Join a Gym, or Get Your Clinical Program in Shape?

Posted by: Joseph Sasson, Ph.D. on Thursday, December 27, 2018


The new year is upon us. In your personal life you are probably defining your new year’s resolution(s), such as: live a more balanced life with loved ones, eat healthier, exercise more, and so on. New Year’s resolutions provide a way for us to focus on a few solid initiatives to better our lives. That focus can be helpful, and most goal setting experts agree that three to five goals are the most that should be set at one time, for both personal and professional endeavors.

While I am not advocating that you abandon your personal new year’s resolutions, the holidays are also a great time to focus on setting organizational goals and strategic priorities for 2019. Many programs have already developed a strategic plan, yet some have not. I asked dozens of groups about their strategic priorities and goals for 2019, and in the spirit of sharing, I wanted to dedicate this week’s blog to reviewing the resolutions and goals that are high on people’s lists for the new year.

The top four are:
1. New Service Offerings
2. Clinical Integration
3. Workforce Strategy
4. Ambulatory Strategy

Let's address new service offerings first, since they are often viewed as driving novel revenue.

The new service offerings being considered by the members I spoke with vary based on their program’s evolutionary development. On the top of the list for many is PET adoption. PET is no longer a daunting modality to engage with. There are plenty of resources and experts to help programs on their PET journey. From turnkey startup services and multiple isotope choices, to guidance and coaching for implementation and peer review, the options can easily match your level of expertise and resource availability. PET's improved diagnostic capabilities and less artifact when working with larger patients have become critical to program operations. Being able to accommodate patients by generating each dose of radioisotope onsite is another benefit for programs, while reduced testing time (compared to traditional SPECT imaging) is a benefit that is enjoyed by both patients and staff.

The second commonly discussed offering is remote monitoring of implanted cardiac devices and a refocus on wearable diagnostics. Today's software and services for monitoring implantable devices revamp the “old way” of doing things. Checking multiple websites for device information and incurring lengthy review processes are things of the past. Device checks can now be automatically scheduled in your EMR and software gathers all the data in one place for easy review. There is software to improve program efficiency, as well as the opportunity to have others carry the entire burden through outsourcing. When done well, both strategies (or a combined strategy) result in increased revenues for the program.

On the wearables side, new patch technologies and the ability to switch a patch from one type to another (e.g., a Holter to an MCOT) without the patient ever coming back to the office is a real game-changer. When you think about how the Apple Watch is expected to create a new deluge of potentially unwarranted concern, it is a great time to make sure that your EP and device staff are prepared to handle the potential influx.

The third offering that nearly every private group and a large majority of integrated groups are evaluating is an Ambulatory Surgery Center (ASC) or a hybrid lab, which can operate some days as an ASC and other days and a POS-11 Office-based Lab (OBL). This strategy allows a physician group to control the patient experience, reduce costs for payers, and participate in the technical revenue associated with procedures done in the lab. Although some private insurers have decided to pay for coronary diagnostics and interventions in ASC’s already, CMS has recently approved 17 diagnostic coronary procedures for the 2019 ASC fee schedule, and most anticipate that coronary interventions will follow in CMS’s 2020 ASC fee schedule. To stay competitive, even hospital systems are reformulating their ASC strategy and contemplating ASCs as a way to partner with physician groups and improve access to care by providing more sites of service.

In addition to these new service offerings, programs shared with me three other major strategies for 2019: Clinical Integration, Workforce Strategy, and Ambulatory Strategy. While each area is distinct, definitions vary based on organizational viewpoints and culture.

For example, some consider Ambulatory Strategy as being inclusive of a variety of ways to best help patients. Those strategies can include telemedicine, a focus on same day discharge, chronic care management, and optimizing disease clinics such as Heart Failure and A-Fib clinics. Others consider Ambulatory Strategy to be focused solely on procedural areas, such as determining risk stratification and care processes for Same Day Discharge, or creating new sites of service such as OBLs and ASCs.

Instead of uniquely defining each of these three strategies, let's touch on the importance of their aggregated goals. Combined, these strategies are aimed at providing a number of benefits, such as improving patient access, decreasing cost, improving quality of care, keeping staff working at the top of their license, better coordinating care amongst the professionals inside and outside of the program, creating disease clinics that help patients stay healthy, and ultimately focusing on population health and patient management strategies. All of these initiatives keep patients healthier, reduce admissions and readmissions, and reduce the cost of care to the system. Each moniker may achieve change in its own way with its own set of strategies, but combined they provide an even more powerful set of tools to redesign care delivery.

All are essentially about optimizing your enterprise, and they differ from simply adding a new service because they require organizational commitment and behavior change. These strategies require appropriate governance and leadership, and can shift a culture towards being more patient-centric. They will also set the stage for new service offerings (such as the ones mentioned above) to be successful and clinically integrated into the organization. Not only do these three strategies create successes in their own right, they also lay a foundation for program growth and future successes.

What are your strategies for 2019? How are you going to prioritize in order to improve patient care and organizational effectiveness? While there are a variety of methods, what’s most important is that you continue your journey toward excellence. Start where you are and take a step forward. Maybe it’s a small step, or maybe it’s a large one, but what’s important is that your organization is focused on its mission and continuously moving forward.

Happy New Year to you and yours, and as always, we are here to help.


MedAxiom’s blog post is published every Thursday at


Joseph Sasson, Ph.D. is Executive Vice President of MedAxiom Ventures. Joe’s work includes helping MedAxiom members to access the technologies and solutions they need most to effectively run their organizations and prepare themselves for the future of value-based care. Simultaneously, Joe works with dozens of companies in med-tech, device, pharma, imaging, cath labs/ASCs, and health IT to deliver economic value propositions and strategies to help companies accelerate commercial growth.

Contact Joe at


Illustration: Lee Sauer

 MedAxiom Consulting is the nation’s leading cardiovascular-specific consulting group, working with a range of private practices, hospitals and health systems across the country to improve the delivery of CV health care. To learn more about our team, please visit our website.                     





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