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INTRODUCTION

To streamline care, improve quality, and reduce inefficiencies, development of disease-specific service lines has often been employed by medical centers and physician groups. Often cited examples of this can be seen with neuroscience centers, wound care, cancer, and other specialties. The concept of developing a multidisciplinary cardiovascular center (CVC) has been around for some time but is not without challenges. The care of the cardiovascular patient is often split between many subspecialties with many of them vying for market share for similar disease processes. Furthermore, parochial silos often hamper productive integration between specialties especially within academic medical centers.

The development of a CVC and in particular the streamlining of care for vascular disease remain a priority for many health systems given the projected growth in the demand for cardiovascular disease-specific service as well as the rapid growth and development of new technologies targeted at vascular disease.

CVCs, like all centers of excellence, bring together a variety of healthcare professionals and in some cases institutions, to provide better value based upon healthcare outcomes and business efficiencies.1

In this chapter, we will discuss not only the management but operational and financial considerations important for institutions and medical groups in forming and operating a successful multidisciplinary CVC.

MANAGEMENT & DEVELOPMENT

The development of a multispecialty CVC by its essence requires the integration and collaboration of multiple groups of physicians focused on the cardiovascular health of the patient. This practice group may include vascular surgeons, cardiologists, vascular medicine physicians, radiologists, and cardiothoracic surgeons all of whom need to seamlessly integrate to provide coordinated, efficient, and quality care. To provide this care requires ensuring access to the “appropriate” specialist at the right time. This in turn needs to be balanced with distribution of care from high volume, central, critical access locations to smaller outreach same day surgery or clinics. Accomplishing this requires among other tasks, efficient patient access, scheduling, minimizing wait times to be seen, reducing no shows, and offering convenient clinic hours.

It is essential that there is a strong leadership team to ensure an effective, integrated CVC that can balance the varying tasks and responsibilities involved with coordinating multiple specialties and providers (Figure 54-1). A “dyad” of a physician leader with an administrator may provide the best value and balance to create an environment of trust and shared values. The leadership team must also integrate several essential skills to provide management oversight finances, daily operations as well as long-term project management and strategic awareness. Most importantly the leadership team must create shared values and goals to achieve buy in from the entire staff and organizational structure. All members must therefore agree upon ideals and be fully invested in the mission of the CVC.

FIGURE 54-1

Management of a cardiovascular center is shown with details of tasks shown under three ...

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