Successful Systemization of Cardiac and Vascular Care: Experiences from MCVI

by Lauren LeBano

The landscape of health care has undergone significant restructuring in recent years as freestanding hospitals merge into larger health care systems and those health care systems begin to standardize quality of care. Miami Cardiac and Vascular Institute (MCVI) has been at the forefront of this change and has established a system that improves patient care while adapting to new revenue and organizational models, explained Barry T. Katzen, MD, the founder and Chief Medical Executive of Miami Cardiac & Vascular Institute.

About 5 years ago, MCVI was an entity based at a single hospital in a health system with several hospitals. Leadership at MCVI critically examined that structure and asked two questions. “Shouldn’t a health care system of our size be the platform for a nationally leading cardiac and vascular system? And can a health care system continue to afford variations in quality and cost across hospitals in the same system? These factors led us at MCVI to begin the process of systemization,” said Dr. Katzen.

A Quality-First Model

Leaders at MCVI agreed that it was in the best interests of both patients and the organization to create a system-wide entity with the goal of quality first. “Within health care, reducing variability in patient treatment reduces costs and improves outcomes,” said Dr. Katzen. To accomplish this goal, the organization would need to harmonize and standardize definitions of quality, as well as unify peer review across the hospitals. Adverse events would be reviewed by a single multidisciplinary committee, and policies would be standardized to limit variation.

A key element of MCVI’s success in implementing system-wide change was physician alignment. “We believe that health care organizations should create win-win solutions for physicians and the organization,” said Dr. Katzen.

With that in mind, Dr. Katzen and MCVI leaders began expanding their management company model, an infrastructure in which physicians and the health system are 50/50 partners. MCVI had operated under the management company for 12 years, and it had proven so successful that the same structure was chosen to continue. MCVI closed the legacy management company and began another one that incorporated physicians from throughout the larger entity.

“We now have 83 physicians who are considered members of MCVI working across 6 hospitals and being compensated to manage quality in everything from EKG to open heart surgery,” explained Dr. Katzen.

The Importance of Physician Leadership

The road to systemization was not without its challenges and involved answering stakeholder questions about why the process was necessary and beneficial for all involved. “The perception of many physicians is that leaders are making decisions without them. That’s not workable in the long run. Organizations want to have physician engagement and involvement,” Dr. Katzen said.

Dr. Katzen advises physicians to become involved early in the systemization process and to try to take a leadership role by engaging with administration and working with other physician leaders. He emphasized that no model, whether employment, co-management, or some mixture, can be successful without physician leadership. The ultimate goals of systemization—increased quality of care—do align with physicians’ definition of professional success, he pointed out.

Developing a unified culture is part of creating a quality environment. Prior to systemization, each hospital and entity of MCVI had its own culture, but those different identities needed to come together. According to Dr. Katzen, standardized definitions of quality and adverse events are one of the best ways to fuse cultures, and the process of determining these definitions offers an excellent opportunity for physician involvement. Systemization should take the best of what each hospital is doing and disseminate it to the group.

Ultimately, most physicians will be faced with systemization as health care continues to evolve, and freestanding single hospitals may not exist in the long term. Proactively pursuing systemization offers an opportunity to reduce costs and improve patient care while fostering physician leadership. In fact, when systemization is not successful, it is usually due to a lack of physician leadership rather than a lack of funding, observed Dr. Katzen.

MCVI offers their positive experience as an organizational model for other institutions seeking a similar change. “Our model has survived and continued to grow over 30 years, and people from all over the country come to observe, but at the same time we continue to evolve. ” said Dr. Katzen. “For most practitioners, success is taking care of patients and producing the best quality results in the best quality environment,” he said.