Shifts in workforce, patient access and service needs have pushed health systems and hospitals to change the way they offer cardiovascular care and innovate with new programs and technology.
Cardiovascular care is facing several workforce headwinds this year:
1. By 2036, the U.S. is projected to have a shortfall of about 7,000 physicians nationwide, with 39,600 cardiology physicians available to meet a demand of 46,600, according to projections from HHS’ Health Resources and Services Administration.
2. Cardiology is facing a structural workforce challenge as retirees outpace new entrants. In 2019, 26.5% of cardiologists were age 61 or older, and projections show the specialty could lose 547 cardiologists per year by 2031 due to retirements and a fixed number of fellowship positions.
3. An April Medicus Healthcare Solutions report found about 22 million Americans live in counties without a practicing cardiologist, with an average of nearly 2,000 patients per cardiologist nationwide.
With increasingly limited resources, hospitals are turning to creative solutions to meet patient needs.
Decentralizing cardiac care
Systems across the nation are improving access to advanced cardiovascular care by bringing procedures, surgeries and screenings to regional and community hospitals. Traditionally, these cardiovascular services were provided only on systems’ main campuses, requiring some patients to drive hours for care. Decentralized care addresses allows patients to find advanced care in their community, and hospitals see an increase in access, patient satisfaction and a financial boost from the increased surgery volumes.
For example, Cleveland-based University Hospitals began expanding cardiac care to community hospitals last year. Leaders were careful to structure the program to ensure that regional community hospitals had essentially the same patient outcomes as those on the main campus. In only a few months, the system saw a 25% increase in volume compared to last year — thanks to their ability to schedule procedures more quickly and accommodate a higher volume across the system.
Some health systems are also decentralizing care by making advanced procedures and management easier for patients and physicians.
Chicago-based Northwestern Medicine’s Bluhm Cardiovascular Institute has seen a 130% increase in aortic dissection surgeries since 2018, thanks to its referral program. The Code Aorta referral program, established in 2020, allows physicians to call the institute’s external transfer line and be connected with a cardiac surgeon and a vascular surgeon within two minutes. Together, they determine the next best steps for the patient, and in cases of a life-threatening aortic emergency, patients can be transferred to the institute. Upon arrival, the EMTs take the patient straight to the cardiac operating room.
At York, Pa.-based WellSpan just 19% of patients across all its clinics were on all four pillar medications for heart failure, and 29% were on three. By implementing a virtual clinic model, the system managed to get over 98% of patients on three of the four pillar medications in under six months and 76% on all four. The virtual clinic was created in January 2025 to improve uptake of heart failure medications as safely and rapidly as possible, while also being convenient for the patient.
Outpatient cardiology care
Hospitals and health systems are also becoming more involved in outpatient care by acquiring or launching their own ASCs.
The number of single-specialty cardiology ASCs quadrupled from 55 in 2018 to 221 in 2023, and 234 Medicare-certified ASCs now offer cardiovascular services. CMS has accelerated this migration by adding more cardiac procedures, including angioplasty, stenting and pacemaker placement, to the ASC-eligible list. As a result, outpatient cardiac procedures are projected to rise 25% by 2035, compared to 8% growth for inpatient procedures.
In February, Austin, Texas-based St. David’s HealthCare, part of Nashville, Tenn.-based HCA Healthcare, acquired Cardiothoracic and Vascular Surgeons. It’s one of many acquisitions Becker’s has covered in the past year. Some systems are also launching their own outpatient care centers. Earlier this year, Palm Springs, Calif.-based Desert Regional Medical Center opened a new outpatient cardiology center. The center offered outpatient care and housed the hospital’s existing congestive heart failure clinic and cardiac rehabilitation program.
Despite growing interest, outpatient cardiology procedures reimbursements remain low. Cuts to Medicare have resulted in a $700 million loss for cardiology services over the last five years, leaders told Becker’s. However, CMS finalized its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2026, adding 573 codes to the ASC Covered Procedures List, including 43 cardiovascular codes and electrophysiology ablation procedures.
Focusing on specific patient populations
A few systems are opening clinics to meet demand for specific patient populations.
In February, Pittsburgh-based Allegheny Health Network’s Cardiovascular Institute opened the state’s first clinic designed to prevent heart disease in South Asian patients. The South Asian Heart Clinic is for individuals of Indian, Pakistani, Bangladeshi, Nepali, Sri Lankan, Bhutanese and Maldivian descent.
That same month, Los Angeles-based UCLA Health established a cardiovascular discovery and translational research chair to support cardiovascular disease prevention in South Asians and other high-risk populations.
In New York City, NYC Health + Hospitals/Elmhurst launched specialty women’s cardiovascular services built for the safety-net community hospital setting.
Many systems are also adding services for heart failure patients and pediatric heart procedures.
Cincinnati Children’s is taking a national, collaborative approach to providing pediatric heart care through four partnerships with hospitals outside Ohio. Cincinnati Children’s provides a number of collaboration opportunities, including remote consultations with any of its more than 1,000 pediatricians and pediatric specialists, shared clinical decision-making conferences, clinical guidelines and protocols, sending staff to overlay with a new operation or catheter intervention, and on-site education, such as a course for cardiac ICU and acute care nurses to improve care.
New technologies and procedures
Meanwhile, federal agencies are clearing the way for more technology and devices to be available to patients. In April, CMS and the FDA proposed a new coverage policy to change Medicare beneficiaries access to certain FDA-designated Class II and III breakthrough devices. The Regulatory Alignment for Predictable and Immediate Device coverage pathway is designed to expedite access to Class II devices participating in the FDA Total Product Life Cycle Advisory Program and Class III devices, regardless of whether they are participating in TAP.
In January, HHS’ Advanced Research Projects Agency for Health launched a program to develop AI tools for managing cardiovascular disease. The initiative, called Advocate, aims to create AI agents that assist patients with tasks such as scheduling, lifestyle guidance and prescription management. A supervisory AI system will also be developed to monitor safety and accuracy.
Hospitals are also finding success implementing robotic devices and new procedure techniques.
Montrose (Colo.) Regional Health has added a mechanical CPR device to enhance treatment during cardiac arrest. The device delivers continuous, hands-free chest compressions tailored to a patient’s body.
Nashville, Tenn.-based Ascension St. Thomas became one of the first in the world to perform a cardiac surgery using the da Vinci 5 robotic platform. Around 35% of all coronary bypass surgeries are done robotically at the hospital. The average robotics cardiac surgery takes about two hours, and that time continues to decrease as the team gains experience.
Mansour Razminia, MD, a cardiac electrophysiologist and medical director of electrophysiology for the Bluhm Cardiovascular Institute at Northwestern Medicine Palos Hospital in Palos Heights, Ill., claims to have not used an X-ray for a single cardiac procedure in more than 16 years.
What he uses exclusively instead is intracardiac echocardiography, or ICE, for thousands of cardiac surgeries, and his affinity for the procedure has dubbed him the “ICE King.” ICE has been around for decades, but Dr. Razminia has been pioneering its use all while working at community hospitals. Dr. Razminia claims ICE holds several advantages: By relying on ultrasound rather than radiation, it is safe for pregnant patients and clinicians. This is especially notable as more physicians and medical associations push hospitals to move away from heavy lead aprons to protect staff from radiation exposure.
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