Cardiology is a Team Sport

Thursday, March 29, 2018 | Joel Sauer

Perhaps more than any other discipline in medicine, cardiology is deeply subspecialized and becoming more so with each passing year. National surveys currently report under four separate categories— electrophysiology, interventional, invasive/non-interventional and general/non-invasive—that all roll up under cardiology. In 2017, MedAxiom was the first to add heart failure as a new designation and will likely add others, such as structural heart and advanced imaging, in the coming years. Cardiology has become so deeply subspecialized that I recently heard a cardiovascular service line physician executive lament, “There just aren’t any generalists anymore!”

Although all subspecialties are part of cardiology, each has very unique attributes that must be leveraged when developing your provider workforce strategy. The skillsets required for electrophysiology, for instance, are very different than those of imaging, with diverse clinical acumen, physical demands, dexterity, and care settings. We find similar differences exist amongst the other cardiology subsets, which makes for challenging management and deployment.

Each discipline’s unique attributes must be honored and accommodated to provide for the best outcomes within that focused clinical domain. At the same time, each is still part of an overall heart team and at the center is the patient – yes the patient, not the provider. It is all too possible that we can achieve high quality marks at each specialty level, yet still blow it in terms of overall value to our patient. How? By operating as independent clinical silos, each myopic on its own territory, without anyone managing all the in-betweens and the total patient.

To avoid this, the cardiology team must take priority over the individual subspecialties and providers.

Team Leadership

In order to achieve a high-functioning team, our leadership structure must consider the special needs of each cardiology area, but through the lens of the entire patient. Our charge as leaders is to achieve maximum patient value, which requires a focus on optimizing the efficiency and efficacy of the overall team, not each individual provider or department. All too often we have subspecialty representation on the leadership team who feel their role is to protect their membership from the overall team. If this is the case, patient value will inevitably suffer. So too will the efficiency of the cardiology team as each silo negotiates its own gains without consideration of the impact to the whole.

To check this, look back at your last several agendas and meeting minutes. Do the topics and discussions emanate from the perspective of the patient and the cardiology team as a whole?  Or do they center on the individual providers or subspecialties?  As mentioned earlier, we must consider and accommodate the unique needs of our specialty team members, but within the context of the whole. Perhaps it’s a matter of nuance – if it is, I would argue important nuance – that we put the patient and/or the overall team at the heart (pun intended) of every decision.

Team Deployment

For the team to operate at peak performance we need our specialists working primarily in their specialized area. Consider a football team where on each side of the ball you have 11 members all with unique positions and responsibilities. These may change with each play, and roles may sometimes cross, but for the most part players stay in a well-defined function. For the offense the team goal is to score a touchdown. A lineman rarely carries the ball over the goal, but without his efforts paving the way for the running back, the team goal would not be achieved.

Likewise in cardiology, patients must be seen, imaging studies read, procedures performed and documentation completed. Each of these roles requires different time commitments and varying physical and mental efforts, but all are critically important to achieving patient value. If any one unit breaks down, the whole suffers. Our chances for success increase when we keep our providers primarily in their specialty positions, syncing with training, desire and skillsets. Going back to our football analogy, we may occasionally ask our running back to throw a pass in order to achieve the overall goal, but most often this position will run the ball.

Our provider deployment strategy should again consider how best to maximize the efficacy of the entire team, which sometimes may be at the expense of the individual. Covering outreach sites is somewhat unique to cardiology and, both in terms of net revenue and wRVUs, tends to be a low yield environment. It is also an invaluable access point for new patients – not just for cardiology, but for the entire health system. With such a critical role to be filled the team would be wise to deploy the right resource, someone who will provide a welcome and open entry point. Sending just anyone will be unlikely to yield the desired team goals.

Critical to team success is making sure our economic model aligns with what we’re trying to achieve.

Creating Team Economics

Critical to team success is making sure our economic model aligns with what we’re trying to achieve. In the above outreach example, it will be very hard to get enthusiastic provider support if covering a clinic location results in a pay cut – which is almost certainly the case in a heavily weighted production model. Related, if our compensation plan pays predominantly or entirely on individual performance, team goals will suffer. Whether intentional or not, in such a scenario what we’re saying loud and clear is “we value the individual over the team.”

Getting this economic alignment right is critical to team and patient success.

Conclusion

Recently I put in front of the MedAxiom Consulting team a hypothetical:  you or a loved one needs advanced cardiac care. You have a choice between a group that is 100 percent equal split (all cardiologists earn the same) or one that is 100 percent production based for physician compensation. Which would you choose?  All chose the equal split group. Why? The belief that there would be a more team-oriented care approach that would lead to better outcomes. Said another way, the right care, at the right time, by the right providers.

Clearly this question was hypothetical and I only provided a binary choice, when there are lots of options in between. These consultants are not novice consumers; all have at least 20 years in the cardiovascular industry and have worked in and with myriad programs. So although my sample size is small – too small for any kind of scientific relevance – I nonetheless feel the results are important. Savvy consumers want a cardiology team!

Delivering true value in healthcare is dizzyingly complicated and as reimbursement reorients itself around outcomes, cost and experience, the stakes for getting it right keep going up. Cardiology delivers the greatest value when all of the component parts are working in sync, focusing not just on the product within a particular clinical focus area, but on the whole patient. To achieve success, the entire organization, from governance and leadership to the workforce deployment strategy and provider compensation model, must orient around the cardiology team. Getting this right is critical not only for healthcare organizations, but also for patients.

For more on this topic by Joel Sauer, click here.

 

 

Illustration: Lee Sauer

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