The past 10-plus years have seen significant shifts in the cardiovascular (CV) provider landscape, with many CV physicians transitioning out of private practice and into direct employment by health systems. Even those providers who remain in private practice tend to be tightly aligned with key referral networks and health systems. Today, ECG estimates that 80% or more of CV physicians are integrated with a hospital or health system—and that number is as high as 100% in some markets.
With this shift to alignment, many health systems have experienced challenges with cultural and operational integration of cardiology practices. This blog post outlines three key strategies health systems can pursue to address those challenges and maximize their CV provider networks.
1. Involve Physicians in Service Line Governance
Under the private practice model prevalent for so many years, CV services were commonly organized in distinct departments without direct physician involvement in service line management.
Figure 1: Siloed Service Line Elements
This resulted in a lack of continuity and patient care coordination across the spectrum of CV departments. Siloed functional areas would make decisions independently, without regard for how their decisions affected patient care and workflows in related CV functional areas. Closer alignment between CV physicians and health systems, with physicians taking an active role in the governance of the service line, enables health systems to establish more formal, clinically integrated CV service lines, organizing services to include all the elements of CV care.
A service line management structure, inclusive of physician leadership, eliminates the vertical silos seen in the traditional organizational chart depicted in figure 1. It creates an integrated structure with dedicated leadership responsible for overseeing all CV-related departments, enhancing patient care coordination, and improving operational activities. This shift expands physician leaders’ role beyond traditional clinical initiatives into roles focusing on how, where, and when care is delivered; new program development; and continual improvement in service line performance. It also creates an opportunity to partner physicians with administrative and nursing leaders to expand oversight to the entire service line.
Within the industry, there is a wide range of service line governance models. An example of an integrated governance model is depicted in figure 2. Regardless of the formal structure, the CV program should engage physician leadership. Demonstrating a commitment to physicians is essential, as CV services contribute heavily to profitability for most hospitals and health systems. Those organizations that proactively work to develop and nurture physician leaders will be best positioned for success.
Figure 2: Clinically Integrated Service Line Governance Model
2. Define an Ambulatory Strategy
Advancements in clinical technology, financial pressures from payers, and changing regulations are continuing to push CV procedures out of hospitals and into lower-cost sites of care such as ambulatory surgery centers (ASCs). This procedural migration is affecting total health system revenues while spurring investment in new assets.
To remain competitive and preserve revenues, health systems will need to grow total CV-related volumes to offset revenue losses from case migration. This growth will be enabled by investing in new sites of care for CV services and adopting effective treatment protocols to ensure patients receive high-quality care (see figure 3).
Figure 3: Evolving Sites of Care for CV Services
The shifting economic landscape will significantly impact an organization’s CV service line as cases migrate out of the hospital, so it is imperative that health systems adopt a deliberate and contemporary approach to providing high-quality, comprehensive services within their communities. Acquiring or developing an ASC or office-based lab (OBL) for CV procedures provides opportunities for physicians to increase case volumes and improve efficiency, enables the hospital to offer a lower-cost site of service to patients and payers, and keeps the case volume within the system. Alternatively, organizations that do not pursue a formal ASC strategy must optimize their existing hospital outpatient department (HOPD) clinics to be efficient, convenient, and up to date for providers and patients.
3. Expand Networks through Regional Outreach and Digital Health
In general, groups that are affiliated with health systems will be better prepared to support recruitment efforts to meet outreach needs, which in turn will drive new volumes to the system. Outreach efforts may be better coordinated to establish a presence in outlying, rural communities and offer telemedicine appointments via established relationships with primary care physicians. Rural markets often suffer from provider shortages and see physicians and APPs practicing CV medicine together to reach a wide variety of patients.
Financial affiliation with a health system removes the administrative burden from physicians needing to operate their own clinic, allowing the organization to better align incentives to reward outreach or efforts in digital health. This gives the system a physical or digital presence in areas that may be traditionally underserved by specialists while also broadening the service area footprint, expanding patient access to care, and reducing out-migration.
Key Takeaways for CV Service Line Leaders
A shared strategic direction for the CV service line is the foundation for successful relationships with employed and aligned cardiology practices. Organizations can build high-performing programs by incorporating CV physicians into service line leadership roles, allowing physician leaders to partner in a dyad relationship with service line administrative leaders. Such partnerships combine the clinical expertise and operational skill sets required to successfully navigate the increasingly complex challenges in care delivery.
ECG’s cardiovascular consulting team is passionate about improving CV care delivery and since 2010 has conducted nearly 300 CV engagements across more than 100 parent companies. Our experts focus on providing executive advisory services to the nation’s leading CV programs.
Edited by: Matt Maslin
