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Redefining Cardio

Elyas Bakhtiari, for HealthLeaders Magazine, April 9, 2009
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Washington Hospital Center established itself as a regional referral center by developing a broad-based program that covers the acute patients as well as referrals from community hospitals, Clancy says. It has a fleet of helicopters ready to transfer complex patients that hospitals technically considered competitors aren't able to handle.

But not every organization can be so ambitious. Organizations can't afford to overreach, particularly under today's budget constraints. A community hospital without the capital and size may need to focus more narrowly on primary angioplasty or interventional procedures, and smaller freestanding centers and physician offices may be limited to simpler diagnostic services. Regardless of the size and goals, however, a diverse mix of services and constant evaluation of new opportunities are important as the environment changes.

Key No. 2: Woo physicians
Patients aren't the only ones carefully sizing up cardiovascular programs. In a competitive recruitment environment, many sophisticated cardiovascular programs compete with one another for physicians and other support staff. Subspecialists not only look for hospitals that offer their niche procedures, but they also judge facilities and equipment.

"There isn't a physician who doesn't come in with a list of things they think they need," says Lori Shannon, administrative director for cardiovascular operations at Methodist Hospital, a 802-bed level-one trauma center and teaching hospital in Indianapolis. "It is a significant issue as you recruit to make sure you have the technology to meet their needs."

It also isn't uncommon for hospitals in competitive markets to poach doctors from each other. Methodist was recently approached by a group that was unhappy with another hospital's restrictive employment contracts and was able to sign the physicians. However, this type of environment can set hospitals off on a technology arms race as they try to woo local physicians.

And it can also push hospitals to overcome reservations about physician employment. Methodist has been employing both cardiologists and cardiac surgeons for three years and sees it as a growing strategy for aligning closely with physicians in the future. Shannon values it as a way to align the hospital and physicians on quality and cost control, scheduling, and access. But it also helps with recruitment and getting existing doctors involved in reaching out to primary care physicians and other referrers.

"When they're employed we can give them credit for when they do outreach to other physicians. It also gives our physicians an opportunity to either have a broad practice or subspecialize," Shannon says.

While employment can align interests to a certain extent, it can't completely eliminate physician relations challenges, particularly when a mix of private practice and employed physicians work in the same service line.

Turf battles, for instance, can be a problem. Procedures that used to be the domain of cardiologists and cardiac surgeons are now also handled by vascular surgeons and interventional radiologists. Beaumont Hospital has been able to bridge some of those gaps by creating multidisciplinary quality teams based on specific diseases. For example, a team involving a cardiologist, vascular surgeon, and interventional radiologist regularly performs chart reviews to collaboratively improve care for peripheral vascular disease.

Key No. 3: Put physicians at the top
Ultimately, an effective physician relations strategy is difficult without physicians' input, or even better, direct involvement.

In fact, top performing hospitals are more likely to have a physician at the top of the organizational chart than average ones, according to a study by ECG Management Consultants, Inc. and Thomson Reuters. The study compared hospitals that had landed in the top quintile of Thomson's annual list of the 100 best heart hospitals with a control group of average-performing organizations. Roughly one-third of the top hospitals had either physician-directed management or a dyad system—a partnership between a physician and a business administrator—compared to only 8% of the control group.

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