Accelerating Comanagement in Cardiac Care
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Success Key No. 2: Flexibility for physicians
In the comanagement structure, PHI has maintained flexibility to bypass traditional administrative procedures or even the physician bureaucracy when needed, Molden says. The result has been a reduction in patient death rates in coronary artery bypass operations.
Over the past 12 months, the hospital performed 632 coronary artery bypass procedures, with a death rate of 0.2%, compared to an average of 1.9% for such procedures. The hospital's ranking is among the country's top 99%, she says, referring to Society of Thoracic Surgery data.
"Better-than-average outcome rate is an example where the physician-to-physician relationship made that possible," she says. The most significant move that Piedmont made in relation to the cardio unit was having a physician in charge of the quality programs, so physicians use a common evidence-based pathway that would have been difficult to achieve without physician leadership, she says.
Success Key No. 3: Accountable care model
The Minneapolis Heart Institute is a group of 60 cardiovascular specialists within Abbott Northwestern Hospital, a 619-staffed-bed facility, and has been involved in referral relationships with healthcare facilities at more than 30 communities throughout Minnesota and western Wisconsin.
In the process, hospital officials have developed a scorecard for measuring its programs with quality as a key benchmark, says Kevin J. Graham, MD, FACC, director of preventive cardiology and president of MHI.
Since its alignment with Abbott Northwestern Hospital in 1995, MHI has opened satellite offices, developed partner clinics, and built consultant cardiology outreach relationships with the more than 30 sites throughout Minnesota and the surrounding area. MHI is part of the Allina Health & Services system. The majority of healthcare facilities it works with "opt to work with us based on years of quality and service," Graham says.
"Our model has evolved differently from many sites around the country where there is a cath lab on every corner," he says. MHI's process has allowed it to maintain tertiary/quaternary technology at Abbott Northwestern Hospital and not at its other facilities, such as outpatient facilities and others within the Allina system. The result has been reduced costs, but patients are still offered a "full range of services and the best outcomes," he says.
Within the MHI program, there are three physician groups—cardiology, CV surgery, and vascular surgery—that have their own internal managers. Their work "feeds" into the COO and Graham. Under the plan, there is one employment agreement between the cardiac physicians and Allina Specialty Associations, a subsidiary of Allina.
"We fit much better into the accountable care organization structure," Graham says. "The crucial thing about accountable care organizations is that you can downsize; it's not like the snowball going downhill on a fee for service, which had been picking up speed the last 30 years. Critically ill patients can be safely transferred from throughout the region, and these patients benefit most from having high-level services concentrated at one site.
"Our feeling is that it is more cost effective and provides better outcomes to support a state-of-the-art transfer system than trying to place acute treatment centers throughout the region for seriously ill patients," Graham says. "This strategy complements the developing ACO strategy when quality and appropriateness will be valued more than revenue generation."
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