The last few years have been financially devastating for the hospital industry. COVID-19 and its variants have plunged the industry into financial chaos, with long-lasting impact on healthcare focused on, but far beyond, mere finances.
The CFA Perspective
A Cardiovascular Consulting Blog from CFA
In the continuing debate linking procedural volume and quality outcomes, recent published research on Transcatheter Aortic Valve Replacement (TAVR) dispersion, center proliferation, volumes and quality outcomes has brought this thorny issue to the forefront.
This is an incredibly timely and probably inevitable situation. West Des Moines, Iowa-based UnityPoint Health sued to block a large physician group, the Iowa Clinic, from opening two cardiac cath labs in its ambulatory surgery center (ASC).
Service-line consolidation has always been a challenge – theoretically feasible, strategically supportable, even desirable (particularly from a health system perspective), yet fraught with practical and political roadblocks.
Periodic News Update and Implications
Periodically, CFA will highlight a few significant news articles on cardiovascular topics -- clinical or organizational. Reprinted below are four news items we found interesting and worthy to highlight.
Amidst the constant barrage of clinical diagnosis and treatment news impacting coronary artery disease (CAD), and the delivery of related services, it is always instructive to be aware of the epidemiological news as well. Several news articles recently came to my attention that I wanted to pass on.
FFR-CT Aims for Real-World Application
Fractional flow reserve-computed tomography (FFR-CT), in the still early stages of clinical implementation, is beginning to make inroads into how some hospitals and physician groups diagnose chest pain patients noninvasively.
Occasionally, CFA will highlight a few significant news articles on cardiovascular topics -- clinical or organizational. Reprinted below are four interesting news items we feel worthy to highlight.
CMS announced its long-awaited updated transcatheter aortic valve replacement (TAVR) national coverage determination (NCD) final rules on June 21, 2019.
Over the last few years, we have continued to blog to keep readers up to date on the evolving state of cardiac valve surgery and the development of transcatheter aortic valve replacement (TAVR) specifically.
Occasionally, CFA will highlight a few significant news articles on cardiovascular topics -- clinical or organizational.
CMS announced its long-awaited updated transcatheter aortic valve replacement (TAVR) national coverage determination (NCD) proposal on March 26, 2019.
In our continuing series on low-volume cardiac surgery programs (LVCS), we previously discussed structural heart programs and the importance of valve surgery volumes in the overall assessment of potential cases.
While low-dose coronary artery calcium scoring scans (CAC) using CT have been around for some time, their effectiveness and relatively low cost in assessing cardiac risk seems to be taking on a new life. Accumulated wisdom and several newer studies have added to the body of clinical knowledge about CAC.
According to the Society for Thoracic Surgeons (STS) Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality, across the 1,119 participating cardiac surgery programs in the database, the average adult cardiac surgery procedure volume in 2016 was 200.8 cases.
Advances in coronary heart disease (CHD) prevention, diagnosis and treatment has progressed significantly over the past two decades.
Hospitals with small to medium-sized cardiac valve surgery programs need to know that the era of TAVR for most or all aortic valve replacement cases (AVR) – regardless of overall risk category – is moving ever closer to reality.
Two recent developments are important for those hospitals monitoring Transcatheter Aortic Valve Replacement (TAVR) developments.
In Part One of this blog we stressed the value of cardiovascular physicians acquiring or updating proven and effective business negotiation skill sets.
CFA has written extensively on the challenges facing the low-volume cardiac surgery program.
Last year CFA posted a cardiovascular physician-oriented blog entitled “6 Keys to Successful Hospital - Physician Negotiation” (https://www.charlesfrancassociates.com/blog/six-keys-to-successful-negotiation-with-your-hospital.)
In the previous blog post (refer to Rethinking Ambulatory Cardiovascular Strategy: Part One – The Big Picture posted on 4/19/18), I discussed the rationale for the need to reconsider your ambulatory strategy.
From the perspective of the cardiovascular service line administrator, let’s look at example approaches and some real world situations to illustrate these issues.
Sometimes being a California company lulls one into a false perception of normalcy. Because of the State’s years as a highly competitive managed care environment, one tends to think that the rest of the country has experienced similar market pressures and developed similar responses.
In a previous blog, I posted about the new opportunities for hospital cardiovascular programs to seek “whole program” accreditation or certification from outside validating organizations. This blog post looks at the strategy implications of pursuing such accreditation options.
Late last year, the opportunity for hospital cardiovascular (CV) programs to seek “whole program” accreditation or certification from outside validating organizations increased with announcements from both the The Joint Commission (TJC) and the American Heart Association/American College of Cardiology.
Following our posting of the blog announcing the CMS Final Rule ending the proposed Mandatory Cardiac Bundled Payment initiative posted on December 5, 2017, a little over one month later, CMS announced its new voluntary bundled payment model (see CMS Announces New Voluntary Bundled Payment Model for Ten In- and Out-Patient Cardiac Clinical Events, posted January 10, 2018.)
CMS announced on January 9, 2018 a new advanced bundled payment model for 29 inpatient and three outpatient clinical episodes. Included are eight inpatient cardiac episodes and two outpatient cardiac episodes.
2017 – A Look Back
By all accounts 2017 was an exceptionally change-driven year both nationally and on a global scale! Most prominent being the effect of the 2016 election which unleashed a massive convergence of governmental, socio-cultural and business environmental dynamics driving change. As is always the case, this created new challenges and opportunities.
The Centers for Medicare and Medicaid Services in a final rule released Thursday, November 30, 2017, closed the loop on its proposed cancellation of the cardiac bundled payment models.
If you follow CFA’s blogs, you hopefully will have read our current and continuing series on low-volume cardiac surgery programs and the challenges they face in the evolving era of value-based healthcare (refer to Low-volume Surgery Programs: Parts One through Five).
In our continuing series on low-volume cardiac surgery program issues and strategies, we thought it would be beneficial to present a conceptually simple and straightforward methodology and approach to “unwinding” a program should that be the decision of hospital management and clinicians.
We have written extensively on the issue of low-volume cardiac surgery and the challenges faced by these programs in today’s competitive environment. There are many options available to these programs to boost their volume, ranging from reinvestment in program development efforts all the way to divestiture or closure if all else fails.
In our continuing series on low-volume cardiac surgery programs, we now incorporate the Center of Excellence (COE) concept into our discussions.
Cardiac Services Expansion: More Hospitals Are Taking a Second Look
In Part 1 one of this blog we discussed the key economic, demographic, technological and financial forces driving a growing interest by hospitals and health systems to develop new or expanded cardiac services.
Pending regulatory review, CMS has proposed cancelling the cardiac and expanded joint replacement bundled payment models. The rule, which was sent to the Office of Management and Budget last week, would...
For more than a decade, new heart program start-ups or expansions have been flat or declining in the US. This has occurred with a concomitant increase in the percentage of what has been termed “low volume heart programs” over the past 10-15 years. (see our previous blog Can Low Volume Cardiac Surgery Programs Be Excellent)
In our recent post, Low-Volume Cardiac Surgery Program “Excellence”, we initiated a multi-part series discussion on the theme of cardiac program excellence. In this article, we address the importance of understanding one’s cardiac program volumes and the difference in key types of procedures that comprise your cardiac surgery program’s procedure volume.
In a previous blog, CFA asked the question, “Can a low-volume cardiac surgery program be excellent?” (posted November 16, 2016). CFA estimates,
In the continuing effort to foster innovation and cost savings in cardiovascular programs, CFA was reminded of two interrelated clinical pathway issues by recently published research.
The Basis for Renewed Financial Optimism
After more than a decade of paltry economic growth, many CFOs and healthcare sector financial analysts are becoming more bullish on the future of their health services organizations’ financial positions and performance.
The integration of Heart and Vascular Services has been an ongoing challenge for the past 15 years or so. CFA has long promoted the benefits of heart and vascular services alignment, as the advantages far outweigh the time and effort necessary to achieve integration.
In a previous blog post, we introduced the concept of episodes of care (EOC) and its conceptual and practical application to improving program performance and preparing for value based care.
As most of us know by now, any transition to bundled payment will necessarily involve episodes of care (EOC). This blog, however, is not about preparing for bundled payment ‒ rather, it will focus on the value of the EOC as a foundation for analysis leading to reduced costs and enhanced value, regardless of when (or if) bundled payment initiatives become commonplace.
In past blog posts we have tried to keep you up-to-date on the proposed mandatory Medicare cardiac bundles that are (currently) set to commence in July 2017 (see Mandatory Medicare Cardiac Bundles: Final Regulations (Possibly) ).
CMS announced on December 20th that they are moving forward with the mandatory Medicare cardiac bundled pricing model by issuing final regulations.
Today’s cardiac catheterization laboratories, noninvasive cardiology and vascular service departments must manage and store extensive amounts of patient data – clinical documentation, analytics and images – tasks that have led to the ubiquitous adoption of a comprehensive CVIS.
It’s easy to take things for granted – until they are gone. Denton Cooley, one of the most famous heart surgeons ever, died Friday, November 18, 2016 at the age of 96, a month or so after the passing of his wife of 67 years, Louise Thomas.
If you follow CFA’s blogs, you know we have written extensively on low volume cardiac surgery programs and the challenges they face in the evolving era of value-based healthcare (refer to Low Volume Surgery Programs: The Need for Next Generation Assessment).
The issue of consolidation of services between hospitals within a system is increasingly important and many health systems are evaluating this option.
It is inevitable that whenever CMS issues proposed rules on new or expanded programming – in this case the recently proposed mandatory Medicare cardiac bundles set to begin in 2017 – comments, criticisms, suggestions and recommendations on the program start to surface. “Pushback,” if you will.
Today’s cardiovascular medical groups must deal with a continual barrage of reimbursement and regulatory changes. Fee-for-value, ICD-10, at risk contracts, and the newly announced cardiac bundling initiative for hospitals (set to begin in selected Metropolitan Service Areas in 2017), are but a few examples.
The results of the second year of CMS’s voluntary bundled payment experiment – Bundled Payment for Care Improvement (BPCI) – are now in, and the results for CV patients are decidedly a “mixed bag.”
CMS has been busy. On July 25th they published their Notice of Proposed Rulemaking for Bundled Payment Models for High-Quality, Coordinated Cardiac and Hip Fracture Care.
A recent article on population health – Six Business Imperatives for Population Health Management – caught our eye.
The article states that taking an organization’s population health capabilities to the next level requires leaders to rethink where, how and to whom their organizations provide services and which services are most appropriate, given the unique needs of the population they serve.
CFA’s prediction that Medicare would inevitably initiate mandatory bundled payment for cardiac procedures, has come to pass more quickly than even we imagined. On July 25th, HHS published their Notice of Proposed Rulemaking for Bundled Payment Models for High-Quality, Coordinated Cardiac and Hip Fracture Care.
Is TAVR1 suitable for everyone? As originally approved, transcatheter aortic valve replacement was intended only for high risk patients who could not otherwise endure an open-surgical (or sAVR) procedure; the selection criteria was strict.
It’s easy to take the congenital heart defect population for granted. It constitutes only a relatively small portion of those impacted by cardiovascular disease and has historically consisted predominantly of children born with inherited defects.
As if the writing was not already on the wall, there is further evidence that HHS will inevitably initiate bundled payment for select cardiac procedures.
Are your cardiologists reluctant to give up old fashioned dictation and transcription for cardiac catheterization (cath) lab structured reporting? Hospitals throughout the country are mandated to have all patient documentation entered into an electronic medical record by the year 2018.
An important Perspective article was published in the New England Journal of Medicine by Michael Porter and Dr. Thomas Lee entitled, “Why Strategy Matters Now.”(1)
An important Perspective article was published in the New England Journal of Medicine by Michael Porter and Dr. Thomas Lee entitled, “Why Strategy Matters Now.” (1) Their p
remise was reprised in a recent Hospital & Health Networks article as “Six Essential Questions for Developing a Value-Based Strategy.” (2) Its implications are important and profound.
What does marketing strategy have to tell us about maintaining or defending a service in a declining or mature market? In essence, quite a lot. For the cardiovascular administrator, there are CV sub-markets in ascension, and there are also those in decline.
Earlier this year, St. Luke’s Hospital, Chesterfield, Missouri announced a cardiovascular clinical affiliation with Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute. This partnering is prominently displayed on the St. Luke’s website, https://www.stlukes-stl.com.
When reviewing healthcare statistics, there is usually both good and bad news. However, looking at the National Center for Health Statistics deaths from heart disease for 2010-2013, there is mostly good news to report. Death rates per 100,000 population (see table) are trending down for Whites, Blacks and Hispanics. That’s the good news.
The bad news is that there are still heart disease disparities between ethnicities when it comes to both incidence and rates of decline.
PARTNER II SAPIEN 3 Trial – TAVR Outperforms SAVR – Again!
The one year results of the PARTNER II, SAPIEN 3 clinical trial for intermediate-risk patients with severe aortic stenosis were recently announced at the American College of Cardiology’s 65th Annual Scientific Session in Chicago. The results are good news for
Over the past several years, the diagnosis and endovascular treatment of peripheral vascular disease has increased significantly in many hospitals.
Physicians all over the country are exploring new ways to align with one another, align with hospitals and create new operating structures in an effort to leverage their position within the current forces shaping the healthcare marketplace.
Your hospital may or may not have a formalized cardiovascular services marketing plan or marketing budget, but if you spend money on marketing, through websites, social media, newsletters, press releases and the like, don’t you want to know if your investment is paying off?
For those of us who have spent significant time in and around hospitals, they can become somewhat routine places to us. They are to be, in their essence, places of healing, compassion and expert care for those who are often dealing with serious illnesses.
Some things we think are new in healthcare, after closer inspection, are really not new and just carry different or more trendy language.
Designing and implementing bundled pricing isn’t easy, but it will be increasingly necessary as Medicare and private payers continue to move away from fee-for-service reimbursement and the payer marketplace continues to evolve.
Given trends in healthcare, and in cardiovascular services specifically, it is instructive to look at the issue of low volume cardiac surgery programs in California.
What: The integration of interventional and surgical techniques is demanding a new working environment for an interdisciplinary cardiovascular team: the Hybrid Operating Room, where angiographic imaging capabilities are integrated in an operating suite.
All-in-all, 2015 was a busy year for CFA, although client work seemed to get in the way of blogging frequency. One of our new year’s resolutions will certainly be to blog more often in 2016.
As Primary Care Physician (PCP)-driven Accountable Care Organizations (ACOs) and population health-based reimbursement models continue to grow, CV specialists are in danger of being de-“valued” in the new era of PCP-controlled healthcare.
Two recent announcements about healthcare payment and costs should wake up every CV service line administrator:
Are You Considering Consolidating (Rationalizing) Clinical Services Across Your Health System? Consider these 12 Key Questions
CFA recently completed an engagement in which the rationalization (consolidation) of cath lab services within a two hospital system was hotly debated.
As we have reported in past blogs, California law now allows hospitals licensed to provide emergent cardiac catheterization laboratory services to perform scheduled, elective PCI regardless of the presence of cardiac surgery-on-site.
Health and wellness is a growing concern for every cardiovascular professional. Research has shown that a significant proportion of CVD is preventable, particularly given the positive impact of regular exercise, good eating habits, stress reduction, early detection, compliance with prescribed medications and the like.
Regulation Changes to Allow California Hospitals with Cardiac Cath Labs to Perform Elective Percutaneous Coronary Interventions (PCI) without Cardiac Surgery-on-Site
California law will now allow hospitals licensed to provide emergent cardiac catheterization laboratory services to perform scheduled, elective PCI regardless of the presence of cardiac surgery-on-site.
The Premier healthcare alliance continues to identify potential savings opportunities for hospitals. Based on feedback from nearly 350 members participating in Premier’s QUEST collaborative, five areas with the largest opportunity for average annual savings at a typical 200- to 300-bed community hospital are listed below
Ian Morrison is one of our favorite futurists and forward-thinkers, so we generally hang on his every word. In an article entitled “The Bridge from Volume- to Value-Based Payment” (www.hhnmag.com, September 4, 2012); he outlines what he calls “the new future” and how to build the bridge to get there.
The American Hospital Association publication, A Guide to Strategic Cost Transformation in Hospitals and Health Systems (available for download at: www.hpoe.org/strategic-cost-transformation) deals with the overriding issue of cost management in an era of evolving value-based business models.
CFA staff has lately been reviewing an assortment of “thought leader” predictions about where healthcare is headed over the next ten or so years. We have a number of ongoing projects that require our input and expertise about cardiovascular (CV) trends and, most importantly, their implications on everything from network strategy to facility design.
We have commented on this subject before (please see Physician/Hospital Integration and Pushback, posted April 22, 2011), but the issue was brought home to us recently by a client’s circumstances.
With all that is going on in healthcare today, and the cardiovascular services environment in particular, why has CFA written a book on strategic marketing for the cardiovascular (CV) service line?
HealthLeaders Media (a division of HCPro), Brentwood, Tennessee, will publish a new book by CFA principals entitled, The Complete Guide to Marketing for the Cardiovascular Service Line. The book is now in the final stages of editing and should be published by the end of this year or early 2012.
According to a study recently published in the Journal of the American Medical Association, older, lower-risk patients undergoing elective PCI can be safely discharged from the hospital the same day as their procedure.
Over the last few years, there has been a keen interest in the patient-centered medical home (PCMH) model of care, highlighted by its prominent inclusion in the Patient Protection and Affordable Care Act (PPACA).
If hospitals are going to align with physicians, most, given the ability, might choose to employ every physician on their medical staff.
A recently published study purports to show that the incidence of acute myocardial infarction (AMI) in the US has decreased over the nine-year period between 1999 and 2008.
Continuing our discussion from Part Two of physician/hospital alignment issues in general, and the reemergence of bundled payment initiatives specifically, an important new pilot will soon take place in California.
Continuing the discussion from Part One of physician/hospital alignment and the reemergence of bundled payment initiatives, let’s discuss the impact of health care reform in the area of bundled payment for care. A national pilot program on payment bundling is included in H.R. 3590, the Patient Protection & Affordable Care Act. This pilot program is set to commence in 2012 (no later than January 1, 2013) and run for five years.
Bundled or package payment across an episode of care such as a hospitalization, the subject of Medicare demonstration projects in the 1990’s, may be poised for a comeback.
The future of physician-owned or joint-ventured heart hospitals would seem to be dead. What officially killed it is H.R. 3950, the Patient Protection & Affordable Care Act, which declares that, unless they have a provider agreement in place prior to December 31, 2010, physician-owned hospitals (of any type) are excluded from Medicare participation.
When was the last time you came across a simple and straightforward change in clinical technique that typically results in better clinical outcomes, fewer complications, higher patient satisfaction, and lower cost per procedure?
Over the long consulting careers of CFA's Principals, the relationship between cardiovascular procedural volume and quality outcomes has continually merited examination.
Three-dimensional imaging diagnostics-in particular, Cardiovascular CT angiography (CCTA)-have been widely touted as the next big thing in the diagnosis of CAD and PAD. Nearly every day a new clinical article related to CCTA shows up in my inbox. What's the current state of 3-D imaging?
Hospital cardiovascular program managers and cardiology, cardiovascular surgery and vascular surgery practice administrators are well aware of the continuing evolution of cardiac and vascular medicine and the multitude of challenges facing each of us.