Submitted by Dignity Health
Thanks to a unique approach to delivering care, heart patients at two East Valley hospitals are receiving more coordinated and efficient medical assessment and treatment.
Thirty cardiovascular specialists from a number of
different practices and several subspecialties in the East Valley have
formed their own management organization to provide optimal specialized
medicine in hospital emergency departments and to inpatients. It’s a
rare concept in health care, and it’s paving the way for other hospitals
and other clinical specialties in Arizona.
From Competition to Cooperation
Much like any other entrepreneurs, primary care physicians and medical specialists may regard themselves as competitors with others in their specialty, especially with those who happen to practice in the same geographic region. It’s unusual to see doctors in the same specialty who are not already partners in practice agree to work together serving a particular population of patients to ensure a higher level of care and greater efficiency in delivering that care.
Typically, when heart patients go to a hospital emergency department, they are evaluated and initially treated by the emergency medicine physician on duty at the time while they wait for an on-call cardiologist to arrive at the hospital. That system generally works well, but administrators and doctors at Chandler Regional Medical Center and Mercy Gilbert Medical Center know there is a more efficient way to care for emergency and inpatient heart patients.
That was part of the motivation for the 30-member group composed of medical cardiologists (heart doctors who patients see most often), interventional cardiologists (who perform procedures such as angiograms), electrophysiologists (who specialize in assessing and treating abnormal heart rhythms) and cardiovascular surgeons from 15 separate practices in Mesa, Tempe, Chandler and Gilbert to band together to form the Heart Health Organization-East Valley (known as “H2O”). The doctors provide on-site care at both Chandler Regional and Mercy Gilbert Medical Centers.
H2O is the only
program in Arizona that has private practice cardiovascular doctors
available in the hospital from 7 a.m. to 9 p.m. every day and who are
there to help patients avoid waiting for the on-call heart specialist to
arrive at the hospital.
The Heart of the Matter
The partnership of cardiovascular specialists was created in March 2013 by the hospitals’ parent, Dignity Health East Valley and local cardiologists led by Roger Bies, MD. Administrators at Dignity Health approached Dr. Bies and other cardiologists about forming an alliance, partly in response to provisions in the Affordable Care Act.
“We are excited about this partnership,” said Tim Bricker, President and CEO of Dignity Health East Valley. “It aligns the incentives of Dignity Health and our cardiovascular physician partners around quality and performance improvement. We see this arrangement as a promising model for integration with physicians in a rapidly changing health care environment, and we anticipate positive outcomes for our patients.”
H2O “is the only provider group in Greater Phoenix that provides in-hospital coverage by attending heart doctors with years of experience to immediately diagnose and treat cardiac patients,” said Dr. Bies, an interventional cardiologist. “All 30 physicians — acknowledged as leaders in their areas of expertise — “have adopted guideline-based ‘best practice’ treatment plans for the spectrum of heart disease that assures consistent high quality and effective care delivery,” he said.
“We’re fortunate to work in an area where we have a great group of physicians who demonstrate a genuine collegial respect and collaborative attitude toward their fellow providers,” Dr. Bies added. “We also recognize the importance of the common challenges we all face with the evolving structure of health care. As care delivery demands push for better outcomes with higher efficiency somehow at a lower cost, we all recognized we could not survive without working as a team to achieve these common goals.”
Heart patients “presenting in an emergency
room in the East Valley are seen by a cardiologist right away,” Dr. Bies
said, “instead of an initial assessment by a physician who doesn’t
specialize in heart disease. We’re already seeing that this saves lives,
spares patients unnecessary testing or admissions, and reduces costs.”
Recognizing the Benefits of Collaboration While Tackling the Challenges
“Creating the H2O eliminated the boundaries between different cardiologists, opening the path to sharing ideas and thoughts about a specific case or patient and thus improving the outcomes in our hospital and community,” said George Nseir, MD, another interventional cardiologist in the Heart Health Organization. “We are currently more open to positive and constructive criticism among ourselves.”
Some of the cardiologists had to be persuaded to join the organization, Dr. Nseir pointed out. “The biggest challenge was convincing solo or small practices to buy into the idea,” he said. “They were fearing initially that being in a big group would eliminate their autonomy and ultimately their group. It took a while to work through the issues and make sure that every individual and every group voice is heard and that they participate actively in the decision making.”
One of the
administrative challenges that many “co-management” arrangements face is
integrating the role of the management company into the fabric of the
traditional medical staff leadership and the clinical staff at the
hospital, explained Mark Kem, a management consultant for the
cardiologists. “The doctors developed a management structure that
includes making sure the various hospital department leads are
represented on committees established by the H20. This has greatly
assisted the doctors in bringing about change.”
The results for patients already have been dramatic. In both hospitals, there are fewer heart re-operations than in the top 10 percent of hospitals nationally. Among heart attack patients, 100 percent are treated within 90 minutes of arrival to an emergency department, the nation’s top benchmark. “Patients treated for heart attacks or heart failure in the two hospitals also have fewer complications and fewer readmissions than in the majority of U.S. hospitals,” Dr. Bies said. In addition, Medicare patients with heart disease experience a shorter length of hospitalization in the two hospitals than in a majority of U.S. hospitals.
And these statistics have led to greater patient satisfaction. The scores of patients who have been treated at Chandler Regional and Mercy Gilbert average 94.5 out of 100, Dr. Bies said. The national benchmark is 92.9.
“We are already outperforming a majority of U.S. hospitals in these areas, and within the next two years, we plan to be better than the top 10 percent in the nation,” Dr. Bies added. “Our need for re-operation after heart surgery is one of the lowest rates in the state and in the country. What is unique about our program is that we have added a number of goals that the doctors thought were important. These include minimizing radiation and kidney problems from imaging tests, reducing unneeded admissions and delays in appropriate care and improving patient satisfaction to an even greater degree.”
“In our group we have the best talents ‘under one roof’
trying to improve the quality of care of patients in a cost-effective
manner,” Dr. Nseir said.
Could this work for other specialties?
Orthopedics may work well with a co-management arrangement, Dr. Bies said, “particularly due to the high patient volume and cost for joint replacements in the baby boomer era. Cancer treatment centers are likely another area where quality and cost can be co-managed effectively. Patients want good care and good value and co-management seems to be an attractive alternative to the less attractive possibility of a national government run health care system.”
Is this the right move for most hospitals?
“H2O has taken a proactive strategy that has already proven itself,” Dr. Bies explained. Hospitals are faced with a daunting task of providing better care and avoiding financial penalties, he said. “It took us three years to create our program, and for many facilities with a less cohesive atmosphere, it may take longer. The clock is ticking as health care promises to remain at the forefront of the national political stage. Most hospitals are already under fiscal pressure with narrow operating margins, and if they don't act soon they may find that a wait-and-see strategy will make them less desirable for prospective insurers and patients.”
Central AZ Heart Specialists 480-899-2020
Roger D Bies, MD
Robert J Hamburg, MD
Suntharo Ly, MD
Rizaldy Villegas, MD
Andrew Cassar, MD
Premier Cardiovascular Center 480-814-0266
Georges Y Nseir, MD
Estela Apolinar, MD
Ashok C Solsi, MD
Lyndon C Xavier, MD
Ziad El Khoury, MD
Valley Heart Associates 480-656-5711
Daniel F Klee, MD
Jon E Stevenson, MD
Gilbert Cardiology 480-786-9100
Gautam Kedia, MD
Zaki Lababidi, MD
Mohammed Hojjati, MD
Cedars Heart Clinic 480-917-5900
Ziad M Elghoul, MD
Bashar Markabawi, MD
Faisal Bahadur, MD
Pioneer Cardiovascular Consultants 480-345-0034
Rajiv M Ashar, MD
Mehul P Shah, MD
Southwest EP Clinic 480-776-6844
Drory Tendler, MD
Huy Phan, MD
Heart Sciences Center 480-612-0400
Nabil Dib, MD
Chandler Cardiology Associates 480-782-0101
Ahtisham Shakoor, MD
Lifeline Internal Medicine 480-219-6840
Abdul Q Memon, MD
Sun State Cardiology 480-821-3800
Jagwinder S Sraow, MD
Heart & Lung Institute, St. Joseph’s 480-728-7564
Marwan Ghazoul, MD
Metro Heart Care 602-776-3464
Michael Kralik, MD
Arizona Advanced Arrhythmias 480-398-3770
Rajdeep Gaitonde, MD
Heart & Rhythm Solutions, LLC 480-289-4550
Himal Shah, MD
East Valley Cardiology 480-899-9430
Robert Dappen, MD