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Revenue-Driving Cardio Subspecialties Thriving

Joe Cantlupe, for HealthLeaders Media, August 8, 2013

Cardio care is a growing margin contributor for hospitals and health systems. That's why healthcare providers are retooling in a big way to develop cardiac care subspecialty programs.

This article appears in the July/August issue of HealthLeaders magazine.

With cardiology among the fastest growing service lines, hospitals are retooling in a big way to win market share by developing cardiac care subspecialty programs that will give them a competitive edge in a flourishing market.

Already, cardio care is a significant and growing margin contributor for hospitals and health systems, with 76% reporting positive margins for cardio and 66% expecting this service line margin to increase over the next three years, according to the March HealthLeaders Media Intelligence Report, Reshaping the Cardio Service Line for Population Health and Reform Challenges. Yet hospitals believe they must tweak their existing programs to create differentiators that will lure more patients in need of greater specialization of care.

Creating multidisciplinary teams with advanced specialties is an important component of wide-ranging heart programs that reach a broad patient population. Faced with more elderly patients who have chronic conditions, hospitals are initiating changes to provide specialized care that will save patients, using what David Wohns, MD, medical director of the cardiac cath labs and interventional cardiology program for Spectrum Health System in Grand Rapids, Mich., calls "a bridge to recovery." Spectrum Health has nine hospitals, 130 ambulatory and service sites, and 1,938 licensed beds.  

"There are new technologies, pumps and assistive devices that can be applied percutaneously or surgically placed. Because of percutaneous procedures, we are able to save people who are very sick, and five years ago they couldn't survive," says Wohns. "It may be a percutaneous device placed in the cath lab or surgically placed in the operating room as that bridge to recovery."

Spectrum has developed a broad swath of programs to improve care, ranging from the development of a transplantation program and ventricular assist device program to a multidisciplinary shock team for critically ill patients.

As a result, surgery volumes at the hospital's Frederik Meijer Heart & Vascular Institute have far exceeded the average for hospitals that are members of the Society of Thoracic Surgery. In 2012, Meijer's bypass surgery volume reached 411, compared to 155 for the average STS member. It handled 444 valve surgeries, compared to 67 for STS.  

Within the hospital system itself, Spectrum has greatly increased patient volumes in subspecialties. Its ventricle assist device implant volumes increased from four in 2009 to 48 in 2012, and its heart transplants increased from two in 2010 to 20 in 2012. In the meantime, its heart failure readmissions—at 23% in 2012—were favorable compared to the national average of 24.8%, based on Medicare data about patients discharged between July 1, 2007, and June 30, 2012.

Hospitals are seeking better market share in cardio specialties and subspecialties to improve care and realize increased ROI. New endovascular procedures are emerging as patients want the benefits of reduced trauma compared to open procedures and the faster recovery associated with minimally invasive surgery and interventional procedures.

Cardio specialties are related to general heart care and vascular surgery, while subspecialties refer to specific cardiac programs, including internal and critical care medicine, interventional cardiology, pulmonary disease, heart failure, cardiovascular disease, transplants, adult congenital heart disease, and others. The American Board of Medical Specialties certifies specialties and subspecialties.

The 437-licensed-bed University of Colorado Hospital in Aurora is expanding programs for congenital heart disease, finding an increased need for specialization. UCH also is among a growing number of organizations working to increase patient volumes by developing advanced subspecialty programs. It offers fenestrated endograft stents as new treatment options for abdominal aortic aneurysms, providing a service for patients who would not otherwise be candidates for traditional endovascular repairs.

The procedures have resulted in decreased complications, early discharge, and a quick return to normal quality of life, says David Kuwayama, MD, MPA, a vascular surgeon and assistant professor of vascular surgery.

"Over time, we've seen an increasing patient load and a lot more referrals for complicated aneurysm disease. There is clearly significant patient demand for minimally invasive ways to treat these problems," says Kuwayama.

More hospitals are also performing cardiac catheterizations through the radial artery, which has proven to lower the risk of vascular complications. Only about 8% of cardiac catheterizations are performed using the radial approach, but hospitals say they realize the patient benefits of transradial interventions.

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