Cenergy is a Washington based consulting company specializing in the implementation of physician alignment strategies and the strategic development of service lines.
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In life there are always two sides to everything. For most of life’s events, a simple question represents this truth – “Would you like the good news or the bad news?” For cardiovascular professionals, we have historically lived in a world with only one side – an ever increasing number of Americans stricken with cardiovascular disease. Each year we have seen more disease, more deaths and more opportunity for cardiovascular professionals to educate and assist in modifying personal choices that increase risk. Add to this the explosion in technology and this has translated into increased volumes and strong financial margins for cardiovascular departments.
In 2007, the good news turned as we saw major reductions in incidence rates and deaths due to cardiovascular disease. The National Institutes of Health announced a significant decline in deaths among women down to 1 in 3 from 1 in 4 in recent years. Overall, the American Heart Association announced a 23% decline in deaths among all demographics. These statistics are the direct result of the prevention and early detection programs provided by cardiovascular programs, physicians and hospitals. Great results for the American public (good news) and not so great result for hospitals (bad news).
In a direct corollary, cardiac catheterization laboratories, heretofore a source of volumes and revenues, have seen a decline of approximately 20% nationwide in the past year alone. This significant decline has generated negative operating margins in both the cardiovascular programs and the overall hospital financial performance.
In the midst of this decline, a new non-invasive technology, cardiac CT, has entered the forefront of discussions in cardiovascular programs. Understanding the potential benefits and impact of this technology drive many conversations among the management ranks. Clinical benefits have been proven such as the negative predictive value of 99% while the potential risk looms as well – is this just another force driving volumes out of the cardiac catheterization laboratory?
Cardiologists, in preparation for the potential risk, are moving quickly to adapt to this technological change; attending courses to become credentialed to interpret these studies. The result: another cardiology – radiology “turf” battle over the reading privileges. And so the stage is set for the next challenge to cardiovascular managers – when to enter this market and what will be the impact of this latest non-invasive technology?
The answer to the question of ‘when’ is simple: NOW (preferably before the competition). The benefits of the implementation of cardiac CT are many:
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Expansion of current services
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Enhancement of capabilities such as rule out coronary disease for Heart Attack programs
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Direct consumer marketing opportunity for calcium scoring
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Platform for physician alignment strategy
Physician alignment is key to successful implementation of cardiac CT due to the multidisciplinary capabilities for interpretation. Providing a combined panel of radiology and cardiology with a common set of credentials and protocols is a fundamental element in a successful cardiac CT service. Secondarily, the ability for economic alignment by way of joint venture, purchased services and other models provides a second level of alignment between physicians and potentially the hospital.
Therefore, implementing the service is a proven strategy for growing volumes, enhancing early diagnosis in acute settings and in aligning multiple physicians to work collaboratively toward a common goal. With these benefits, why not pursue this immediately? That answer lies in understanding the second component of this equation – what is the impact of the implementation on my cardiac catheterization laboratory and on my program?
On initial glance, it might appear that the implementation of cardiac CT will further reduce the volume of cardiac catheterization procedures by replacing traditional coronary angiography with CT angiography. Although strides have been made in this non-invasive technology, traditional coronary angiography remains the ‘gold standard’. Coronary CTA is most useful to determine whether symptoms of chest pain may be caused by a coronary blockage, particularly in individuals that may be at risk, such as those with a family history of cardiac events, diabetes, high blood pressure, smokers, and/or those with elevated cholesterol. This benefit allows for quick rule out and rapid mobilization of the acute interventional team. A significant clinical benefit and a strong marketing tool resulting in a potential increase in the number of patients through the chest pain center.
The cardiovascular program overall receives several benefits from coronary CT ranging from the improved marketing for the chest pain patients through the continued opportunities resulting from the physician alignment strategy. Bringing together the multi-disciplinary team of radiology and cardiology lays the foundation for further collaboration in areas such as endovascular procedures.
Implementing a cardiac CT service opens the door for new services (calcium scoring), assists in rapid detection of coronary blockage in the acute setting and provides the framework for a radiology – cardiology collaborative model. With decreasing volumes in cardiovascular programs across the country, the tactical deployment of cardiac CT provides a real opportunity to recapture market share.
