i r l i v e s a n d t o i c a t i o n s t o h e l p h e a r t p a t i e n t s e x t e n d t h e i r l i v e s a n d t o The COURAGE trial-fewer PCIs down the road for stable angina

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19 Underworked PCI docs

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21 Appropriate Stents or else

22 PCI Inappropriate?: Medical Review Panel Censure

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24 Appropriate Use Criteria for Coronary Revascularization Focused Update 2012 Endorsed by

25 Media Hysteria! Stent Overuse Heart Stents Still Overused, Experts Say NY Times, August 15, 2013 Deaths Linked to Cardiac Stents Rise as Overuse Seen Bloomberg, Sept. 26, 2013 Stents Overused in Stable Heart Patients WebMD, Feb. 27, 2012 Heart Treatments Overused, Study Says WSJ, July 6, 2011

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28 WW Cardiology Market Trends $20B $16B $12B Future Segments: TAVR Hypertension LAA Occlusion Transcatheter Mitral Valve PCI Future Segment CAGR = 30% $8B $4B Existing PCI CAGR = 1-3% $B New market segments may exceed PCI market size by 2020 Emergence of future segments relies on technology and clinical data OUS markets will lead and exceed the size of US markets Source: Industry, May 2011

29 Peripheral Vascular Procedures Growth from (X 1000) CAG: WW 6% US 4% US ROW ~1.8 million by Multiple Industry Sources

30 TAVR Procedures Growth from (X 1000) CAG: EU 14% US 27% US EU ~90K procedures by Multiple Industry Sources

31 Mitral Valve Repair Procedures Market projected to be ~$0.2 billion in 2016 (worldwide) 6,450 2,500 US EU +51% 3,800 1,050 2, ,100 1, , ,950 2,750 3, Multiple Industry Sources

32 LAA Closure Procedures Market projected to be ~$0.7 billion in 2020 (worldwide) +28% 113, , ,500 88,700 66,700 49,900 16,900 21,500 28,700 38, Multiple Industry Sources

33 Did you miss the bus if not doing Struct. HD or PVD?

34 Live to be in cath lab less of an option Read echos, nukes, CTA Office 1-2 days/week Peripheral practice builder Get Straight in your head what you want, what you can live with, and what is a deal-breaker Be a grown-up

35 1450 LVHN CC Total PCI Volume by FY FY8 FY9 FY10 FY11 FY12 FY13 Trend FY14

36 250 LVHN CC Total PCI Volume by Doctor Twelve Months Ended November 30, A B C D E F G H I J

37 Indications for PCI

38 Know Where You re Going

39 Know Where You re Going Outreach Hospital

40 Partners will be watching you Personal character, clinical care, judgment, and interactions with others will be more important than technical skills i.e. & Are >

41 Keep Low Profile Until Trusted

42 Congratulations! Welcome to the family of interventional cardiology! Finishing your interventional fellowship ranks right up there with marriage, kids, etc. Finding the right job to make you happy is an even greater challenge

43 Final Key Thought PAID in 1. Money 2. Time 3. People you call partners 4. Work environment that leads to balance

44 Final Key Thought PAID in 2. Time 3. People you call partners 4. Work environment that leads to balance 2,3, and 4 are by far the most important!

45 Find the job that fits you or leads you to the one that does!

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