CHICAGO—“Today, cardiovascular services sit on the precipice of change,” said Brian Contos, executive director of The Advisory Board Company in Washington, D.C., April 15 at the annual leadership meeting of the American College of Cardiovascular Administrators (ACCA).
“We have to consider how well organized our organizational structure is to accommodate this notion of accountable care," said Contos. Organizations need to consider the transition from a siloed department structure to multidisciplinary care services, he continued.
Rather than focusing on the growth of referrals and procedural volume like in the current healthcare structure, Contos said hospitals will have to move toward standardizing the quality of care, which will be the wave of the future. “We need to be sure that shared accountability exists across the entire care continuum," said Contos.
“Cardiovascular programs have to be more aligned,” he noted. “This will be an absolute must.”
Particularly as diseases become more complex [coronary artery disease, heart failure, atrial fibrillation and peripheral vascular disease], and treatments become more diverse, specialists must work in multidisciplinary fashions as cardiovascular programs begin to align.
"Vascular services are continuing to grow rapidly and care coordination and economics must all be accounted for," said Contos.
A multitude of forces are changing the current landscape and these include growing relative value, a changing competitive landscape, specialty remodeling, shifting sites (where patients are being treated) and increasing care complexity.
“We must look at vascular services in a different light,” Contos offered. While PCI and open heart procedures used to be “bread and butter procedures,” said Contos, “We are struggling to keep these volumes.”
Currently, vascular cases are continuing to ascend while cardiac revascularization cases decline. In fact, AAA has increased by almost a quarter, Contos noted. “Medicare inpatient revenue for coronary interventions had a 31 percent decline while peripheral intervention revenue jumped 20 percent.”
In 2004, vascular services accounted for 17 percent of overall revenues, however, in 2009 this jumped by 10 percent, to 27 percent. Coronary procedures decreased between this time period, 83 percent to 73 percent.
In 2001, carotid artery stenting procedures were nonexistent in hospitals, but in 2009, 588 hospitals offered the service. Endovascular techniques like AAA and carotid revascularizations have increased as well between 1998 and 2009, from 5 percent to 76 percent and 3 percent to 13 percent, respectively.
Contos said there are six imperatives for highly effective CV programs:
- Organize to achieve global CV management;
- Engage physicians in program governance;
- Establish equitable pathways for participation;
- Foster collaborative evidence-based care;
- Coordinate care among providers and across settings; and
- Establish a shared commitment to business growth.
To organize to achieve global CV management Contos suggests combining heart and vascular service lines and creating a multidisciplinary leadership structure. Choosing either a dyad (a structure including a business administrator and a physician or RN) or triad (including a business administrator, physician and RN) service line structure may be most beneficial, he offered.
“We need to be evolving toward a more inclusive patient-focused service line that must include physicians and multidisciplinary structure. If you can’t get everyone to play in the same sandbox that is not a reason to stop your efforts,” Contos said.
“Quality has to be at the core,” concluded Contos. “Everything has to be inundated by quality including evidence-based decisions and care coordination.”