The current shift from traditional fee-for-service to value-based payment models necessitates that physicians and hospitals work collaboratively in looking for more efficient and less costly healthcare that provides better outcomes. The question is how to do this while also maintaining or improving quality and performance.
To date, non-healthcare industries have successfully used a service-line approach, making use of methodologies such as Six Sigma or Lean to achieve these goals. These approaches can be applied to healthcare delivery and, more specifically, are a natural approach for cardiovascular (CV) care, which accounts for a large percentage of healthcare costs.
CV care is inherently conducive to collaborative management because the types of services provided are historically highly visible, highly marketed and account for a large percentage of hospital revenues. Yet, CV services are also the focus of many Medicare quality and outcome measures.
Development of a service line approach to CV care within a hospital or hospital system takes advantage of these facts and engages various members of the healthcare team in a manner that shifts responsibility for quality, cost and data management to those actually delivering the care. However, implementation of a well-managed CV service line requires dynamic leadership, a strong but flexible organizational structure and a commitment to a physician/hospital partnership.
When it comes to leadership, the increasing complexity and cost of care coupled with reimbursement challenges demand a type of leadership that joins qualified physicians and non-physician administrators as partners. Organizations that develop this type of “Dyad Leadership” likely will outperform those that do not.
Governance and organizational structure within the service line are critical, as they make the difference between success and failure in reaching organizational goals. Blending cultures to create a collaborative service line is also critical. Administrators and physicians bring strengths and perspectives from different professional backgrounds and cultures. Blending these cultures is one of the biggest challenges; thus, the ability to understand and manage differences in a positive way is important.
On the financial side, the ability of physicians to minimize costs while maintaining quality requires that they understand the finances of the service line on a much deeper level than merely knowing the fee for a particular treatment. Determining how patients are admitted, how DRGs are assigned and cost per case are a few of the critical financial components.
Understanding and managing data also can pose challenges. Hospitals and physicians already are judged on the basis of quality and, gradually, will be reimbursed accordingly. The capability of a service line to understand and manage its own data and use those data as a roadmap to drive quality and outcomes is another key component of success.
Lastly, identifying and training physician leaders are imperative for the success of a CV service line. Although the role of the chief medical officer is essential, creating leadership positions for practicing physicians and training them will help ensure the continued success of the team. At the end of the day, the ability of leaders to instill a sense of ownership at every level of care will drive success and ensure that patients receive superior CV care.
Whether the management of a CV service line is part of an integrated delivery system or a separate part of a clinical co-management agreement, the challenges are the same. By proactively ensuring the key components are in place, we can successfully adapt to a climate of increased volume, decreasing reimbursement and increasing competitiveness. More importantly, we can improve quality and maximize efficiency and profitability; we can engender physician loyalty; and we can recruit, train and retain outstanding staff for providing and managing advanced specialty services.
Itchhaporia is the chair of the American College of Cardiology’s Board of Governors. Biga is president and CEO of Cardiovascular Management of Illinois.