Cardiothoracic Surgeon Compensation in a Low Volume Cardiac Surgery (LVCS) Setting: Part 1
Overview
Advances in coronary heart disease (CHD) prevention, diagnosis and treatment has...
In a previous blog, CFA asked the question, “Can a low-volume cardiac surgery program be excellent?” (posted November 16, 2016). CFA estimates,
through our participation in and review of national proprietary hospital database(s) and a review of states that report hospital cardiovascular volumes and outcomes, there are at a minimum of 300 to as many as 500 heart programs with cardiac surgery volumes of less than 120 cases per year[i]. We have received positive feedback and significant interest on this subject, so we have decided to write a series of articles on the general topic of low-volume cardiac surgery programs and the pursuit of excellence. This is a first in a series that addresses the general excellence topic. Future blog posts will continue to investigate the topic and help you understand why it is critical, how it can be successfully addressed, and what the journey to achieving excellence will look like.
There probably isn’t a cardiovascular service line administrator who does not believe that the pursuit of excellence is not one of, if not the most important of her or his goals; both personally, managerially and for their program. Conceptually inherent in modern management, the term has been so inculcated into healthcare management that it would be hard to dispute its importance. However, like many “fuzzy” management terms, it can mean nothing, something or everything, depending on your perspective. What really is “excellence?” Who defines it for cardiovascular services? How is it measured? How does volume influence the equation? Why is it so conceptually simple, yet ultimately so complex? And finally, does being “excellent” really make a true difference? Does excellence actually have a return-on-investment (ROI), or is it more fuzzy thinking or viewed intrinsically by managers as simply the “right thing to do?”
Why Excellence Now?
CFA’s consultants have been addressing the “excellence” question for many years. In the 1990’s, we pioneered a methodology and approach to defining CV centers of excellence when the market in many regions was open to that approach for specialty contracting. We periodically revisited the question of program volume and quality (not that this issue has or will ever go away!). We have been called in to diagnosis ailing and low-volume programs and found issues relating to excellence as a foundational cause. Market dynamics and payer/contracting issues can and certainly will impact program volumes as well. Much of our personal work philosophy is based on building a high-quality product designed to support the production of excellent clinical results. It is so fundamental in our work DNA we can all sometimes take it for granted, but we should not.
Recent changes in the evolving national market are causing us to rethink the concept and the practical achievement of excellence. These changes include the overall decline in cardiac surgery and interventional cardiology procedure volumes, the evolving payer market, the national issue of repealing and replacing existing coverage programs, and other impacts. Clinical issues relating to the relationship between volume and quality still exist and the volume/quality/outcomes conundrum of whether or not it equals or doesn’t equal excellence is perpetual and should perhaps remain as such, lest one downplay its importance! Overall, this is a major issue to address, and it can’t be discussed at any length in one sitting, hence our decision to author a series on the subject.
Addressing the Concept of CV Excellence
Here are some of CFA’s thoughts on excellence, relating to general cardiovascular services, just to get the conversation started and on which we intend to embellish and revisit from time-to-time in future postings.
In an upcoming post, we will dig deeper into this subject and address the multiple factors affecting the development of a Cardiac Surgery Program of Excellence such as the interplay between local and national market dynamics, impact of your program profile, reimbursement issues, operational structure and physician issues.
Implications
CFA does not believe it has to convince any cardiovascular program administrator to actively pursue excellence. We take that as a given. However, the pursuit of excellence specifically tied to strategies to enhance low-volume cardiac surgery programs may be a tougher sell – both philosophically and in practical terms. Why it is done, how it is done and the overall effectiveness of the effort will vary significantly from program to program, market to market and region to region for many reasons we didn’t have time to discuss today but will address in the future.
Remember that all important endeavors take time, commitment and dedication. However, none of these factors, even taken as a whole, should detract from the overall goal of achieving programmatic excellence.
We will be posting additional articles regarding developing excellence within low-volume cardiac programs in the near future.
If you are interested in learning more about strategies to deal with low volume cardiac surgery programs and/or programmatic assessment for cardiovascular services, please contact CFA at (949) 443-4005 or by e-mail at cfa@charlesfrancassociates.com.
[i] Definitive Health National Hospital Database, 2017
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