Integrating a Cardiology Private Practice with a Hospital System:
for success cont.
commitment to quality patient care. Additionally, technical innovations including ultrasound contrast agents, strain imaging, and 3D imaging have enhanced the reputation of echocardiography as the “one stop shop” for essentially all cardiac imaging questions. On the cost side of the value equation, echocardiography stands alone, with low platform costs, low staffing requirements, low supply costs, and high patient throughput. A sophisticated analysis we recently performed indicated that at Saint Luke’s Mid America Heart Institute, we can perform 5.3 echocardiograms for
Integrating a private practice into a hospital setting is a complex process. Integration (like all change) can be challenging. However, as retired U.S. Army four star general Eric Shinseki stated, “If you don’t like change, you’re going to like irrelevance even less.” If you are considering integration with a hospital system, these six tips may help you manage that change, and help you remain relevant.
I believe echocardiography has distinct advantages over competing modalities and is best equipped for success in the coming age of population health management. the same cost as one cardiac nuclear study. (see figure 6) Considered in the context of patient satisfiers such as lack of radiation exposure, portability, and interaction with highly educated and informed sonographer health care providers at the point of care, echocardiography is most likely to succeed in the coming era of bundled payments and population heath management. Educating our colleagues and hospital partners on the quality and cost attributes of echocardiography can only enhance the odds of successful long term integration.
FIGURE LEGENDS Figure 1. Integrating a private practice with a hospital system is a complex process. These six tips may help increase the odds of success. Figure 2. Cardiovascular Consultants and the Saint Luke’s Health System have worked together for nearly 50 years. When CC integrated with SLHS in 2010, trust between these two entities was well established. Figure 3. Cardiovascular Consultants physicians Drs. Geoff Hartzler and Barry Rutherford meet with Dr. Andreas Gruntzig at the Saint Luke’s Mid America Heath Institute in 1980. Gruntzig had performed the world’s first coronary angioplasty in 1977. Hartzler and Rutherford went on to illustrious careers in interventional cardiology, pioneering the use of coronary angioplasty in acute myocardial infarction and in patients with multi-vessel disease. (This photograph originally appeared in Circulation, 2012; 125:2958-2960, in the article Geoffrey O. Hartzler, MD: A Tribute, by Barry D. Rutherford, MD; Joel K. Kahn, MD; David Strelow; and David R. Holmes, Jr, MD.) Figure 4. Organizational structure of Saint Luke’s Cardiovascular Consultants. A governance structure focused on physician leadership is the most important key to success. Figure 5. Saint Luke’s Health System Cardiovascular Service Line Contribution Margin (minus cardiovascular surgery). 40 / / /
Dr. Main is the medical director of the cardiovascular ultrasound imaging laboratory at Saint Luke’s Mid America Heart Institute. He also serves on the Board of Directors of Saint Luke’s Cardiovascular Consultants, a large cardiology group which successfully integrated with the Saint Luke’s Health System in 2010. He also serves on the ASE Advocacy Committee.
Although SLCC has more expenses than revenues, this is only part of the story. Technical fees are also derived from the echocardiography lab, the nuclear lab, the cardiac catheterization lab and the electrophysiology lab. The result is a very robust net contribution margin which must be considered in its entirety. Figure 6. Relative cost per unit of service for inpatient and outpatient cardiovascular imaging within Saint Luke’s Health System.
TIPS for SUCCESSFUL INTEGRATION
- Date Before You Commit - Maintain Governance - Align Incentives - Understand Your Costs…and Contributions - Don’t Bet the Farm on Imaging - Prepare for Population Health Management