Case Studies



Case Study #1



Existing Cardiovascular Services Optimization

For many years, this hospital had repeatedly contemplated to establishment of a comprehensive cardiovascular program.  A number of preliminary assessment had been conducted, but no decision was able to be reached.  At approximately a year after a new hospital CEO was appointed, CFA was retained following a competitive process.  CFA’s initial engagement with this client was to conduct a comprehensive feasibility assessment including a regional cardiovascular market assessment and the evaluation of the hospital’s current facilities, technology and clinical support for such a program.  The results of the feasibility assessment led to the development of a long range cardiovascular services development plan to coincide with substantial new construction required to bring a cardiovascular program to the hospital.

CFA was instrumental in the planning and development of comprehensive cardiovascular services for the hospital.  Various consulting engagements included the full facility and clinical planning for diagnostic and therapeutic cardiac catheterization, cardiothoracic surgery and electrophysiology services.  Following the establishment of those services, CFA was retained to assist with the assessment and initial planning for expanding the hospital’s electrophysiology (EP) program.

The outcome of the work CFA did to support the potential addition of comprehensive cardiovascular services at a hospital that heretofore had only offered noninvasive cardiac diagnostic testing, was the  establishment of a successful and well regarded full service cardiovascular program in an area the most patients had been traveling significant distances to receive higher acuity care.

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Case Study #2

Systematic Hospital Cardiac Program Growth over 20 Years

 The CFA team supported this mid-Atlantic community hospital client in the development of a highly successful comprehensive cardiovascular program over the course of multiple engagements during 20+ years.  At the time of initial engagement, the program had 2 cardiologists on staff and offered non-invasive cardiac services.  During this work, the consultants assisted in the development of a cardiac catheterization laboratory with business and facility/equipment advice.  Projects to follow included Feasibility Assessments and Strategic Business Plans for CV program development and program organizational development. 

In the early 2000s, CFA assisted the hospital to develop and initiate a Percutaneous Coronary Intervention program without Surgery on Site – a program that was ranked Number 1 in Quality in the State for 4 straight years.  After the program grew to nearly 300 PCIs annually, CFA was integral to the planning and implementation of a comprehensive Cardiothoracic Surgery program.  CFA assisted in Feasibility Assessment, Business Planning and submittal to the State for Certificate of Need approval. 

During the CON process, CFA helped to prepare submittals and was a leading participant/presenter in the State hearings.  Upon State approval, CFA directed the 18 month implementation process.  CFA helped in garnering support and assistance from a highly regarded Cardiothoracic Surgery Practice and its home hospital – support that brought about short term staff training assistance during implementation and a long term agreement for surgeon backup support.  CFA also directed, managed and staffed the Cardiothoracic Surgeon recruitment process. 

CFA assisted in the initiation of a full-service electrophysiology program with a dedicated catheterization laboratory.  Most recently, CFA helped the hospital in evaluating structural heart services and a hybrid operating room.  CFA prepared a detailed, comprehensive business model that facilitated decision-making and was integral to achieving approval from the hospital’s corporate headquarters.  The hybrid operating room is currently under construction. 

During the course of CFA’s regular and systematic assistance, the hospital cardiovascular program has grown to 10 cardiologists, 2 cardiothoracic surgeons, 3 cath labs (including an EP lab), 2 cardiac ORs, and is performing more than 1,000 caths, 200 surgeries and 400 PCIs annually.  It maintains the highest levels of quality outcomes and has become a destination center for cardiac services in its region of the State.

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Case Study #3

Health System Cardiovascular Services Planning and Development and Competitive Re-Positioning

 CFA was retained to conduct a comprehensive hospital system cardiovascular services assessment for a three hospital health system in California.  Included in the assessment work was a facility by facility assessment of cardiovascular services capabilities, a healthcare services market and competitor assessment and a managed care payer market assessment.  The health system hospitals were providing services to a five-county region and faced strong competition from a longstanding, leading cardiovascular provider in the community.  The primary goal of the initial engagement was to determine potential strategies that would lead to a competitive advantage for the health system.  A number of strategies were identified and evaluated with health system leadership.  The leading option of the health system leadership and key community cardiovascular physicians was the prospective development of a joint-ventured heart hospital.  

The CFA team was engaged to conduct the comprehensive heart hospital development analysis and to develop the implementation plan for the new, joint-ventured heart hospital to be built in the largest city in the 5-county region.  The comprehensive feasibility assessment, business and facility planning segments of this project included the evaluation of development options and strategies for the future of the health system’s cardiovascular service line after the new heart hospital was completed.  In the course of this project, CFA worked with more than twenty local cardiologists representing several physician groups. 

The outcome of this major engagement was the development and implementation of a regional specialty heart hospital that was co-owned and co-managed by the health system and 49 cardiovascular and other specialty physicians in the region.

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Case Study #4

Medical Center Heart and Vascular Services
“Next Generation” Cardiovascular Services Development

 This Medical Center in the northwest had a noninvasive and diagnostic cardiac cath program for years.  For decades, virtually all patients requiring invasive and interventional cardiac and vascular services were referred to providers in another city that required 1-2 hours, or more, of drive time to access.  The hospital leadership determined the need to comprehensively assess the potential for cardiovascular program growth and the addition of new clinical capabilities at the medical center to provide appropriate care in the local area and region.

 CFA was engaged to assist in the development of a heart and vascular services strategic business development and marketing plan.  CFA worked with administration, management and local and regional cardiovascular medical staff to assess the market and craft strategies and tactics for expanding heart and vascular services. The expanded services targeted in the plan were the addition of PCI services and expanded vascular services detailed in the program development plan with key action steps and timeline.  These action items included recruitment of invasive/interventional cardiology and vascular medical staff.

 Following the completion of the identified key development steps from the original planning work, CFA was again retained to work with the Medical Center to develop the “next generation” of cardiovascular services development planning.  This engagement included facility planning assessment, capital and operational budget planning, and projected financial outcomes for a further expanded program to incorporate a second invasive/interventional procedure room and support facilities.  This project also involved the planning for an employed cardiology clinic model for cardiology to be implemented and expanded over time.

 The primary outcome of these engagements was the development of an action oriented cardiovascular services development plan based on well-documented local and regional market demand.  In the two phases of assistance provided by CFA, the medical center was able to expand its invasive and interventional cardiac and vascular services, successfully recruit the required physician and clinical support resources, and operate the new PCI without cardiac surgery onsite program in a sound clinical and financial manner.

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Case Study #5

Integrated Hospital and Physician Clinic 
Comprehensive CV Program Assessment and Expansion

 This Health System, located in the upper Midwest, is an integrated hospital and physician clinic model with all active cardiologists in the community employed within the Clinic.  The organization had been providing a moderate range of cardiovascular services to local communities and to a broad geographical region spanning a state line. Recognizing the need to develop a more integrated program with its cardiovascular physicians and to assess the viability of new clinical services, the health system sought outside, experienced assistance with this process.

CFA’s initial engagement was to conduct a comprehensive Cardiac and Vascular Program Assessment, including a comprehensive Market/Strategic Assessment and Internal Clinical, Operational and Financial Assessments of the Cardiovascular Service Line.  The detailed assessment process integrated the CV physician providers and health system administration and service line management.  Through this work, the CFA team identified a number of opportunities to capture additional market share, enhance program cohesiveness and efficiency, add appropriate elements to the clinical services offering, and improve financial performance.

The subsequent engagement built on the initial comprehensive assessment phase and produced a Strategic and Business Plan for the CV Program, a Heart and Vascular Center development action plan, a Physician-Hospital Alignment Strategy, and an analysis and plan for the development of Electrophysiology Services. 

The key outcome of this engagement was the development of a detailed, research/findings-based Strategic and Business Plan for the CV Program.  Health system leadership utilized the CFA recommendations to make fundamental refinements to the cardiovascular services organization, operations and offerings resulting in a well-coordinated CV services organization and the addition of new clinical capabilities needed in the community and region.

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Case Study #6

Multihospital System in the Midwest:
Developing a Regional Model for Cardiovascular Services

 A three hospital health system in the Midwest with hospitals in a large urban area and a facility in an outlying high growth rate county, determined the need to deeply analyze the local and regional market for cardiovascular services and to develop an informed and forward looking Cardiovascular Services Strategic Development Plan.  CFA was engaged to lead the process and to coordinate with health system leadership and with the management teams and medical staff of the three hospitals.

 Key outcomes of this initial engagement included the establishment of a regional model for cardiovascular services administration, the recruitment of the regional cardiovascular administrator, identification of key strategies to mitigate competitive threats in the region and the specification of appropriate clinical services development opportunities at the newest hospital system campus.  A subsequent phase of consulting assistance resulted in enhanced performance of the service line through consolidation, the addition of new services at the right location to take advantage of population shifts in the region, and the creation of a solid foundation for ongoing cardiovascular service line growth.

 With the success of the initial engagements, CFA was retained some years later to provide a cardiovascular environment and market assessment update for the region for this client.

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Case Study #7

International Cardiovascular Services Consulting
Heart Hospital Feasibility Assessment and Initial Business Planning

 This private Cardiovascular Institute, located in the Caribbean, historically has provided cardiac physicians, nurses and technical staff for comprehensive cardiovascular procedures to the hospitals in their country.  In discussions with a partner hospital in their market, the institute and partner hospital leadership decided to evaluate the feasibility of developing a heart hospital on the hospital campus in a high quality clinical operations model.

CFA was retained by the institute to conduct of a comprehensive Feasibility Assessment that addressed the questions:  Is the proposed project strategically, politically, clinically, operationally and financially feasible?  What option(s) for the future development appear to be most appropriate?  The key issues addressed in the engagement included:

  • Regulatory and legal issues (both existing and potential)
  • Market size, composition and potential volume
  • Proposed program and service offerings
  • Business and medical community political environment assessment
  • Facility size, design and potential phasing
  • Potential joint venture or other relationship with the partner hospital, other provider(s) or individual physicians/investors
  • Alternative ownership/equity models
  • Financial pro formas reflective of key financial assumptions and issues
  • Funding requirements and alternative sources of capital
  • Realistic time frames for development, construction and initiation of operations

The primary outcome of this engagement was the preparation of the Heart Hospital Feasibility Assessment Report of Findings.  This assessment allowed the institute and its partner hospital to make a “go/no go” decision to proceed with the detailed business planning required to operationalize the project in the next phase of work.  As of this writing, the project has been on hold due to capital funding needs.

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Case Study #8

CFA CVIS Consulting Team Accomplishments – A Brief Case Study

A CFA CVIS Consulting Team success story at a community hospital: The hospital had purchased state of the art CVIS/CPACS technology and the vendor installed and provided physician and staff education.  However, after several years, the physicians were still not completing their cardiac cath lab procedural reporting using the electronic structured reporting capabilities. The staff had developed so many difficult and time consuming redundant steps to get cath report data into the HIS.   Departmental charges were routinely missed as the procedure and equipment lists in the hemodynamics system were not up to date.  CFA was retained to do a comprehensive assessment of the cardiology department and cardiac cath labs’ current state technology, clinical workflow, culture and mapping of information flow and processes.  This work included comprehensive interviews with physicians and staff.  A project improvement plan was developed and the work initiated.

The end result was a fully operational and optimized CVIS/CPACS that was interfaced and integrated with the hospital’s HIS.  The physicians and staff were provided education and competency training on new and improved reporting templates and workflow processes. This work achieved the following:

  • Substantially streamlined the clinical workflow of the staff
  • Achieved 100% of the physicians doing structured reporting
  • The CV Administrator can now query quality and accurate data reports which help make positive change
  • The productivity of the department has increased by 50 percent
  • Charges are accurately captured and billed, after the first month of implementation over a million dollars in lost revenue was found and billed. 
  • Streamlined reporting and immediate procedural data transfer has routinely saved 10 to 15 minutes between each case,allowing the staff to improve the cath lab procedure turn over time. This resulted in an increase in the number of cath procedures able to completed daily.

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