Integrated Cardiovascular Care Private Practice Perspective

Transcription

1 Integrated Cardiovascular Care Private Practice Perspective Florida Hospital Cardiovascular Institute Kevin Accola, M.D., F.A.C.S. CARDIOVASCULAR SURGEONS, P.A. Program Director, Valve Center of Excellence Orlando, Florida

2 Disclosures Edwards Life Sciences Consultant and speakers bureau, Transform FDA trial participant, Mitral Magna Ease 23mm FDA trial participant Cor Matrix study participant / speaker ON-X trial participant / speaker

3 Private Practice Alignment Private practice is not dying.. It is in a very uncertain transition in very uncertain times.

4 Alignment vs. Integration Alignment: Private Practice works jointly with facilities through various arrangements to improve quality and reduce costs by providing services under various designed agreements Integration: Private Practices are acquired by facilities

5 Health Care Delivery Trends Medical Community Culture Prevails - All politics are local. - All health care is local Hospital system strategy to have totally integrated systems works in many communities but not all Culture eats strategy for lunch everyday.

6 Media Attention -Time Magazine Article -60 Minutes Health care costs actually increase as physician groups join hospital systems

7 Trade Association of Independent Practicing Physicians (AID) -Hospital Alignment -Referral support -Legislative actions / education

8 Cardiovascular Surgeons PA years in existence - Nearly 100,000 cardiac cases in data base - Created Cardiac/Thoracic Surgery in Orlando community and Central Florida - Previously 7 surgeons, currently 5

9 Cardiovascular Surgeons, PA Group - 5 Surgeons - 23 employees (FTE) - Each Surgeon functions with a separate team (private scrub & PA) while supporting each other - Services Provided Adult cardiac and thoracic surgery, limited vascular, cardiac transplantation and LVADs, adult congenital, critical care

10 Hospital Alignment Options -Physician Services Agreements - Directorships / Program directors - CV Institute leadership positions - Transplant / LVAD support - Reimbursement for OR nurses -Adult congenital heart assistance and support

11 Alignment Alternatives Professional Services Agreements Emergency Department Call Services Rounding Nurse Services CMS Initiatives and demonstration projects Hospital Based Quality Initiatives / Benchmarks

12 Professional Services Agreements Emergency Department Call Services Trauma Call Hourly on-call fee basis Bill for cases performed Emergency Call Services ( code STEMI ) Hourly on-call fee basis Bill for cases performed Additional payment for meeting quality goals

13 Professional Services Agreements Scrub Nurse Services Hospital pays hourly rate X factor X anesthesia time ( blended equation rate per case ) Payment made for each case CVS provides surgical scrub nurse Basis: Hospital paid for nursing services, CVS providing nurses, thus reducing cost to hospital.

14 Professional Services Agreements Specialty Call Services Pediatric Cardiovascular Call Services: Provide coverage for adult congenital cases; assist pediatric CV surgeon in adult congenital cases Provide daily post operative care Paid daily coverage rate

15 Professional Services Agreements Transplant Services Provide adult heart transplant services Provide back-up and assistance to heart transplant surgeons Paid daily rate for providing CV surgeon and Physician Assistant

16 Medical Directorships Serve in Medical Directorship positions. Paid for services provided as Medical Director Provide OR staff training Attend meetings Represent hospital in various functions Participate in annual budgeting Basis: Hourly rate X set number of hours per year

17 Bundled Payment: CMS Initiatives Work with hospital in pursuit of CMS initiatives There are risks involved, must understand impact to practice and potential referring physicians Financial Hospital responsible for your payment Referrals Referrals will participate, even if unwittingly

18 Bundled Payment: CMS Initiatives Work with hospital in pursuit of CMS initiatives There are risks involved, must understand impact to practice and potential referring physicians

19 tommy thomas slides.

20 Whale eating seals

21 Private Practice Challenges - Attrition / retirement of senior partners - Hiring of young talent - Stark regulations and concerns with hospital affiliations ( legal review and consultation ) - Cannibalization of smaller hospital systems and group practices

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23 Conclusion -Hospital / Private Practice physicians alignments can be successful and a win-win collaboration - Practices must demonstrate value and obtain predetermined benchmarks -Both sides must have transparency and an acceptable level of trust to be successful

24 Florida Hospital Cardiovascular Institute

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