Why Cardiovascular is (still) the Health Care Leader

Thursday, April 27, 2017 | Larry Sobal

 

If you did not attend last week’s CV Transforum conference, and are involved in a cardiology practice or CV service line at a hospital, you may have some catching up to do.

The movement from volume to value is now very much a reality, particularly for MedAxiom’s 370 member heart programs. That was clear as both CV administrative and physician thought leaders from around the country shared their insights and innovations at the conference. 

There is no doubt that these organizations are already preparing for whatever waves of changes are thrown at them—from federal health policy, competitive marketplaces, and patient demands for better access and service. Their practicality is matched by their passion to continually drive clinical improvement.

If you aren’t already planning for the future, fear not: these heart programs are leading the way and happy to share what they are doing so others can steal shamelessly and innovate on their innovations.  

Before I discuss some of the highlights and key messages from the conference, let me first reiterate why heart programs are so important to health care and their communities:

• About610,000 people die of heart disease in the United States every year—that’s 1 in every 4 deaths.
• Heart disease is the leading cause of death for both men and women, almost equally.
• Despite increases in awareness over the past decade,only 54% of women recognize that heart disease is their #1 killer.
• Coronary heart disease(CHD) is the most common type of heart disease, killing over 370,000 people 
• Every year about735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack.
• Almosttwo-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms; half of the men who die suddenly of coronary heart disease have no previous symptoms
• Nationally, cardiovascular care accounts for somewhere between 20-60% of the operating margins for hospitals.
• Cardiology is ahead of almost all other physician specialties in driving quality through clinical registries, evidence-based guidelines and other guidance on the appropriate use of services.

It’s no surprise that heart program leaders see their work as vitally important to the overall well-being of their communities and their organizations, and can often be found taking the lead role in driving improvement and change. Let me share some of the stories of how that is happening.

While many organizations struggle to understand MACRA, a large majority of attendees are planning to fully participate in the 2017 “pick your pace” options. Heart programs were already successful in the PQRS and Meaningful Use programs, and have mapped out how to meet the various data submission requirements for this year.

The heart programs attending the conference are not fearful of change—they embrace it.

 

Although CMS may have placed a hold on the rollout of Episode Payment Models, a large percentage of attendees reported that they are actively moving ahead, either to be ready as one of the 98 MSAs, or to learn how to master episodic care and leverage that expertise in their market.

As is tradition at the MedAxiom Spring meeting, members got a first look at the annual survey data, with some interesting analysis between those cardiology practices that are employed by health systems versus those that are independent practices. Possibly of greatest interest was the data on physician performance (such as the myths and realities of compensation per wRVU), patient panel sizes per cardiologist, and trends in diagnostic testing.

Among the many presentations, which featured over 40 administrative and physician heart program leaders or other health industry experts, were the following:

• Dyad Leadership: How to Make the Relationship Work
• Institutionalizing Change: Operationalizing Improvements and Implementing Change Over Multiple Locations
• The Benefits of Cath Lab Redesign, Trans-radial Access and Same-Day Discharge
• My Hospital System is Losing Millions on Physician Practices: Is it a Death Sentence?
• APP Utilization Models: Successes and Challenges
• What’s Your Ambulatory Strategy?
• Physician Burnout: New Perspectives on the Problem and Solutions
• The RN Role in a Busy Ambulatory CV Program
• Using Phone Apps within CV programs
• Optimizing Performance of the Service Line: Beyond the Transactional Phase
• TAVR Programs: Challenges, Successes and Lessons Learned
• PET Optimization
• Quality Initiatives for the CVSL
• I Wasn’t Selected for the Medicare EPM Program—Now What?
• Chronic Care Management: How to Effectively Implement and Maintain
• Why Telemedicine is the Future of Health Care Delivery
• How to Assess “Commercial Reasonableness” in Physician Compensation and its Relationship to Fair Market Value

From general session presentations and breakouts to physician-only sessions and small Pod discussions, here are my key takeaways and observations from the meeting:

First, the heart programs attending the conference are not fearful of change—they embrace it. In an era where most innovations are great big failures, these programs continually beat the odds through effective governance, leadership talent, and some old-fashioned grit.

Second, physicians and their administrative dyad partners work closely as a team and learn how to leverage what knowledge, experience and perspective each brings to the table. The best dyad teams spend a lot of time together talking, and more importantly, listening to each other and their constituents.

Third, they execute on the strategies and tactics that matter. That’s not to say they don’t struggle with prioritization in a world where there are more problems and opportunities than there are resources and time to expend. Rather, they find creative ways (and unconventional means) to get some important things done. As one physician leader shared, “We are finding that optimal balance between seeking forgiveness and asking permission, and there is a lot more seeking than asking.”

Finally, these heart programs invest in learning. While other organizations seem to be fighting fires all the time, these leaders take the time to get out of their daily grind to stay on top of what the rest of the health care world is doing, and keep an eye on the future to be prepared for the unexpected. That probably explains why I have been seeing some of these people at MedAxiom meetings for 15 years or more.

I’m already looking forward to CV Transforum Fall’17 in October, where the theme will be Action in the Face of Uncertainty.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

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