LAUSR

Cardiologists are an ambitious and creative group, continually striving to relieve suffering from cardiovascular disease and extend the quality and quantity of life. As a result, cardiology is a field of technological firsts. From the first attempts at thrombolysis in acute myocardial infarction to new catheter-based valve replacement procedures, cardiologists have pushed the boundaries of technological innovation. This drive to innovate must now turn to the payment system that dictates, in part, how these technological advances will apply to our patients. Physician and health system reimbursement is changing rapidly as payers increasingly move from paying for volume to paying for value. As cardiovascular specialists, we have firsthand knowledge about how our care benefits our patients. So how do we apply this knowledge and innovate to redesign payment models to incentivize higher-value health care for our patients? In this issue of JAMA Cardiology, Farmer et al1 outline emerging payment reforms that may affect cardiologists. The authors review a range of new payment models, from fee-forservice with links to quality, to alternative payment models built on fee-for-service architecture, to population-based payments. Each model’s role will increase in cardiovascular specialists’ reimbursement. However, these new payment models are not a fait accompli, but rather are a work in progress. There is a particular need for new alternative payment models that address the specific design needs of payment for specialty care, such as cardiology. Innovations in value-based specialty payment are an emerging focus for the Centers for Medicare and Medicaid Innovation and the PhysicianFocused Payment Technical Advisory Committee, and policymakers are encouraging clinical leaders to create payment models that are designed for and applicable to specialty care. As specialists, we have an opportunity to inform payment model innovation. Engaging in model design—and with the measures selected for each model—lets us decide as a clinical community what we value most and how we agree to hold ourselves accountable to core standards. We offer a few principles around payment model design and implementation to motivate discussion in the cardiovascular community. We hope that such discussion will help us achieve our most important goal: improving care and outcomes for patients with cardiovascular disease.