Blog Post

Cardiovascular—integrated in name only?

August 1, 2018

    Cardiovascular programs have spent decades developing strategies to optimize the care for cardiac conditions. Vascular conditions, on the other hand, are often approached as an afterthought.

    Through our conversations with Cardiovascular Roundtable programs and national benchmarking initiatives, we've learned a lot about how truly "integrated" cardiac and vascular programs are today. Here are three key insights:

    1. A moment of self-awareness

    When you consider the market dynamics vascular programs currently face—an increasing patient population, appropriateness scrutiny, and office-based lab competition, to name just a few—one thing is certain: The status quo will no longer be sufficient to ensure programmatic success. Vascular has long taken second place as a cardiovascular service line priority, as programs have worked to ensure that their cardiac services are functioning properly and efficiently.

    When we surveyed CV programs on their service line model, we found that approximately 30% of programs said they have not integrated cardiac and vascular services. This means that more than two-thirds of CV programs told us they have an "integrated" cardiac and vascular service line—but, in conversations with Cardiovascular Roundtable members, we find that even institutions who consider their cardiac and vascular programs "integrated" struggle to truly align these two different and complex specialties.

    However, we know that integration isn't the end-all-be-all to ensure alignment or even success as a program. In fact, some programs we work with have experienced success without full integration. Nonetheless, regardless of their service line model, programs must implement strategies to ensure greater coordination between services moving forward.

    2. Little consensus on vascular leadership

    One strategy to coordinate cardiac and vascular services is through an aligned leadership model. However, currently there is little consensus on what leadership model for vascular services is the right one, which is understandable. There's no one-size-fits-all approach to leadership, and different CV programs have reported success across all the models presented here—be it a dyad model, a triad model, or an administrative leadership role.

    Although programs have found success through a variety of leadership models, adopting a defined approach to vascular leadership can help programs take greater ownership over vascular services. As the data above illustrate, however, many CV programs have yet to fully engage with the vascular side of the business.

    3. Future success demands high-value, aligned vascular care

    There are two pressing reasons why greater coordination between programs is essential. First, vascular procedures are a likely target of future value-based scrutiny. For instance, when MedPAC initially proposed conditions for readmissions penalties, procedures classified under "other vascular," which includes peripheral vascular interventions, were included among them. "Other vascular" is not currently included in the readmissions reduction program, but the fact it was initially proposed indicates that MedPAC may consider it in future proposals.

    Second, coordination is essential because vascular patients are often cardiac patients, and vice-versa. In fact, 63% of patients with peripheral vascular disease have coronary artery disease or cardiovascular disease. A comprehensive value-based model will allow programs address these conditions simultaneously. Without it, programs can experience complete success in preventing adverse outcomes in cardiac care, only to lose a patient to a vascular condition.


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