MedAxiom: Physicians, admin must partner to reform care

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CHICAGO—As the world of cardiovascular care continues to transform, hospital administrations constantly look for ways to remain financially viable; however,  the most difficult task may be getting physicians to help share in cost-saving responsibilities. Reginald Blaber, MD, of Lourdes Health System in Camden, N.J., said physicians won't come on board until they know exactly how change will impact quality.

During a June 6 presentation at the 2nd annual MedAxiom Cardiovascular Service Line Symposium, Blaber, the system's executive director and vice president of cardiovascular services, outlined how leveraging physicians’ roles with administration can lead to alignment and ultimately improve value.

Lourdes has 49 integrated cardiologists and 30 affiliated cardiologists. But, in the last couple of years, Blaber said the entire healthcare system has seen many shifts in care. For example, he said that there has been a decrease in the number of single-vessel PCIs as some patients instead are being placed on medical therapies.

“As the healthcare system continued to change, we realized that something pivotal and seismic had to change to make things work in our marketplace,” Blaber said.  

As revenue continues to fall and medicine continues to be “assaulted,” change has become even more necessary, Blaber added. But shifting to collaborative partnerships is challenging.

“There have been a lot of physicians and hospital systems that have come together, but it has by no means been a marriage made in heaven,” he said. The reason for this may be because physicians are put off by the bureaucracy and red tape seen at the administration level.  

Blaber, who went from being a practicing cardiologist to a “suit” three years ago, said that sometimes he feels he is standing on the yellow line in a highway attempting to explain physicians to administration and administration to physicians.

“We now need to decide whether we will do things the way we have always done them--cut costs and blame the other guy--or innovate our way out of the current predicament. In the long history of humankind (and animal kind, too), those who learned to collaborate and improvise most effectively have prevailed," Blaber said, quoting Charles Darwin.

While he added that administration and physicians have rarely seen eye to eye, it will be important for the two parties to come together for the good of the patient. To achieve that, the hospital set up a co-managment program. The initiative worked to create a partnership with physicians and administration to help improve cardiovascular care at the lowest possible cost.

“I used to open catheters and show nurses the difference between this one and that one. This approach doesn't work anymore," he said. "Now we are being held accountable." Now, physicians must navigate toward cost savings. However, Blaber cautioned that “only physicians will be able to change the behavior of other physicians."

He said that the physician’s role should be to own patient quality and become accountable for it.

“We have to stay focused in our scope and understand what is important: core measures, adherence to evidence-based guidelines, patient satisfaction and resource utilization,” he said.  “You can’t talk about costs without also talking about quality … physicians will stop listening.”

Lastly, Blaber offered five tools for creating a successful CV enterprise:

  • Ensure physician engagement and leadership;
  • Foster physician-driven reductions in variation of care;
  • Foster care team development (chronic disease management);
  • Leverage information technology; and
  • Commit to having a transparent performance environment.