Innovation in the desert
“At the end of the day, healthcare is a volume business,” says Brian J. Silverstein, MD, senior vice president of The Camden Group in Chicago, which handles the integration of groups among other services. “The U.S. healthcare model is trying to migrate from a volume-based payment system to one based on performance. While it may be five to 10 years before that model is set, there are incremental pieces being put in place.”
Until we shift away from the present volume-based model of reimbursement, small cardiology practices, such as Desert Cardiology of Tucson, Ariz., are doing what they can to not only survive but bring added value to their services.
Desert Cardiology, which has served two hospitals in the northwestern portion of the city for 20 years, has seven cardiologists (four interventional, two invasive, one noninvasive), as well as one electrophysiologist and one nuclear medicine physician. Two years ago, the practice opened a sleep lab as a way to generate more revenue and address the increasing number of heart patients with obstructive sleep apnea. At the lab, which is separate from the other six clinics, studies are read by a qualified sleep physician. Follow-up visits for compliance and status are conducted by a cardiologist.
“It’s a profit center for us,” says Jeff Askam, the practice’s CEO. “It has helped solidify our existing relationships with referring physicians, as well as bring in new referrers, because 15 to 20 percent of these patients are from outside referrals.”
The practice has three echo techs but realistically needs only 2.5 to perform their stress and rest studies. Rather than layoff a tech or reduce hours, the practice now offers a carotid intima-media thickness (CIMT) ultrasound scan, an indicator for heart disease risk. The practice pays a fee to Medical Technologies International to use their CIMT knowledge-based software. Not covered by insurance, the CIMT offering resulted in 400 cash studies last year, generating a profit for the practice, Askam says. “More than half of referrals came from outside physicians, again helping to solidify existing referral relationships, as well as develop new ones,” he says.
To counter the reimbursement cuts to practices for nuclear cardiology, the group decided to “grow their way out of the potential hole” by increasing growth in new patients, each of which is “worth about $800 in the first year,” Askam says. The practice hired a full-time marketing person to help identify potential referring physicians and to strengthen internal processes so that current referrers don’t slip through the cracks. “We tried to make life easier for the referring physicians and this person has had a significant impact on them,” Askam says.
Another profit-making initiative undertaken by the practice involves imaging oncology patients. One of Desert Cardiology’s physicians noticed that an occasional oncology patient would need an echo study. The practice put together a proposal for the large group of oncologists in the area. The oncologists wanted a guaranteed 24-hour turnaround for each echo report. The practice now has their business.
The group also is in the process of buying a new nuclear camera that, unlike its current camera, can handle thallium as well as technetium studies. Imaging time is faster by nearly 40 percent, potentially increasing throughput and decreasing radioisotope dose, Askam says. “It’s a potential revenue stream, but not necessarily something that will control costs.”
In addition, the practice spent time with staff polishing its customer service and initiated a series of cardiology-specific lectures at retirement communities, which are free and include refreshments. The first lecture, which drew about 80 participants, resulted in about five new patients “almost immediately afterwards.” The second lecture drew about 120 participants and resulted in another round of new patients. “If these people experience a cardiology issue, we want them to remember us,” Askam says.
“In today’s economic environment, practices have to be creative; they need to leverage their relationships with hospital and community physicians,” Askam says. “Physicians might tend to get complacent. Our physicians try—at least once a day—to call a referring physician on a medical issue to remind him or her that we are here. Before the rise of hospitalists, it was easier to stay in touch with primary care docs. Now you don’t see them as much, and we