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How Docs Can Make Cardio Service Lines More Profitable

 |  By jcantlupe@healthleadersmedia.com  
   December 06, 2012

Top docs have a message for the C-suite: Get physicians involved, really involved, in your cardiology programs, and you'll improve patient care and earn plenty of money.

OK, maybe it's not that easy.

But with some work, and coordination, the potential is there. Good outcomes and financial rewards await a healthcare system that arranges cascading benefits to physicians. Sure, it's a gamble. That's how Geoffrey Rose, MD, FACC, FASE, an adult cardiologist and director of medical imaging at Carolinas Health Care System's Sanger Heart and Vascular Institute sees it.

But it's worth a throw of the dice, especially for one of the more profitable service lines. "Those who embrace a collaborative approach will be playing with all the chips; he says.  He insists, "consolidation is coming."

During a recent "Cardiology Service Line: From Volume to Value" webinar hosted by HealthLeaders Media, Rose and top officials of the Wellmont Health System in Kingsport, TN, and Sacred Heart Hospital in Eau Claire, WI explained how they have improved efficiencies.

The positive impact resonates in areas ranging from having integrated physician networks and easing the transition for independent physicians who work in competing groups, to negotiating better pricing from vendors.

Getting physicians on board for hospital governance—both figuratively, and literally—is essential for cohesive cardiology service lines.  "Through meaningful transparent dialogue, we have been able to instill in cardiologists a sense of ownership of the program," says Andrew Bowman, RN, clinical director of cardiovascular services at Sacred Heart Hospital.

At Sacred Heart, the ownership isn't of the bricks and mortar variety.  Aligning with physicians is important to overcome the day-to-day issues of running a cardiovascular service line: scheduling the catheter labs; supply chain management, and standardizing protocols.

Bowman emphasizes the importance of physician alignment and also flexibility. "Don't rely on a single methodology for physician alignment," he said. "Understand your market and be open to different strategies for partnerships."

Sacred Heart is considering a co-management leadership structure with physicians, but it isn't there yet. As of now, the hospital runs a cardiology management committee, which includes physician partners that represent competing cardiology groups. Physicians are having more leverage in how the hospital runs its administrative business, including human resource management, areas "vetted and acted upon" by the cardiology management committee, Bowman says.

Having competing physician groups at the table is no easy task. "Those conversations were difficult at the beginning, sitting across the table with some history of competition that initially could not be overcome. It took many meetings and a lot of time and energy to get through it," Bowman says.

Having competing physician groups at the table is no easy task. "Those conversations were difficult at the beginning, sitting across the table with some history of competition that initially could not be overcome. It took many meetings and a lot of time and energy to get through it," Bowman says. 

The hospital developed its service line to overcome what started as "unstable coverage" of a single cath lab in 2001, when two competing physician groups were involved, he says.  Now, there are two cath labs accessed by eight cardiologists, who perform 2,500 procedures annually.

"The cardiology management committee set the foundation for how we engage physicians. The ... committee consists of one representative from each of the three competing cardiology groups," he says.

Gradually, the hospital coordination has resulted in substantial savings for the cardiology service line. In 2007, strategic performance improvements saved about $5 million, Bowman says, which he attributed to "front line staff, administrative operational leadership, and physician leaders."

Wellmont, an 8-hospital system in northeastern Tennessee and Western Virginia, has been evolving their cardiovascular service line within a co-management structure with physicians, according to Tim Attebery, system VP of cardiology vascular services.

The cardiovascular co-management agreement with a cardiovascular group, which includes a dyad leadership model, was established several years ago and led to formation of the Wellmont CVA Heart Institute, which includes eight hospitals and ambulatory facilities. 

Physicians' leadership and involvement also have generated savings and efficiencies at Wellmont, Attebery says, including the system's relationship with vendors.

Wellmont includes a chest pain center and expanded STEMI (ST-elevation myocardial infarction) heart attack program designed to improve clinical outcomes, identifying physicians as "accountable care leaders," Attebery says.

An estimated $5 million in cost reductions occurred between 2003 to 2006. He attributes the savings to standardization in major supply items, achieved when physicians pushed unit price reductions with suppliers and vendors.

Rose of the Carolinas Health Care System's Sanger Heart and Vascular Institute also emphasized the physician involvement in care and the importance of "a definite institute vision" to "create value from the cardiovascular institute."

Coordination has led to improved treatment in the Carolinas Health Care System's STEMI program, with quick times reported for patients moved from the emergency departments to the cath labs. The Carolinas Health Care System's treatment time is 48 minutes, less than half of the 90-minute benchmark issued by the American College of Cardiology, Rose says.

Invariably, data are reviewed and discussed in plenty of meetings among physicians and other hospital staff around the cardiovascular service lines. Ultimately, "trust" is the most important element, Rose says.

"Trust and collaboration among the stakeholders—how do you get to that point of trust?" Rose asks. "The interest of the stakeholders needs to be aligned and executed very well."

Rose realizes that vision statements are sometimes seen as simple exercises, but their importance should not be underestimated. "It's not just an exercise, but sets the stage for what you want to be and how to get there. It helps to overcome the very difficult task of building trust."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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