SUN-849 - Outpatient Revenue Differences between Cardiology and Endocrinology Are Driven by E/M Capacity Utilization Rather than Procedural Volume

Background

Cardiology generates higher outpatient revenue than endocrinology, often attributed to procedural and imaging services. The relative contribution of evaluation and management (E/M) versus procedural revenue remains unclear.

Objective

To identify the primary operational drivers of outpatient revenue differences between cardiology and endocrinology, with emphasis on E/M activity, visit mix, and clinical capacity utilization.

Methods

We performed a retrospective comparative analysis of outpatient clinical activity at a mixed academic and community-based U.S. institution, including endocrinology and cardiology, with subgroup analysis of procedural cardiologists (interventional, electrophysiology, and structural cardiology). Variables included weekly clinical sessions, visit duration, new-to-established visit proportion, session-level white space (frequency and duration), E/M revenue, procedural and imaging revenue, and imaging performed outside dedicated visit slots. Inpatient activity and additional revenue from advanced practice providers were not assessed. Independent-samples and Welch’s t-tests were used as appropriate.

Results

The cohort included 28 endocrinologists and 35 cardiologists (57% generalists, 20% interventionalists, 17% electrophysiologists, and 6% structural). Projected full-time work RVU productivity was 7,038 for endocrinology, 8,818 for cardiology overall, and 9,522 for procedural cardiologists. Weekly clinical sessions did not differ significantly between specialties. Cardiology had a higher proportion of new patient visits than endocrinology (19.8% vs 8.3%; mean difference 10.4%, 95% CI 1.5–19.3; p = 0.022), with shorter new-patient templates (median 21.3 [20.0–29.0] vs 38.7 [31.8–40.0] minutes) and greater new-patient–associated E/M productivity per hour (median 6.2 [4.6-8.0] vs 4.8 [3.5-5.4] wRVUs/hour). Endocrinology demonstrated greater session-level white space than cardiology, both in frequency (1.57 ± 0.86 vs 0.39 ± 0.30 slots/session; p < 0.001) and duration (32.1 ± 16.9 vs 11.9 ± 10.5 minutes/session; p < 0.001). Imaging studies in cardiology were frequently performed outside dedicated visit slots, allowing incorporation into existing clinic sessions. Procedural and imaging revenue contributed numerically more but did not independently explain the observed revenue difference.

Conclusions

Outpatient revenue differences between cardiology and endocrinology are primarily driven by E/M–based capacity utilization and visit-mix efficiency, rather than procedural or imaging revenue alone. Lower clinic session-level white space, higher relative new patient volume in shorter visits, and integration of ancillary services within existing clinic time produce additive effects that result in large annual revenue differences despite comparable clinical time commitment.

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