Strategic partnering: Missteps & successes

ATLANTA—Integration can have its highs and lows, even in a good relationship. Leaders from Austin Heart in Texas and St. David’s HealthCare offered an example of each June 12 at the Cardiovascular Service Line Symposium in Atlanta.

Norman Risinger, MD, south regional medical director at Austin Heart, and John Rebok, vice president of physician operations at St. David’s HealthCare, underlined the importance understanding your own culture and “having your house in order” before venturing down the road of a partnership. Internal communication is key during the initial stage.

Err on the side of over-communication with your physicians and staff, Risinger said. Austin Heart had grown into a cohesive 47-cardiologist group whose members wanted to be in the loop when it initiated its search for a strategic partner in 2009. “You can’t communicate enough,” he advised.

Also be cognizant of the terms, values and cultural differences between a practice and a health system. The decision-making process at St. David’s HealthCare, which is part of the HCA system, is much slower and more layered than Austin Heart’s group of 47 cardiologists, Rebok said. Risinger added that leadership at the practice level tends to have little turnover, but at the corporate level chief executives are likely to move on to other positions within two to five years.

It is the responsibility of the leaders on each side to develop a good working relationship that aligns goals and missions. A strong relationship will help to carry both sides through problems.

Failure to communicate

Risinger and Rebok offered two contrasting case studies to illustrate the point.   

When Austin Heart and St. David’s HealthCare integrated, the physician group knew its EMR would need a rehaul. “The thing we didn’t do well is integrate our partner’s IT with our IT,” Risinger said. “When our system failed, which it did, we said, ‘We need your help.’”

The decision-making process went up HCA’s corporate chain of command. Physicians rejected suggested solutions and insisted on only one vendor, whose pricetag was $30 million. “It became sticker shock,” Rebok said. “The good thing about that is it forced the system to go back to the table and find a workable solution” that is much less costly.

Neither side communicated well, they said, with the health system focused on cost and the cardiologists digging their heels in on the product. Part of the solution now requires the physicians to be accountable for their decision.

“We’ve asked them to be the physician champions of the system,” Rebok said, “You asked for the system. You won the system. Make the system work for us.”

A strong business case

Risinger pointed to Austin Heart’s transcatheter aortic valve replacement (TAVR) program as an example where good communication and aligned values led to success. Austin Heart had paved the way to become a valve clinic for investigational studies. HCA, on the other hand, had several other partners who wanted to become TAVR centers.

Austin Heart recognized that the initiative would be costly, but emphasized the quality of its research program and staff, relationships with other hospitals and physicians and potential gains in volume. Two physician leaders took charge of the initiative, and the system helped them identify performance indicators that would be used to measure success.

“The practice got good at making a business case,” Rebok said.

As other TAVR centers have reported, Austin Heart’s program attracted not only TAVR candidates but also patients who could benefit from other approaches. “There was a huge uptick in volume that was non-TAVR,” Risinger said.

Be sure that kind of message gets to the health system’s chief financial offer, Rebok said. “If you look at TAVR by itself, without these additional cases, it is a money loser,” Rebok said. “Net-net for the enterprise, this was a big one.”