A Better Way to Pay for High-Value Heart Care

Cardiology is built around decisions that can prevent disability, avoid hospitalisation and extend life. Yet payment systems often reward the number of consultations, tests or procedures rather than the quality and continuity of care surrounding them. That mismatch can make it harder for practices to invest in prevention, coordination and timely follow-up.

The Campaign for Patient Access supports value-based payment models because they offer a more sustainable way to recognise clinical results. The aim is not to reduce appropriate care or place financial risk on doctors without support. It is to ensure that payment reflects improved health, safe treatment and reliable access for patients.

This issue has clear relevance in Australia. Cardiovascular disease remains a major burden across metropolitan, regional and remote communities, while Medicare rebates, private insurance arrangements and workforce shortages shape how people reach a cardiologist. A payment model that rewards good outcomes must therefore protect access as carefully as it measures performance.

Why Payment Design Matters

Traditional fee-for-service arrangements pay for individual activities. A cardiology practice may receive a rebate for a consultation, diagnostic test or procedure, but the payment may not reflect the time spent coordinating with a general practitioner, explaining medicines or checking whether a patient is recovering safely at home.

Those unpaid activities can determine whether treatment succeeds. A patient with heart failure may need medication adjustments, weight monitoring, education, rapid review and communication between several clinicians. If the system values only face-to-face appointments, practices have less incentive or capacity to build the follow-up systems that prevent deterioration.

The campaign’s position is that payment reform should strengthen, rather than weaken, patient access. Stable and predictable funding can help practices retain nurses, improve scheduling, adopt secure digital tools and offer appointments to people who need ongoing management. The goal is a system where high-quality care is financially viable.

What Value Means in Cardiology

Value-based care does not mean choosing the cheapest treatment. It means considering the health outcomes achieved for the resources used, with safety, patient experience and equity included in the assessment. In cardiology, relevant outcomes might include better blood pressure control, fewer avoidable admissions, appropriate use of evidence-based medicines and faster follow-up after a cardiac event.

Measures must be clinically sensible. A cardiologist should not be penalised because a patient has multiple chronic conditions, limited transport or difficulty affording medicines. Risk adjustment, patient-reported outcomes and appropriate exclusions are essential if measurement is to reflect professional performance rather than social disadvantage.

The strongest models combine several forms of payment. A practice might receive a base payment for ongoing care, additional funding for complex patients and a quality incentive for achieving agreed outcomes. This blended approach provides stability while still encouraging improvement, instead of forcing clinicians to chase volume.

Protecting Access While Rewarding Outcomes

A poorly designed incentive can create new barriers. If payments depend too heavily on narrow targets, clinicians may avoid patients who are medically complex or socially vulnerable. Smaller practices may also struggle to purchase data systems or employ staff needed to report performance.

For that reason, value-based contracts should include safeguards for rural communities, Aboriginal and Torres Strait Islander peoples, older patients and people living with disability. In Australia, a patient in inner Melbourne may have several cardiology options, while someone in the Northern Territory or regional Queensland may depend on visiting specialists and telehealth. A fair model must account for those differences.

Access should be measured directly. Useful indicators include waiting times, missed follow-up, availability of urgent advice, continuity with the care team and the proportion of patients receiving recommended preventive support. These measures help ensure that a payment reform does not improve averages while leaving particular communities behind.

Lessons for Australian Health Services

Australia’s mixed health system makes local design especially important. Medicare benefits under the Medicare Benefits Schedule support many consultations and services, while state and territory systems fund public hospitals and private health insurers influence elective care. A cardiology payment model must work across these boundaries rather than assume that one organisation controls the patient’s entire journey.

Primary Health Networks, local hospital partnerships and private cardiology groups can help coordinate care in practical ways. For example, a shared pathway could support a patient from a general practice in Adelaide through specialist assessment, hospital treatment and community follow-up. The payment arrangement would recognise communication and monitoring, not only the specialist appointment.

Digital care also needs a realistic Australian framework. My Health Record, telehealth and secure messaging may help clinicians share information, but adoption, consent and interoperability remain important. Any exchange of clinical information must respect the Privacy Act 1988 and the expectations established by the My Health Records Act 2012. Better data should make care safer, not expose patients to unnecessary privacy risks.

How Data and Team-Based Care Make It Work

Value-based cardiology depends on trustworthy information. Practices need to know whether patients received follow-up, whether medicines were tolerated, whether symptoms improved and whether an emergency visit could have been prevented. Data does not have to mean a burdensome reporting exercise; carefully selected measures can be built into normal clinical workflows.

A team-based model is equally important. Cardiologists, GPs, nurses, pharmacists, exercise physiologists and Aboriginal health workers may each contribute to a patient’s result. Payment should recognise that shared work. This is particularly relevant for cardiac rehabilitation, smoking cessation, diabetes management and long-term risk reduction, where progress depends on repeated support rather than a single specialist encounter.

Patients should have a voice in defining value. A technically successful procedure may still leave someone unable to return to work, exercise or care for family. Patient-reported symptoms, confidence in self-management and ability to access care can provide a fuller picture of quality. In Australia, these insights can also reveal whether a service is culturally safe and practical for people outside major cities.

Principles for Sustainable Payment Reform

A workable model should be tested gradually, published transparently and reviewed with clinicians and patients. Policymakers should avoid imposing complex targets before practices have the tools, workforce and funding needed to meet them. Any savings should be reinvested in prevention, staffing and access rather than treated as an automatic reduction in professional payment.

The Campaign for Patient Access also emphasises the importance of physician and patient stories. Statistics can show a trend, but lived experience demonstrates what a delayed appointment, a sudden fee change or the loss of a local specialist means in daily life. Those accounts can inform payment policy and keep the focus on people rather than formulas.

Practical principles for a patient-centred model include:

• Fund continuity, care coordination and timely follow-up alongside consultations and procedures.
• Adjust quality measures for clinical complexity, rurality, disadvantage and access to medicines.
• Use a blended payment structure that provides a reliable base with carefully designed incentives.
• Include patients and frontline clinicians in selecting outcomes and reviewing contracts.
• Protect privacy through secure systems, clear consent processes and limited data collection.
• Publish access, safety and equity results as well as financial performance.
• Reinvest demonstrated savings in prevention, cardiac rehabilitation and underserved communities.

The main approaches can be compared in simple terms:

Payment approach	What it rewards	Potential strength	Main risk	Suitable role in cardiology
Fee for service	Number of activities delivered	Straightforward and familiar	Can encourage volume over coordination	Base funding for necessary consultations and procedures
Bundled payment	A defined episode of care	Supports cooperation across providers	May underfund unusually complex cases	Heart attack treatment, procedures and structured follow-up
Capitation	Ongoing care for a patient group	Encourages prevention and continuity	Can encourage under-service without safeguards	Chronic cardiovascular disease management
Quality incentive	Agreed clinical or patient outcomes	Focuses attention on improvement	Poor measures may distort decisions	Add-on for safe, meaningful results
Blended model	Access, ongoing care and outcomes	Balances stability with accountability	Requires good data and governance	Broadest option for sustainable cardiology care

Payment reform works when it gives clinicians enough certainty to plan while holding the system accountable for results. It should never turn a patient’s health into a simple score or make a specialist choose between financial survival and appropriate treatment.

The campaign’s case is therefore practical: preserving access requires sustainable physician payment, and sustainable payment should recognise the full value of cardiovascular care. In Australia, that means adapting the principle to Medicare arrangements, public hospital funding, private care, regional access and local privacy obligations.

Patients, clinicians and community organisations can help shape this conversation by sharing evidence about what supports timely, coordinated heart care. Policymakers should hear when funding settings threaten a local service, when administrative demands take time away from patients and when team-based care produces better outcomes. Supporting value-based models means supporting payment that keeps high-quality cardiology available, measurable and centred on the people who depend on it.