Preparing for the Future: Expanding Vascular Services in the Cath Lab

Traditionally, program development in hospitals has largely focused on growth in cardiac services, but it has become more evident that systemic vascular disease —cerebrovascular, carotid, aortic, and peripheral vascular — is a growing concern, though many of these disease types remain under-diagnosed in the majority of the U.S. population. This trend has huge connotations in developing a cardiovascular program that is cardiac and vascular — designed to meet the needs of both highly overlapping populations. Some programs across the country have begun to evaluate the need to incorporate vascular care within the walls of the cardiac catheterization laboratory, allowing for a more comprehensive continuum of care. Many cath labs offer state-of-the-art imaging and mobility, allowing for higher resolution, along with greater movement and visualization of more than just the coronary anatomy. In fact, in some cases (although rare), cardiac cath labs have even gone as far as embracing a more robust approach to cerebrovascular care through integrating cardiac, vascular, peripheral vascular, and neuro services in a more co-located platform. In these circumstances, physician specialists are more easily united in a cohesive approach and the facility integrations should drive the needs of the patients to the foreground. These may sound like easy goals, but in reality, this involves more than just casual conversation or commitment. It will require a “unified” front, involving all parties, inclusive of executive leadership and multiple specialists, as well as any referring practitioners. Certainly, the market for vascular services is expanding, with the number of programs nationwide increasing along with the aging of the population. In fact, vascular centers that address the full scope of care for patients with vascular disease, encompassing peripheral arterial disease, endovascular services, diabetes care, and stroke treatment, will be best positioned to take advantage of new revenue streams in the marketplace. As we assist many of our clients in understanding the critical importance of strategic planning as they look to expand cardiovascular services, and more clearly understand how best to compete in today’s ever-changing market, the vascular component is becoming a critical component of clinical, financial, and operational success. For most programs, creating a comprehensive vision — one that includes cardiac AND vascular components — will be challenging. However, an even greater challenge may be identifying a strong leader to put at the helm to navigate through rough and most often uncharted waters of integrated service lines. A Focus on Vascular Progressive cardiac programs are starting to realize the value of assimilating vascular into the full continuum of care. Screening, diagnosing, and treating patients for vascular conditions can improve the overall health of a community by raising public awareness of symptoms and treatment options. We believe that such a focus also improves the hospital’s reputation for providing life- and limb-saving advanced care. Unlike cardiac, the vascular market remains untapped, and must be targeted due to the overlap of cardiac, vascular, and cerebrovascular disease. To begin, hospital leadership must take a proactive and assumptive position that the vascular market is important enough to address, and those physicians willing and capable of working together will remain at the table and share in the benefits. A market assessment goes hand-in-hand with the planning effort. Conducting a thorough review of the existing and potential vascular cases within the hospital service area will provide an excellent snapshot of the vascular program’s potential viability. Meanwhile, turf battles, primary care physician (PCP) appreciation of the symptoms of vascular disease, a lack of cutting-edge technologies, and low numbers of vascular-trained physician specialists must be addressed. In fact, according to information presented at the 63rd Annual Meeting of the Society for Vascular Surgery in June 2009, the United States alone will be short nearly 400 vascular specialists by the year 2030. This shortage, along with other significant challenges, will require considerable effort and tough decision-making, both of which can be facilitated with a strong strategic planning effort. A large portion of the vascular market is already present in PCP offices, the hospital, and in other healthcare venues (i.e., nursing homes), and these physicians have the least restricted access to these patients; therefore, they must be involved and at least understand the market and become better aware of the benefits that accompany top-notch vascular care — for the patients, and also for themselves and the hospital or practice. Turf Battles Oftentimes, hospitals are faced with multiple specialists vying to compete with one another in order to provide the same level of high-quality vascular care. It is our belief that a cooperative and collaborative approach will help these specialists to understand that the “pie” will only get bigger. Collaboration in offering vascular services is one of the main elements that must be present for success. Without physicians, administrators, and clinicians working toward a common vision, the complex and potentially profitable vascular service line will falter. Corazon’s experience proves that more often than not, the physicians — interventional cardiologists, interventional radiologists, vascular surgeons and perhaps even neuro specialists — share a common vision; however, in most cases, these specialists have difficulty coming together in compromise very easily. An official forum or regularly-scheduled meetings between physicians and hospital leadership can solidify the commitment to aggressively pursue the vascular market. But, collaboration cannot be forced. Frequently, bottom line revenues and patient referral control are the ‘hot’ issues that can derail collaborative discussion. Quality can also become an issue. We recommend that the hospital insist that proper clinical credentialing, clear protocols, and established privileging criteria be applied to perform vascular procedures. Collaboration can grow from this environment. We sometimes recommend having a cardiovascular department or division of the medical staff, which can assist. Understanding the physician dynamic can be quite complex at best. Education Physician education is another hurdle, as many PCPs and other specialists that can come across vascular disease (podiatrists, endocrine specialists, and orthopedists) aren’t aware of the signs and symptoms. However, when physician education is formally scheduled and marketed to the various physicians involved, the sessions are well-attended and quite beneficial. As with any educational initiative, improved quality should be the result. Quality must come from the review process of cases and effective medical oversight. This can be achieved within the various subcommittees involving clinical protocols and QA. The cardiac cath lab staff and/or post care unit managers are often invited to assist in these review processes. After all, they are working hand-in-hand with the physicians providing patient care and in most cases have developed and implemented patient care protocols. Who better to assist in a quality forum? Similarly, patient education is vital to any program’s success as well. Organizations have finally begun to consider the “baby boomer” population, which is coming into an age range when cardiac and vascular disease is most prevalent, though ensuring that these patients know and understand the signs and symptoms of the disease, when to seek treatment, and who to call can be a challenge as well. Most baby boomers expect to know everything they can about how to prevent a chronic condition that could slow them down. For instance, advertisements for procedures and medications related to the diagnosis and treatment of PAD are on the rise. These commercials, often paid for by the drug companies, promote the sales of statins and blood thinners, though they also contribute to increased awareness of these conditions and the options available. Conclusion We realize there is more to creating the “vision” for a successful vascular program. Deciding to focus on this underserved population isn’t enough to solidify commitment and ensure success. Organizations must create a solid planning effort and also address the challenges noted above head-on, as well as other unique challenges which could crop up and potentially derail even the most committed members of the team. There is also a need to clearly understand the financial impact. Typically, hospitals that don’t effectively plan ahead fail in their efforts; however, such failure may not be easily noticed, manifesting in compromised efficiencies, less-than-optimal patient capture, or ineffective utilization. These weak points may not cause serious financial problems, though over time, they could become a drain on the program, which would impact long-term viability and success. To avoid failure without even noticing it, the planning process should include a detailed plan and market assessment with detailed financial information included. As more hospitals expand to offer advanced cardiovascular services, it is imperative to remain competitive. A formalized vascular program can help capture a new revenue stream while diagnosing and treating patients in dire need of vascular care. As mentioned earlier, the overlap of cardiac, vascular, and cerebrovascular disease is critical and those programs able to capture this patient population will benefit in other areas of the hospital as well, through a “halo” effect. Corazon advocates that programs looking at a vascular expansion understand how to address the full scope of patients’ needs for peripheral vascular disease, endovascular services, diabetes care, and stroke treatment. These programs will no doubt be best positioned to take advantage of new opportunities in the cardiovascular marketplace, while also raising the level of health for patients in the community. Conrad Vernon is a vice president and Amy Newell is a manager at Corazon, offering consulting, recruitment, and interim management for the heart, vascular, and neuro specialties. To reach one of the authors, email cvernon@corazoninc.com or anewell@ corazoninc.com. To learn more about Corazon, visit www.corazoninc.com

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