Revenue-Driving Cardio Subspecialties Thriving

Joe Cantlupe, for HealthLeaders Media , August 13, 2013
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By utilizing the clinic, Spectrum has increased its volume of procedures, including afib ablations, which increased from 270 in 2009 to 400 in 2011. Ablation is a procedure used to treat arrhythmias. The type of arrhythmia determines how ablation would be performed. Evaluations of supraventricular tachycardia, a common heart rhythm disturbance where the heart beats faster than it should, increased from 500 in 2009 to 550 in 2011. At Spectrum, other evaluations—such as premature ventricular contractions, a cause of irregular heart rhythms—increased from 25 to 50 from 2009 to 2011.

Patients are seen and evaluated within three days of referral. The clinic also provides a timely response for monitoring mediation therapy and devices.  

"There's a large variety of ways to treat afib," says Gauri. "At least 15% to 20% of procedures can be medically stabilized in a 24-hour observational unit, and that won't count for hospital admissions. In the beginning, there was some pushback about the unit, but now physicians are seeing the value."

Success key No. 4: TAVR program

Although open-heart surgery, also known as surgical aortic valve replacement, has been considered the standard for replacing aortic valves for severe aortic stenosis, some elderly and frail patients with varied complications are physically unable to withstand the procedure.

As a result, more hospitals are trying to fill that gap by providing transcatheter aortic valve replacement, or TAVR, as alternative treatment for aortic stenosis, says Turi, director of the Cooper University Hospital center.

Aortic stenosis and aortic valve disease affects nearly 300,000 Americans, and that is expected to increase significantly over the years, Turi says. "As the population ages, aortic stenosis is going to be more and more prevalent and it will be more of a problem for healthcare," Turi says. With aortic stenosis, "there's wear and tear on the heart valve, like pitchers' arms," he says. "The valve is full of calcium and it creaks open rather than flies open."

With conventional aortic valve replacement, surgeons make an incision in the chest, stop the heart, put the patient on a heart-lung bypass machine, and remove the old valve replacing it with a new one. They then restart the heart and sew up the chest.

With TAVR, the new valve is placed inside the old valve while the heart is still beating and deployed with the aid of a balloon that pushes aside the old valve and allows the new valve to expand into place. The valve is introduced through a puncture in an artery in the leg or through a small incision made in the side of the chest.

People who have symptomatic aortic stenosis have a mortality rate as high as 50% in one year. With TAVR, people who have had previous chest or heart surgeries, severe lung disease, chest radiation, or other serious medical conditions have another chance to live better and longer lives, Turi says.

With TAVR, Turi says, "There's a less invasive procedure and patients tolerate it better. It's much easier on the patient."

Cooper University Hospital is now involved in clinical trials named PARTNER (Placement of Aortic Transcatheter Valve), which evaluated TAVR. According to the findings of PARTNER studies in 2011 and 2012, there was comparable or even favorable quality and efficiencies for the procedure compared to open surgery. In a study known as PARTNER B, survival for patients at one year was significantly higher with TAVR (69.3%) compared to patients who received other therapy (49.3%). The trial included 380 patients in 21 hospitals and academic facilities in the United States, Canada, and Germany.

TAVR patients also had fewer hospitalizations and better symptom relief than did those receiving standard medical care. The University of Colorado Hospital also participated in the PARTNER trials, says John Carroll, MD, director of cardiac interventions at the UCH. TAVR is among the "novel therapies [that] are really transforming [cardiovascular care]," he says.  

Implementing TAVR in hybrid ORs requires a special team approach, says Turi. "Sites that have succeeded need a strong working relationship among multiple disciplines," he says."  

Like the hybrid OR, the solutions hospitals pursue for cardiology subspecialties are apt to be hybrid—known for their adaptability, efficiency, and efficacy in care as the population of patients needing this kind of treatment soars.

Reprint HLR070813-7

This article appears in the July/August issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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