MedAxiom Takes the Windy City by Storm
How can restructuring within a hospital help the bottom line? That question was paramount as administrators, cardiovascular (CV) service line executives and others discussed reinventing service lines, creating co-management agreements and using the latest technological advances to help hospitals save overhead during MedAxiom’s CV Service Line Management Symposium June 6-8 in Chicago.

“It’s not about integrating, it’s about partnering,” said Patrick White, president of MedAxiom, at the event’s kickoff. Partnering was one of several themes emphasized by presenters. Below are some topics addressed at the three-day conference.

Physicians, admins must partner to reform care

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 J. Blaber, MD, of Lourdes Health System in Camden, N.J., said physicians won’t come on board until they know how change will impact quality.

Blaber outlined how leveraging physicians’ roles with administration can lead to alignment and ultimately improve value. However, he admitted that shifting to collaborative partnerships will be challenging. The reason for this may be that physicians are put off by the bureaucracy and red tape seen at the administration level.  

“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, citing Charles Darwin.

While administration and physicians have rarely seen eye to eye, Blaber said it will be important to come together for the good of the patient. At Lourdes, staff did this by creating a co-management program. But it also is essential to stay focused on core measures, adherence to evidence-based guidelines, patient satisfaction and resource utilization.

“You can’t talk about costs without also talking about quality … physicians will stop listening,” Blaber summed.

How to build successful CV service lines

When building regional CV service lines, focus on cost, speed and quality, said Gregory D. Timmers, CEO of Prairie Cardiovascular in Springfield, Ill. Master two of these goals and the third will come soon after, he suggested.

At Prairie Cardiovascular, 62 cardiovascular physicians practice at 57 clinical locations and log 5,000 hours and 270,000 miles in travel time per year. Timmers outlined how systems can help build volume for their CV programs by working from the ground up.

“What we have done is basically consider these tertiary campuses as locations where we can assimilate a critical mass of physicians with their expertise,” said Timmers. “When you have new campuses and non-hospital-based campuses, the tendency is to recruit a person on a fellowship at this location.”

Physicians now appreciate the opportunity to plan and start new service lines. Prairie uses a simple motto: learn, be nimble and evolve; but with the changing times, this motto has transformed into quality, cost and speed.

Timmers said that professional service agreements have become a key element at Prairie. Development of the health network has focused on three goals:
  • Enhance community clinics and referral relationships;
  • Enhance customer service and accessibility; and
  • Increase brand awareness.

Remote monitoring improves care, revenue

Setting up a telemonitoring program for the 1,900 device patients cared for at the Heart Center of the Rockies in Fort Collins, Colo., was no easy feat for Lisa Diederich, RN, a certified cardiac device specialist, and colleagues. Yet, it transformed patient care while improving the bottom line, said Diederich.

The reimbursement scenario is potentially favorable, too. In fact, 2012 reimbursements for remote monitoring vs. in-clinic monitoring are $62.57 and $38 (with no programming), respectively. These same reimbursements for ICDs are $94.77 vs. $66 (with no programming), respectively.

Pacemaker and ICD revenue generated from telemonitoring equated to $794 and $8,195 in 2007. In 2011, these numbers jumped to $86,999 and $210,357, respectively.

“One of the big things for us has been the economics of it,” Diederich said. “We are able to see more patients and bill more frequently, thus improving revenue.”

She outlined the benefits of remote monitoring:
  • Closer surveillance of device patients with rapid notification of alerts;
  • Ability to use diagnostics to follow up on medication changes, percentage of arrhythmias and biventricular pacing, without having patients travel to the clinic;
  • In difficult economic times, it saves patients the travel expenses of getting to the clinic; and
  • The ability to review more patients and bill more frequently, thus improving revenue.

“Remote monitoring is a great way of improving patient care while also improving your revenue,” Diederich summed.

Will starting a TAVR program be cost-effective?

While transcatheter aortic valve replacement (TAVR) remains all the rage, Cathleen D. Biga, president and CEO of Cardiovascular Management of Illinois, delivered a sobering outlook based on the national coverage decision in May.

“The national coverage decision [for TAVR] was much anticipated,” Biga said. The decision is now out, but it may not guarantee a hospital payment.

“We need to understand the different nuances that come along with this,” she said, adding that the majority of physicians performing this procedure are not getting paid for it and those who do are averaging a price of only $30,000.

Biga noted that TAVR codes from the physician perspective are approximately $2,000; however, she noted that the payments trend toward the facility side rather than to the physician.

“If we get CPT [current procedural terminology] codes, then we are hoping that the DRG [diagnosis-related group] fall somewhere between $30,000 and $44,000 for the DRG payment.”

Biga said that while TAVR may not be classified as a break-even procedure fiscally, it holds promise for high-risk, very sick patients.