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©2014 The Advisory Board Company • advisory.com
Cardiovascular Roundtable
The Playbook for Optimizing CV Organizational and Leaderships Structures
• Roundtable Toolkit for Managing CV Service Line Structural Change
• Diagnostic for Determining CV Service Line Purview
• CV Service Line RASCI Chart, Froedtert & the Medical College of Wisconsin
• RASCI Starter Kit for the CV Service Line
• CV Clinical Operations Director Job Description, University of Michigan
• Director of Cardiac Services Job Description, Covenant Health
• Physician-Administrator Responsibility Chart, Froedtert & the Medical College of Wisconsin
• President of Heart and Vascular Institute Job Description, Carolinas HealthCare System
• Chief of Adult Cardiology Job Description, Carolinas HealthCare System
• Specialty Medical Director Job Description, Carolinas HealthCare System
• Regional Medical Director Job Description, Carolinas HealthCare System
• Medical Director of Heart Failure Services Job Description, Mercy Hospital Springfield
• Disease Center Business Plan Outline, Mercy Hospital Springfield
• Clinics Manager Job Description, Kander Care System1
• Clinics Director (Multiple Sites) Job Description, Kander Care System1
• Spectrum of Sophistication for Service Line Characteristics
• Spectrum of Sophistication for Program Profiles
CV Specialist Partnerships: Collaborating with Hospitals and Primary Care
• Sample Who/What/When (WWW) Form
• Heart and Vascular Council Charter, Texas Health Resources
• Physician-Hospital Strategic Plan Crossover Update Form, Ervin Health Care1
• CV Physician Practice Performance Metrics Pick List
• Compensation Incentive Metric Selection Diagnostic
• Medical Neighborhood Score Card, Colorado Systems of Care
• CV Complex Case Conference Charter, Kaiser Permanente Southern California Region
• Sample PCP-Specialist Service Agreement, Catholic Health Systems
• Service Agreement Compendium
• Referral Guideline Compendium
• HF Advanced Therapy Risk Assessment Tool, Intermountain Healthcare
Appendix
The New Best-in-Class Cardiovascular Program
1) Pseudonym. Source: Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company • advisory.com
Cardiovascular Roundtable
CV Specialist Partnerships: Collaborating with Hospitals and Primary Care (Cont.)
• High Blood Pressure Management Two-Page Flashcard, Intermountain Healthcare
• High Blood Pressure Management Care Process Guidelines, Intermountain Healthcare
• Heart Failure Care Model, AtlantiCare
• PCP Follow-Up Checklist for HF Patients, Intermountain Healthcare
• Nurse Navigator Job Description, Bon Secours Health System
• Cross-Continuum HF Workflow, Bon Secours Health System
The Guide for Assembling the Accessible CV Network
• Cardiovascular Services Site Audit and Redistribution Guide
• Cardiovascular Consolidation Readiness Self-Assessment
• Cardiovascular Partnership and Affiliation Diagnostic
• Telecardiology Program Opportunity Assessment
• Telecardiology ROI Metric Pick List
• Discussion Guide: The Guide for Assembling the Accessible CV Network
Source: Cardiovascular Roundtable interviews and analysis.
Appendix (Cont.)
The New Best-in-Class Cardiovascular Program
©2013 THE ADVISORY BOARD COMPANY • ADVISORY.COM
Toolkit for Managing CV Service Line Structural Change
Source: Cardiovascular Roundtable interviews and analysis.
Roundtable Toolkit for Managing CV
Service Line Structural Change
Diagnostic: Do We Need to Reorganize?
Benchmarking Report: Comparing
Executive, CV Administrator Views on
Service Line Strategy (Coming Soon)
Discussion Guide: Aligning Executive
and CV Administrator Goals for the
Service Line and Reorganization
Ready-to-Use Slides: Drivers of CV
Service Line Organizational Change
Customizable Workplan: Reorg Design
Team Charter, Timeline
Communication Template: FAQ on
Service Line Change for Staff
Each item available for download at our online
toolkit by clicking here.
©2013 THE ADVISORY BOARD COMPANY • ADVISORY.COM
Diagnostic for Determining CV Service Line Purview
Diagnostic Available Online
Full copy of the Diagnostic for Determining CV Service Line
Purview is available for download by clicking here.
Source: Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 5
Froedtert & The Medical College of Wisconsin
CV Service Line RASCI Chart
Source: Froedtert & The Medical College of Wisconsin, Milwaukee, WI;
Cardiovascular Roundtable interviews and analysis.
Responsibility Chart Roles
Service Line Management Positions
• SLMD: Service Line Medical Director
• Ex Dir / VP: Service Executive Director / VP
• HP: Hospital President
• CHAIR: Physician Department Chairman
• MCP CEO: Medical College Physicians CEO
• CPP Pres: Community Practice Physicians President
• SVPSLD: Senior VP of Service Line Development
• ECMO: Enterprise CMO
• R = Responsible
Carries out the task
• A = Accountable
Liable for ensuring the task is
completed; has veto power
• S = Suppots
Assists R in completing the task
• C = Consulted
Provides guidance R before starting
the task
• I = Informed
Alerted when task is complete
Task Description SLMD Ex
Dir/VP HP CHAIR
MCP
CEO
CPP
Pres
SVP
SLD ECMO
1 Create service line operating budget R R A S C C A S
2 Monitor and report service line profit and loss
performance R R I S I I I S
3 Generate system annual capital budget requests R R A/R C R R C S
4 Create entity level capital budget A A A/R C R R C S
5 Set and monitor service line customer service
goals R R A C C C C A
6 Set and monitor service line quality goals R R A C C C C A
7 Improve and maintain entity level service R R R S R R S A
8 Improve and maintain entity level quality R R R S R R S R
9 Set, monitor, and improve physician engagement S S R R R R S S
10 Set, monitor, and improve staff engagement S S R S R R R S
11 Standardize care pathways across the system R R S S S S S R
Service Line
Leadership
Dyad
Physician Practice
Leadership Triad
©2014 The Advisory Board Company advisory.com 6
Froedtert & The Medical College of Wisconsin
CV Service Line RASCI Chart (Cont.)
Task Description SLMD Ex
Dir/VP HP CHAIR
MCP
CEO
CPP
Pres
SVP
SLD ECMO
12 Set, monitor, and improve service line strategy
and growth across the enterprise R R S S A A A C
13 Set, monitor, and improve referral development
plans R R S S A A A S
14 Formulate and recommend program and service
distribution across the system R R S C A A A I
15 Create workforce planning requests R R S R A A A S
16 Recruit, hire, and terminate physicians C C S R C C C S
17 Set and monitor access metrics R R R S S S S S
18 Attain access goals R R S S S S S S
19 Monitor regulatory compliance R R S I R R S I
20 Create service line marketing plan (MARKETING
IS RESPONSIBLE PARTY) A A S S S S A I
21 Improve philanthropy (DEVELOPMENT IS
RESPONSIBLE PARTY) S S R S S S S I
22 Determine the research agenda and focus R/S R/S S R S S C S
23 Support education mission S S S R S S S S
Service Line
Leadership
Dyad
Physician Practice
Leadership Triad
Source: Froedtert & The Medical College of Wisconsin, Milwaukee, WI;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 7
RASCI Starter Kit for the CV Service Line
Starter Kit Available Online
Full copy of the RASCI Starter Kit for the CV Service Line is
available for download by clicking here.
Source: Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 8
University of Michigan Samuel and Jean Frankel Cardiovascular Center
CV Clinical Operations Director Job Description
Source: The University of Michigan Frankel Cardiovascular Center,
Ann Arbor, MI; Cardiovascular Roundtable interviews and analysis.
Basic Function and Responsibility
Responsible for managing the clinical operations of the Cardiovascular Center including the CVC multi-disciplinary Clinic,
Call Center, Cardiac Surgery Advanced Practice Team, Inpatient Access Team, Circulatory Support (Ventricular Assist
Device) Team, and other clinical operations that may be added by consensus of the CVC Directors; as well as the
Wellness Resource Center, Quality/Lean operational initiatives, clinical efforts and interdisciplinary program development
that results from the strategic planning process, and process improvement while meeting unit of service targets,
preparing and proposing activity, operational and capital budgets and responding to variations in the forecast throughout
the fiscal year.
In addition, the role includes leading and tracking strategic clinical initiatives including market analysis, financial analysis,
understanding our outreach strategies and enhancing referring physician communications and processes, as well as
understanding ACO development within and external to the UMHS.
Responsible for providing leadership and professional expertise and/or services through leveraging the knowledge and
skills of others; manages the administrative and operational objectives of the CVC clinical programs; manages people,
processes and projects to implement the overall strategies and/or achieve the goals of the CVC.
We, the staff and faculty of the U-M Cardiovascular Center (CVC) team, are committed to advancing medicine and
serving humanity through living and teaching our core values of Respect and Compassion; Collaboration; Innovation; and
Commitment to Excellence.
Each CVC employee is expected to understand and demonstrate that in every interaction we represent our entire
organization in the care we provide and in the courtesies we extend to patients, families, and each respective team
member. The CVC is dedicated to partnering with patients and families to deliver the safest and highest quality of health
care. Applicants are expected to review the following PowerPoint presentation which provides an overview of the
Cardiovascular Center’s philosophy and culture: http://www.med.umich.edu/cvc/cvcpotentialteam.pdf
Excellent service is an expected and integral part of the CVC culture. To be considered for this position, a cover letter is
required and should be attached as the first page with your resume. The cover letter should address each of the
following points in about 50 words or less:
Describe your background and qualifications and why you believe you would be a good fit for this position at the CVC.
Outline your service excellence skills and experiences which would be applicable to this position.
In your most recent position, how was service excellence emphasized?
Describe a situation in which a customer or colleague was upset and the steps you took to resolve the issue to a
reasonable conclusion.
Describe your key impressions of the CVC presentation found here: http://www.med.umich.edu/cvc/cvcpotentialteam.pdf
Characteristic Duties and Responsibilities
Leads the clinical programs of the CVC including advising managers and supervisors regarding operational and human
resource issues, processes and continuous improvement efforts.
Makes decisions regarding projects, programs and initiatives that support the objectives established by the CVC
Directors and senior leadership, and /or to ensure compliance with standard protocols and/or theories of a professional
discipline.
©2014 The Advisory Board Company advisory.com 9
University of Michigan Samuel and Jean Frankel Cardiovascular Center
CV Clinical Operations Director Job Description (Cont.)
Participates in and/or leads efforts in enhancing the culture of the CVC including internal work flow and communication;
service excellence among divisions and our end customer; and creating the ideal work environment for faculty and staff
and the ideal patient care experience for our patients.
Participates in and/or leads Patient and Family Centered Care initiatives to promote the CVC as a venue that strives to
create the ideal patient and family care experience to enhance our services for those we serve.
Works with clinical managers and supervisors with regards to human resources management questions, issues and
works to comply with respective employment contracts to assure we are enhancing learning opportunities for staff,
coaching and mentoring and meeting the intent of labor practice.
Manage respective financial accounts to meet forecasting assumptions, provide variance reporting when actual does not
meet projected plans, and provide timely responses in preparing forecasts (operational, activity and capital). Works in
partnership with respective units to develop appropriate unit of service targets and then achieve them.
Provides operational support for the strategic initiatives of the CVC including understanding target markets, clinical
strategies, and how to assess and adjust operations to meet the strategic objectives.
Prepare MQS A3’s in problem resolution, bringing appropriate representation together in problem solving and working
through Lean principles to reach improved communication and understanding of issue to bring to resolution.
Provide written and oral proposals to leadership that clearly identify issues or requests for resources in a manner that is
data driven, logical, and meets the needs of the respective parties, and is cost effective, benchmarked appropriately to
reach a logical, well thought-out conclusion.
The scope of the role can range from assisting managers with advice and leadership with regards to daily operations to
recommending the strategic direction and providing leadership in the operational changes for the CVC overall and
contributing to the overall strategy, direction and vision for several function areas.
Responsible directly or indirectly for the CVC administrative team’s human resources management (hiring, promotion,
salary changes, performance coaching, disciplinary actions, training and development, ensuring consistent application of
organizational policies, etc.)
Incumbent has measurable impact on operational effectiveness, attainment of department/unit objectives, service to
customers and attainment of clinical goals.
Management duties include interviewing, selecting and training of employees; setting and adjusting their rates of pay and
hours of work; planning and directing their work; appraising their productivity and efficiency for the purpose of
recommending promotions or other changes in their status; handling their complaints and grievances and disciplining
them as necessary.
Management responsibilities include the authority to hire, fire, or promote assigned employees or make
recommendations that are given particular weight.
This role has a direct and significant impact on budgeting, controlling costs, planning, scheduling, and procedural
change.
Supervision Received
Direct supervision is received from the Cardiovascular Center Chief Administrative Officer and the Cardiovascular Center
Directors.
Source: The University of Michigan Frankel Cardiovascular Center,
Ann Arbor, MI; Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 10
University of Michigan Samuel and Jean Frankel Cardiovascular Center
CV Clinical Operations Director Job Description (Cont.)
Supervision Exercised
Direct supervision is exercised over CVC clinical managers including the CVC Clinic/Call Center Manager, Inpatient
Access team, Cardiac Surgery Advanced Practice Team Director, Wellness Resource Center, Circulatory Support Team
Manager, and staff engaged in support of these clinical efforts.
Necessary Qualifications
Demonstrated experience of at least 3-5 years in managing clinical operations including one or more of the following
areas: ambulatory care operations, inpatient support team operations, non-invasive testing areas, and/or administrative
support staff.
Master’s degree in a relevant discipline and considerable professional operational experience with reasonable prior
management, supervisory or team leader experience.
Significant experience indicating increasing responsibilities in a clinical venue setting as described above.
Excellent organizational skills in setting priorities and balancing multiple priorities and demonstrated follow through
bringing tasks to closure with acceptable outcomes.
Excellent interpersonal, written and verbal communication skills with an emphasis on customer service especially in
working with departments and services across multiple areas.
Demonstrated experience in planning, coordinating and executing clinical operational work plans, process improvement,
new program development, and/or clinical program proposals.
Ability to work independently with minimal supervision and maximum collaboration in a team environment.
Ability to work with a diverse group of people in a diplomatic and effective manner.
Demonstrated problem solving and conflict resolution skills.
Demonstrated commitment to enhancing work place culture, embracing diversity and a commitment to creating the ideal
work environment for faculty and staff.
Ability to multi-task and work well under time constraints.
In depth knowledge of University policies, rules and regulations, and professional knowledge is required.
Commitment to the CVC Core Values is required.
Desired Qualifications
Demonstrated clinical management experience 10 years or greater.
Demonstrated knowledge of cardiac and/or vascular clinical operations and the understanding of cardiovascular disease
processes, terminology and procedures.
Understanding of the UM CVC faculty and services provided.
Under FLSA, incumbents in this position meet the criteria for exempt status. Source: The University of Michigan Frankel Cardiovascular Center,
Ann Arbor, MI; Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 11
Covenant Health
Director of Cardiac Services Job Description
Source: Covenant Health, Lubbock, TX;
Cardiovascular Roundtable interviews and analysis.
Job Summary
• Under the general direction of the Vice President, is responsible for the quality of service delivered by assigned
area(s). Participates as a member of the hospital's management team in planning, policy formulation, and
administrative decision making with particular reference to the role, functions, and operations of the hospital's cardiac
services. Is responsible for patient care management, resource management, and fiscal management.
Essential Values-Based, Leadership, and Management Competencies: Demonstrates competencies in line with the
four core values that are the foundation of all activities performed by management employees in order to achieve the
Mission of the St. Joseph Health System (see attached list of behavioral definitions):
• Dignity: Demonstrates competence in communication, interpersonal relations and leading courageously.
• Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, teamwork,
motivating and developing others, problem-solving and decision making, displaying financial understanding, managing
daily operations, and demonstrating business / job specific knowledge.
• Service: Demonstrates competence in customer/patient focus, adaptability, and shaping change.
• Justice: Demonstrates competence in community orientation, stewardship, and strategic planning and action.
Essential Functions
1. Responsible for all identified outcome measures as denoted on Performance Assessment.
2. Leads the management team in planning, directing, supervising, and assessing all Cardiac service line activities.
3. Directs the coordination of diagnostic and interventional cardiac services to promote efficiency, continuity of care and
physician satisfaction.
4. Promotes physician satisfaction and referrals by researching and providing state-of-the-art technology while
maintaining fiscal integrity of the institution.
5. Oversees the management of multiple safety issues (radiation and electrical, infection control, physical stress)
relating to staff and patients.
6. Collaborates with Materials Management to negotiate effective contracts and follow-through with sales and service
vendors for Cardiac Services.
7. Facilitates statistical analysis and research methodologies that compare Covenant Heart and Vascular Institute's
processes and outcomes with national and international benchmarks.
8. Responsible for achieving budget target and excellent customer satisfaction.
9. Exercises creative approaches to problem solving. Deals with conflict and problematic situations in an open and
tactful manner respecting the dignity of others.
10. Oversees the tracking process for data related to throughput of the cardiac patients and provides data to the Cardiac
Service Line Committees and VP Cardiac Services to initiate change as appropriate and to improve outcomes.
11. Assists in educating physicians, nursing, ancillary staff, new employees, and community groups on best practices
and cardiac services.
12. Chairs the Chest Pain Center Committee. Serves as resource and hospital spokesperson for Chest Pain Center
locally, as well as in the region or nationally.
13. Works closely with Medical Directors and Emergency Medical Services to assure continuity of care and improved
outcomes for ACS patients, from pre-hospital to hospital. Works closely with quality management personnel to
assure that metrics are in place to show continuous improvement in the care of the ACS patient. Works across
continuum of Cardiac service line to improve quality and patient care.
14. Assures compliance with Joint Commission, Society of Chest Pain Centers, and other pertinent regulatory
requirements
Additional Responsibilities
• Participates and performs other duties as assigned.
©2014 The Advisory Board Company advisory.com 12
Covenant Health
Director of Cardiac Services Job Description (Cont.)
Knowledge./Skills/Abilities
1. Applies principles of organization, theories of management, and human resources management.
2. Develops and implements strategies of management. Actively develops and participates in the financial
management of the organization.
3. Communicates and implements the foundations of health laws to nursing and non-nursing personnel.
Minimum Position Qualifications
• Education: Bachelor's Degree in Business, Health Care Administration or from an accredited School of Professional
Nursing, Radiologic Technology
Preferred Position Qualifications
1. Master's Degree in Business, Finance, Nursing or Health Care Administration or related field from an accredited
college/university.
2. Five years leadership experience in Finance or Healthcare
3. If applicable, possesses current license or temporary permit to practice nursing from the Texas State Board of Nurse
Examiners, or registered as a Radiologic Technologist with American Registry, certified by the Texas Department of
Health.
4. If applicable, specialty certification related to practice.
5. Cath Lab Experience.
Source: Covenant Health, Lubbock, TX;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 13
Froedtert & The Medical College of Wisconsin
Physician-Administrator Responsibility Chart
1) Medical College of Wisconsin.
2) Froedtert & The Medical College of Wisconsin.
3) Focused Professional Practice Evaluation.
4) Ongoing Professional Practice Evaluation.
5) Froedtert Hospital.
6) Institute of Medicine.
7) Medical College Physicians.
Service Line VP Shared MCW1 Service
Line Director
• Recruit and hire Directors
and other leaders
• Assure the competence of
leaders through robust
onboarding, evaluation,
and continuing
development process
• Set department level
standards for clinical care
• Responsible for fiscal and
other resources at
Froedtert Hospital
necessary to achieve
F&MCW2 strategic goals
and patient care outcomes
• Review, at least annually, the effectiveness and efficiency of
services provided for patients throughout the continuum of care
• Develop and implement plans to meet current and future care
needs for patients and families at local, secondary, and tertiary
levels
• Set personal performance goals for organizational leaders that will
achieve the strategic goals
• Assure compliance with behaviors consistent the F&MCW code of
conduct
• Recruit and hire
professional staff
• Assures compliance with
the Medical Staff Bylaws
including FPPE3 and
OPPE4
• Set department level
standards for clinical care
• Responsible for fiscal and
other resources at MCW
necessary to achieve
F&MCW strategic goals
and patient care outcomes
Service Line Director Shared Service Line
Medical Director
• Assume responsibility for
performance of FH5 staff
as committed and
effective members of the
F&MCW service line team
• Provide resources for
planning, budgeting and
performance improvement
• Collaborate with Directors
and Senior Leaders at FH
to recruit and hire strong
individuals to who will lead
the work units and
initiatives to further the
aims of the service line
• Achieve the mission
through excellent
interdisciplinary patient
care, teaching and
research
• Direct development and growth of the service line:
– Developing strategic plans
– Beacon programs
– Developing and coordinating on and off campus programs
• Determine faculty recruitment priorities
• Direct service line operations to coordinate care over the continuum
• Apply evidence based practices
• Determine and measure annual performance improvement goals
• Benchmark performance against 6 aims (IOM6)
• Manage operating and capital budgets for the service line
• Enhance profitability through efficiency and service
• Assure compliance with behaviors consistent the F&MCW code of
conduct
• Assume responsibility for
MCW (professional) staff
• Provide MCW resources
for planning, budgeting
and performance
improvement
• Ensure that MCW staff are
committed and effective
members of teams and
actively participate to
achieve the goals set
by/for the service line
• Collaborate with Chairs
and MCP7 to effectively
and efficiently deploy
physician and mid-level
providers throughout the
continuum of care
• Achieve the academic
mission through excellent
interdisciplinary patient
care, teaching and
research
Source: Froedtert & The Medical College of Wisconsin, Milwaukee, WI;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 14
Froedtert & The Medical College of Wisconsin
Physician-Administrator Responsibility Chart (Cont.)
8) National Patient Safety Goals.
Director Shared Senior Medical Director
• Recruit and hire managers
and other leaders for the
hospital, clinics and
outpatient service areas
• Assures the competence
of managers and other
leaders through a robust
onboarding, continuing
development and
evaluation process
• Plan and implement
staffing models that will
meet unique needs of
patients throughout the
continuum of care
• Provide a structure for the
development,
dissemination and
review/evaluation of
standards of practice
• Evaluate the effectiveness
of services provided in the
department or service
area
• Assure compliance with the F&MCW Policies and Procedures
• Assure a consistent and efficient delivery of services which support
patient care
• Ensures timely access to clinical service
• Standardize policies and procedures across function to promote
quality outcomes and efficient services
• Ensure a safe environment and clinical care through compliance
with the NPSGs and the safety program:
– Monitor adverse and other events to identify trends and
determine corrective actions
• Be a liaison and resource to medical center and clinical
departments and service lines
• Develop priorities and tactics to achieve F&MCW strategic goals:
– Prioritize improvement initiatives
– Ensure plans which are reliable and actionable to achieve
goals
– Collaborate with process teams and service lines to
coordinate care and services for efficiency and consistency
– Evaluate the outcomes of patient care and services at least
quarterly
• Be a liaison and resource to medical center and clinical
departments and service lines
• Develop annual operating and capital budgets
• Participate in F&MCW committees or teams
• Promote activities which will enhance patient satisfaction and
provider and staff engagement
• Assure compliance with behaviors consistent with the F&MCW
code of conduct
• Ensures appropriate
Medical staffing
• Provide input to chair on
recruitment of medical
staff
• Approve criteria for clinical
privileges
• Ensure program of
surveillance of
professional performance
and intervenes when
necessary
• Ensure a program of
ongoing professional
development for medical
staff
Source: Froedtert & The Medical College of Wisconsin, Milwaukee, WI;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 15
Froedtert & The Medical College of Wisconsin
Physician-Administrator Responsibility Chart (Cont.)
Manager Shared Medical Director
• Recruit and hire clinical
and other staff for the unit,
clinic, or outpatient service
area
• Assure the competence of
staff through a robust
orientation, onboarding,
continuing development
and evaluation process
• Determine new skills
necessary to meet the
needs of patient
populations served and
implements plans for staff
to acquire them
• Collaborate with other
managers and service line
directors to coordinate
services for consistency
and efficiency
• Attend faculty meetings
• Ensure efficient and effective delivery of patient care:
– Promote timely access
– Monitor effectiveness
– Ensure patient safety; coordinate care to prevent adverse
events or conditions
• Manage daily operations for the assigned unit/area
• Implement plans to achieve strategic priorities:
– Improvement initiatives
– Department or area specific goals
– Collaborate with process teams and service lines for
efficiency and coordination of care
• Participate in the quality program to improve care and services in
the assigned unit/area
• Ensure that the standards of practice are followed
• Review and revise policies and procedures to be consistent with
current evidence and regulatory standards
• Be a support and resource to medical center and clinical
departments and service lines
• Manage the fiscal and other resources to meet the budget targets
• Assure compliance with behaviors consistent the F&MCW code of
conduct
• Manage all medical staff
functions:
– Ensure daily staffing
– Interview, select, and
orient medical staff
– Perform surveillance
of professional
development for
medical staff
• Implement Medical Staff
quality improvement plan
• Conduct faculty meetings
• Attend FH staff meetings
for assigned area
Source: Froedtert & The Medical College of Wisconsin, Milwaukee, WI;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 16
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Heart and Vascular Institute President Job Description
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
Purpose and Scope of the SHVI President
The Sanger Heart and Vascular Institute (SHVI) President – with assistance from SHVI Vice President (VP), Clinic
Operations; and SHVI VP, Hospital Operations – will be charged with providing overall direction; goal setting; and input to
key strategic, clinical, and operational issues facing SHVI. Responsibilities and qualifications of the SHVI President are
described in the following sections:
Responsibilities and Duties
The SHVI President will perform the following duties:
A. Provide Vision, Leadership, Organization, and Direction to SHVI
• Be held accountable for all financial, operational, and clinical aspects of SHVI.
• Foster a culture of collaboration and teamwork, with a dedication to patient care and quality outcomes.
• Lead the development of new clinical programs and the establishment of service line strategy and goals.
• Manage physician relationships and enforce SHVI policies and guidelines among physicians.
• Lead quality initiatives, including the measurement and monitoring of key metrics, and the development of
standardized protocols and policies.
• Monitor and assess key SHVI performance metrics.
B. Serve as Chairman of the SHVI Strategy Council & Chief’s Council
• Facilitate coordination and partnership with Carolinas HealthCare System (CHS) and Carolinas Healthcare
System Medical Group (CHS MG) leaders to achieve SHVI goals.
• Ensure that appropriate resources and/or materials are available to support development of strategy.
• Develop meeting agendas based on input from key stakeholders.
• Lead meeting discussions, as appropriate, and ensure that proto-cols are adhered to.
• Implement select strategies as charged by the Chief’s Council.
• Work with individual Strategy Council members, as needed, to build support and consensus for major
initiatives.
• Ensure that duties delegated by the Chief’s Council to other SHVI members (e.g., physicians, medical
directors, management) are fulfilled.
– Monitor progress between meetings.
– Obtain status updates as needed.
– Provide periodic updates to the Chief’s Council between meetings.
– Identify resource gaps or delays in the planning process and notify the Chief’s Council.
Time Commitment
The position requires at least a 0.5 FTE commitment.
Knowledge and Abilities
This position requires a physician with strong clinical and administrative experience. The SHVI President will need to
possess the following professional and personal attributes in order to successfully execute the roles and responsibilities
of this position:
• Demonstrated distinction within the medical community, known within his/her specialty for clinical excellence.
• Visionary leader who will encourage service line esprit de corps and excitement by his/her strategic vision,
charisma, and sense of leadership.
©2014 The Advisory Board Company advisory.com 17
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Heart and Vascular Institute President Job Description (Cont.)
• Knowledge and understanding of hospital operations and financial management principles.
• Evidence of the leadership, business acumen, management, and financial skills necessary to manage the
service line.
• Ability to plan and delegate assignments, review work, and super-vise.
• Management style that emphasizes communication, collegiality, flexibility, and the ability to work with a
diverse, highly qualified medical staff.
• Highly accomplished in interpersonal diplomacy and able to estab-ish and maintain effective working
relationships with physicians and hospital administration.
Educational Requirements
The SHVI President must be licensed or qualified for licensure to practice medicine in the state of North Carolina and be
board-certified in a cardiovascular-related specialty. Coursework in business management is encouraged.
Work Experience Requirements
The SHVI President should be a practicing physician in the community. He/she must have management experience and
possess extensive leadership experience. Demonstrated familiarity with clinic and hospital finances is a necessity.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 18
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Chief of Adult Cardiology Job Description
Purpose and Scope of the SHVI President
The SHVI Chief, Cardiology (“Chief”) represents the collective interests of the SHVI Adult Cardiologists. In collaboration
with the Chair, SHVI Regional Operations Committee the Chief is responsible for assessing and making
recommendations to SHVI Administration regarding the clinical and business environments of SHVI Adult Cardiology,
and assisting management in the effective deployment and staffing of physician manpower. The Chief is a member of
the SHVI Metro Committee.
Responsibilities and Duties
1. Collaborate with the Chair, SHVI Regional Operations Committee and recommends to SHVI Administration a
sufficient number of qualified and competent physicians and care providers to provide clinical services.
2. Works with the Hospital Based Medical Directors in quantifying and planning for adequate ancillary staffing and
other resources relative to their areas of responsibility.
3. Facilitates the integration of the SHVI MDs into the primary functions of SHVI relative to Metro hospitals, and
collaborates with the Chair, Regional Operations Committee for the same into Regional hospitals.
4. Ensures SHVI physician are aware of SHVI strategic plans, and facilitates implementation of those plans.
5. Works with SHVI physicians, management, and leadership in assuring successful operational performance relative
to annual goals, strategic plans, and overall financial success.
6. Assists with the coordination and integration of interdepartmental and intradepartmental services.
7. In collaboration with the SHVI physician scheduler for MCP, directs scheduling activities to achieve efficient,
appropriate, and adequate physician coverage of Metro responsibilities. Collaborates with the Chair, Regional
Operations Committee to ensure efficient, appropriate, and adequate staffing within the Regional Division.
8. Appoints the Medical Director of the Dickson Heart Unit and Leader of the Chest Pain Evaluation Center, along
with assisting in the appointments of other SHVI Medical Directors.
9. Makes recommendations to SHVI management in matters affecting patient care, including personnel, space, and
other resources, supplies, special regulations, standing orders, and techniques.
10. Assists in interviewing physician and administrative applicants seeking employment with SHVI, and provides input
into the hiring decision.
11. In collaboration with the Chair, Regional Operations Committee is responsible for the development and
implementation of policies and procedures that guide and support the provision of clinical services.
12. Assist SHVI Management in the preparation of reports and budget planning as required by SHVI Leadership.
Requirements and Terms
1. The Chief shall be elected by majority vote of the SHVI Adult Cardiologists. The term of office of a chief shall be
for a period of three (3) years.
2. Removal of a Chief during a term of office may be initiated by a two-thirds (2/3) vote of the SHVI Adult
Cardiologists, for failure of the Chief to perform the duties of the position held, for conduct detrimental to the
interests of SHVI, for a physical or mental infirmity that renders the individual incapable of fulfilling the duties of the
position, or if guilty of such other neglect as SHVI may judge as justifying removal.
3. To be eligible to serve in the role of Chief, the following must be met:
a. Partner Status within SHVI;
b. Metro based;
c. Adult Cardiologist;
d. Must possess a minimum of five (5) years tenure with SHVI. Tenure acquired as a member of a group
integrated into SHVI will apply.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 19
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Specialty Medical Director Job Description
Purpose and Scope
The Medical Director of SPECIALTY is responsible for the overall quality, safety, and efficiencies of the SHVI
SPECIALTY Services owned or operated by CHS. The Medical Director is responsible for MD communications,
maintaining performance standards, patient safety, and operational policy. Assures the timely completion of medical
records. Is responsible for MD behavior, MD satisfaction, and patient service.
Responsibilities and Duties
The SHVI Medical Director of SPECIALTY is responsible for the following:
A. Performance Standards, Operational Policy, and Efficiencies:
• In association with the SHVI Vice President, Hospital Operations is responsible for Lab and User
performance metrics, quality data, and operational policy.
• Promotes compliance with the rules, regulations and standards promulgated by JCAHO, the North Carolina
Department of Health and the conditions of participation under CMS.
• Assures compliance with performance standards that measure physician satisfaction, patient satisfaction,
clinical competence and billing and coding audits.
• Participates in the development and review of policies and procedures governing delivery of SPECIALTY.
• Ensures Patient and Physician satisfaction meets or exceeds established targets.
• Assures adequate, proper and timely medical records with respect to all patients examined or treated by
SHVI for SPECIALTY.
• Identifies opportunities to reduce cost and improve efficiencies through product standardization where
applicable, process improvement, utilization review, and reductions in length of stay.
• Reviewing clinical / cost performance of SPECIALTY and recommends actions for improvement as
necessary.
B. Strategy Development, Communications, and Implementation
• Assist in the strategic development, communications, and deployment of new clinical programs and
practices, including an Integrated Delivery Model for SPECIALTY within CHS.
• Consults and coordinates services with the SHVI VP, Hospital Operations and the SHVI VP & Medical
Director, Metro Operations.
• Acts as a liaison to members of SHVI and other Medical Staff to en-courage the proper and appropriate use
of SPECIALTY.
• Physician shall consult with members of the Medical Staff of CHS as requested or required by situation or
directives of SHVI.
• Assists SHVI Administration with the design, implementation, and coordination of resources to ensure
efficient and effective processes.
• Chair or serve on SHVI, CPN, or CHS committees.
C. Leadership
• Serves in a Leadership role with all organized SPECIALTY MD communications, meetings, and initiatives.
Responsible for MD behavior, MD compliance with expectations, and ensuring appropriate and constructive
MD communications in the Lab.
• Provides professional review as needed for SPECIALTY pro-vided to patients at any CHS owned Hospital.
• Participates regularly in designated meetings of SHVI and the various CHS Hospitals, or as requested by
SHVI Administration.
• Provides leadership in upholding MD compliance to vendor con-tracts.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 20
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Specialty Medical Director Job Description (Cont.)
• Identifies MD conflicts, to include behavior and non-compliance, and ensures their resolution.
• In collaboration with the members of the SPECIALTY team, develops, implements policies and procedures to
facilitate the adoption of evidence-based medicine (EBM) and / or practice-based standards.
• Plan and implement new clinical programs as directed by the Executive Committee, SHVI Executive
Director, or SHVI President.
D. Quality
• Advises SHVI Administration, Hospital Presidents, and the Chair, SHVI Quality Committee concerning the
adequacy, scope, availability and quality of SPECIALTY.
• Recommends changes / improvements to existing technologies, practices, techniques, and equipment,
which will impact overall quality of care provided to patients.
• Encourages and identifies professional development opportunities for SPECIALTY physicians and staff.
• Participates in committee work and attends meetings dealing with SPECIALTY, including, but not limited to,
morbidity and mortality conferences, department conferences, meetings with vendors, and local, state and
national meetings, as requested by SHVI Administration.
• Responsible for Patient Satisfaction scores as relates to areas of responsibility.
• Responsible for Referring Physician Satisfaction scores in the areas of responsibility
• Shares accountability for SHVI financial performance.
Knowledge and Abilities
This position requires a physician with clinical and leadership skills. The SHVI Medial Director of SPECIALTY will need
to possess the following professional and personal attributes in order to successfully execute the roles and
responsibilities of this position:
• Known and respected within his/her specialty for clinical excellence.
• Knowledge in EBM and technological advances in SPECIALTY.
• Ability to plan and delegate assignments, review work, and super-vise other physicians.
• Leadership style that emphasizes communication, collegiality, flexibility, and the ability to work with a
diverse, highly qualified medical staff.
• Ability to establish and maintain effective working relationships with physicians and administration.
Educational Requirements
The SHVI Medical Director of SPECIALTY must be licensed or qualified for licensure to practice medicine in the state of
North Carolina and be board-certified in SPECIALTY.
Performance Metrics
Goals and objectives for the Medical Director and the team he is assigned to lead will be developed annually and tracked
no less than quarterly. These will be built to address the CHS system goals along the lines of the following outline:
1. Service Excellence
a. To exceed established Patient Satisfaction targets as measured by PRC appropriate for each team
(80%tile). Add or replace with ambulatory (Press Gainey) scores if applicable.
2. Growth
a. Increase Market Share (lagging) by focusing on increased Year over Year (YoY) encounter volume
(leading) across SHVI
b. Increase Net Revenue
c. Expand the scope of services to complete the continuum of care within the product line as
warranted
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 21
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Specialty Medical Director Job Description (Cont.)
3. Performance Excellence
a. Increase contribution margin as a % of net revenue
b. Reduce per case variable cost (e.g. labor and supplies),
c. Improve utilization/efficiency of resources
4. Quality
a. Achieve Top quartile performance for mortality and morbidity as measured and available from
external sources (STS, ACC, etc)
b. Where externally published benchmarks are not available => Improve YoY outcomes for mortality
and morbidity
c. Exceed CHS targets for appropriate care measures
d. Reduce risk adjusted ALOS
5. Employee Engagement
a. Exceed CHS targets for MD and EE Satisfaction Survey’s
6. Community Benefit
a. Support CHS goals by exceeding goal for Community Benefit Campaign
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 22
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Regional Medical Director Job Description
Job Summary
The Medical Director – REGION is responsible for providing physician leadership in areas of Customer Experience,
Growth, Office Performance, Communications, Physician and Hospital Relationships, Community Engagement, Quality,
and Physician Coverage for SHVI in the REGION. As a physician leader in an integrated healthcare delivery system, the
SHVI Medical Director assists with development and implementation of systems of care; recognizing best practices for
delivery of office and community based care and those requiring tertiary / quaternary care. Works in collaboration with
the Chair, Regional Operations and SHVI Clinic Director.
Essential Responsibilities
A. Leadership:
• Serves as primary point of information and contact for SHVI Administration in the REGION; to include all
designated SHVI sites and designated hospitals.
• Serves on the SHVI Regional Operations Committee.
• Meets periodically with Physicians, Practice Managers, Clinic Director, and hospital leadership.
• In collaboration with the Clinic Director and VP Clinic Operations, assists in defining and implementing action
plans for realization of SHVI Regional strategy.
• Acts as spokesperson and Leader for SHVI in the REGION.
• Responsible in addressing clinical and physician behavioral issues, including those associated with specialty
clinics, up to and including recommendations for Performance Committee review.
• Facilitates collaborative relationships between the SHVI MDs that create perception and functionality of a
Regional Business Unit.
• In collaboration with the Clinic Director and Practice Mangers, establishes an “on-boarding” process for new
SHVI MDs in the REGION including specialty clinics.
• As designated or appropriate, establishes routine and effective relationships with hospital leadership, offering
physician leadership and services as needed or required. These services may include collaboration with
Metro Committee Medical Directors in the application of Cardiovascular Expertise in the REGION.
B. Management, Growth, and Performance
• In coordination with the Clinic Director, establishes goals for individual office performance, and performance
of the REGION. These may include productivity, finance, budget performance, outreach, and other metrics.
• Monitors performance dashboards for the REGION, and works with the Clinic Director to establish action
plans for all areas noted to be deficient.
• Ensures MD staffing and call coverage for all areas of responsibility. Empowered to direct staffing,
coverage, and resources as situations and performance direct.
• Leads the development and nurturing of relationships with referral MDs, hospital administrators, and other
sources within the Region.
• Maintains awareness of Eastern market dynamics and communicates changes and opportunities to the
Chair, Regional Operations and SHVI Administration.
C. Community Engagement/Growth
• Working with CHS Marketing and SHVI Marketing and Physician Liaisons, identifies and acts upon
opportunities in the local communities of the REGION to promote SHVI and CHS, integrate SHVI into the
community, and provide overall community benefit.
• Actively identifies referral source opportunities for SHVI, CPN, and CHS within the REGION, and in
cooperation with CHS Marketing and SHVI Marketing and Physician Liaisons, develops action plans to
promote referrals and growth for SHVI and CHS in the REGION.
• Identifies opportunities for SHVI to develop relationships in the local community and participate as a good
corporate citizen in that community.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 23
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Regional Medical Director Job Description (Cont.)
D. Service and Customer Experience
• In collaboration with the Clinic Director, creates a culture of behavior within all SHVI offices that focuses on
customer service and service responsiveness.
• In collaboration with the Clinic Director, ensures all SHVI processes focus on a positive customer
experience.
• Ensures that the Clinic Director and Office Management quickly and assertively address and correct any
situations that do not adhere to a customer service oriented environment.
• Ensures all SHVI MDs and staff are educated on the results of patient, employee, and MD satisfaction
surveys.
• Working with SHVI MDs and practice managers, develops systems for SHVI that actively promote patient
satisfaction with SHVI physicians and staff.
• Monitors patient satisfaction for all SHVI offices in the Region, working with the Clinic Director to develop
action plans as indicated
• Ensures SHVI clinic MDs and staff understand and apply principles of Customer Service.
Appointment and Term
SHVI Administration shall appoint this position. The term of this position shall be for a period of three (3) years, with not
more than two consecutive terms.
Knowledge and Abilities
This position requires a physician with strong clinical and leadership skills. The SHVI Regional Medical Director should
possess the following personal and professional attributes in order to successfully execute the roles and responsibilities
of this position:
• Ability to plan and delegate assignments, review work, and supervise other physicians.
• Management style that emphasizes communication, collegiality, flexibility, and the ability to work with a
diverse, highly qualified medical staff.
• Ability to establish and maintain effective working relationships with physicians and administrators.
• Ability to maintain and display a positive perspective in all interactions.
Requirements
• Licensed or qualified for licensure to practice medicine in the state of North Carolina.
• Board-certified in a cardiovascular-related specialty.
• Regional Based (Except for East / Central Region).
• Partner Status is preferred.
• Previous management experience is encouraged.
Hospital Based Responsibilities & Annual Time Commitment
• Meets quarterly with CMC REGIONAL HOSPITAL Administration to discuss quality, patient care, and other
areas of clinical interest: 8 hours in total
• Assists CMC REGIONAL HOSPITAL with development, delivery, and monitoring of CV care relative to ED,
Hospitalists, and SHVI: 24 hours in total.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 24
Mercy Hospital Springfield
Medical Director of Heart Failure Services Job Description
Source: Mercy Hospital, Springfield, MO;
Cardiovascular Roundtable interviews and analysis.
The Heart Failure Services shall function under the direction of a physician with admitting privileges to our Institution.
The physician shall have an expressed interest and expertise in the field of heart failure and the diagnosis and treatment
of cardiovascular disease. During periods of absence, these functions shall be delegated to an individual with the
appropriate qualifications. The duties are listed below:
Physician and Provider Leadership/Liaison: Medical Staff Involvement
• Serve as Medical Director of the Heart Failure Center.
• Oversee all clinical/medical aspects of heart failure diagnostic, therapeutic, and interpretation functions.
• Function as a liaison for all Medical Staff issues related to the care and treatment of heart failure (privileging &
credentialing, diagnosis and treatment).
• Participate in planning and improving any required documentation functions (order entry and results reporting),
including optimization of the EMR to improve communications related to patient care and procedure reimbursement.
• Provide coordination oversight of all aspects of medical care on the “continuum of patient care” related to the diagnosis
and treatment of heart failure disorders.
• Provide support and education for physicians on issues related to appropriate procedure ordering, direct medical
patient care, and patient care documentation matters.
• Provide consultation service for medical staff physicians, professional/technical personnel, nursing staff, and mid-level
providers.
• Participate in relevant M&M Committees related to the Heart Failure Center and VAD Center.
Administrative & Financial Performance
• Provide physician leadership for device and operational supply chain purchase recommendation(s). Participate in
creating an acquisition strategy for significant items (devices, catheters, etc.). Provide strategic input and planning
support for System programs.
• Assist in creating and reviewing supply item utilization guidelines; review performance to benchmark and provide
intercession as deemed appropriate.
• Offer recommendation and medical support for patient documentation and coding, as they relate to heart failure
services.
• Create standardized, disease-oriented, patient care approaches to the diagnosis, treatment, and maintenance of patient
with heart failure; (i.e., best practices protocols, guidelines, care paths, and treatment algorithms). Work closely with
administrative management to implement approaches and assure high levels of utilization.
• Assist in the marketing and promotion of heart failure services; participate in outreach activities and functions significant
to business expansion and program growth.
• Work closely with appropriate administrative work teams to optimize the use of EPIC as an IS tool; to include functions
such as procedure order entry, process flow, documentation structure and access, procedure scheduling, and results
reporting.
Operations Assistance
• Assist with development of the policies and procedures governing the medical aspects of heart failure services, and
update same on a regular basis (i.e, access to services, appropriateness criteria, etc.).
• Responsible for all medical functions of the heart failure services on behalf of the Institution.
• Responsible for medical oversight of infection control measures in the heart failure and VAD initiatives, in conjunction
with the Hospital nurse epidemiologist and the Infection Control Department.
• Participate in developing and deploying orientation and continuing education programs on behalf of Heart Failure
Hospital & Clinic personnel, including nursing & allied support personnel and the medical staff, on an as-needed basis.
• Perform ascribed functions of Medical Director as defined by Joint Commission Standards and/or requested by the
Hospital Medical Staff organization.
• Working with the personnel responsible for technical program leadership, create program goals and objectives, and
facilitate execution of activities to attain said goals and objectives.
• Provides input and comment, as requested, on staffing issues in areas associated with heart failure initiatives.
©2014 The Advisory Board Company advisory.com 25
Mercy Hospital Springfield
Medical Director of Heart Failure Services Job Description
(Cont.)
Quality Assurance & Performance Improvement
• Participate in the ongoing development of criteria and metrics for continuous quality improvement, in both the clinical and
operational arenas of the heart failure initiative(s).
• Provide periodic rounding of selected heart failure patients and follow-up with appropriate nursing personnel and/or
medical staff, on an as-needed basis.
• Provide general oversight of nursing care delivery systems, as they pertain to heart failure disorders.
• Assist with periodic monitoring and review of quality indicators (clinical and operational) related to heart failure.
• Working with the personnel responsible for technical program leadership, monitor quality of operational performance and
offer comment on improvement of same.
• Provide oversight of specific quality measures, as they relate to the Heart Failure Center and VAD Center services:
including (but not limited to) heart failure CORE Measures.
Capital and Operational Resource Planning & Acquisition:
• Working with the personnel responsible for technical program leadership, perform periodic technology review and
resource planning & acquisition functions aimed at maintaining and improving the quality of patient care.
• On behalf of the Heart Failure Center, act as Medical Staff advocate/liaison for matters related to capital and operating
resource planning and acquisition.
• Engage in capital planning and selection processes to assure appropriate access to Hospital and Clinic heart failure
resources that are required for quality patient care. Work within system capital constraints to optimize departmental
operations despite these limitations.
• Working with Department personnel that are responsible for technical leadership, review and comment on financial
matters directly related to the overall operation of the Heart Failure Center (including annual budget and long-term
capital planning matters).
Community Service
• As a public service, offer informative lectures and supporting materials on heart failure to community groups and other
interested parties.
• Provide education and case demonstration services, on an as-needed basis.
• Provide physician content expert support services for inquiries related to heart failure procedures.
Source: Mercy Hospital, Springfield, MO;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 26
Mercy Hospital Springfield
Disease Center Business Plan Outline
Electrophysiology Business Development, Cardiovascular Services
1. Executive Overview
2. Background
a. Leadership/Strategic Direction
b. Service Offering
c. Resource Assessment
d. Operational Issues
e. Program Quality Assessment
f. Other
3. Strategy for Business Growth & Development
a. Goals & Objectives
b. Program Strengths & Weaknesses/Opportunities & Threats (SWOT)
c. Patient Referral Sources
d. Detailed Strategy
e. Key Success Factors
f. Long-term Program Benefits
g. Monitoring Progress/Program Quality Indicators
h. Other
4. Marketing Plan
a. Marketing Overview
b. Resources Requirements
• Capital
• Space Planning
• Supplies & other resources
• Personnel
• Other
c. Advertising Recommendations
d. Patient Access & Scheduling
e. Feedback Systems- Advertising Assessment (ROI)
f. Other
5. Operations Planning
6. Other Significant Issues
a. Research
b. Teaching
c. Key Support Areas
d. Partnerships/Contractual Relationships
e. Other
7. Financial Projections
a. Historical Performance
• Volumes
• Finances
• Budget
• Other
b. Pro-Forma Financial & Budget Estimates
c. Return on Investment (ROI) Indicators
d. Other
8. Conclusion
Source: Mercy Hospital, Springfield, MO;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 27
Kander Care System
Clinics Manager Job Description
Summary: Responsible for managing a site on a day to day basis to include, but not limited to, front desk reception and
scheduling, nursing functions and overall management responsibilities. Functions as the primary liaison between patients,
staff and clinicians. Ensures efficient patient flow, efficient business operations, appropriate staffing, compliance, and
attainment of financial targets.
Responsibilities:
1. Coordinates the daily operations of a site. Initiates recommendations and follow-up actions to respond to identified
problems. This includes staff and provider staffing, scheduling and productivity. This also includes supply ordering or
delegating appropriately.
2. Utilizes the frontline management system on a daily basis. In charge of daily process management on an hour-by-hour
basis. Utilizes lean principles for improving processes. Partners with site Leadership to implement, support, and cascade
all improvement efforts. Meets/exceeds site performance metric targets. Accomplishes departmental goals relative to
patient satisfaction, revenue cycle, provider productivity, payor mix and volumes.
3. Rounds with patients to ensure optimal patient experience. Responsible for leading service recovery efforts.
Continuously keeps the patient in the forefront for improvement related activities. Coordinates patient committees or
patient outreach activities.
4. Responsible for the recruitment, screening, interviewing, and selection of frontline employees for assigned area.
Conducts employee rounding, annual performance evaluations, coaching, and performance management. Partners with
system resources to ensure staff are clinically competent. Ensures employees are orientated to the organization, business
unit, site and position. Ensures a respectful and healthy work environment for a diverse work force.
5. Responsible for regulatory quality assurance. Audits on a regular basis to ensure clinic is meeting standards. Complies
with standards and requirements of all accrediting, licensing and governmental agencies pertaining to the area of
operational responsibility.
6. Responsible for providing superior leadership and excellent communication skills while demonstrating professional
examples for staff to follow.
7. Human Resources Management: Manages department's human resources ensuring proper utilization of human
resources and positive employee relations. Sets performance standards, reviews performance, provides coaching,
feedback and recognition on job performance on an ongoing and timely basis. Drives employee selection and ensures
employees are orientated to the organization, business unit and position.
8. Budget Management: Prepares/assists in the annual budget and monitors budget for monthly variances. Identifies,
recommends and implements changes that will improve productivity and/or financial performance.
Education: Bachelor's degree in Business Administration, Healthcare Administration, or related field or equivalent
combination of experience and education required.
Experience: Three years of experience in a related health care field or medical management with clinic experience
required. Two years progressive management experience preferred.
Competencies: Frontline Leader Competencies. Also: Problem Solving, Critical Thinking, Team/Relationship Management,
Decision Making, Medical Staff Relations, Conflict Resolution
1) Pseudonym. Source: Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 28
Kander Care System
Clinics Director (Multiple Sites) Job Description
Summary: Responsible for the oversight of operations for multiple sites. Manages both short-term issues and problems
and long-term strategic objectives and tactics that will ensure the continuing growth and success of operations for
assigned areas. Supports the value stream work and cascades it to actionable frontline improvements.
Responsibilities:
1. Supports daily operations for multiple sites. Leads improvement efforts and ensures that staff and clinicians are
supported and held accountable through consistent expectations. Acts as a liaison between site leadership and system
resources/partnerships.
2. Supports the frontline management system by coaching, conducting gemba walks, and rounding on employees for
continuous improvement efforts. Partners and leads improvement related activities through the business unit entity. Leader
of pillar, A3s and/or kaizen events.
3. Acts as a subject matter expert in patient satisfaction data. Understands key drivers and initiates action plans to
continuously improve the patient experience. Articulates and leads changes to align system efforts across key drivers.
4. Responsible for the recruitment, screening, interviewing, and selection of Manager Ambulatory-Site employees for
assigned areas. Conducts employee rounding, annual performance evaluations, coaching, and performance management.
Partners with system resources to ensure staff are competent. Ensures employees are orientated to the organization,
business unit, site and position. Ensures a respectful and healthy work environment for a diverse work force.
5. Acts as a subject matter expert for quality and regulatory standards. Has the ability to articulate the standards into daily
practices, operations, and process improvement efforts as needed.
6. Develops frontline leaders through exhibiting superior leadership and excellent communication skills while
demonstrating professional examples for all to follow.
7. Human Resources Management: Manages department's human resources ensuring proper utilization of human
resources and positive employee relations. Sets performance standards, reviews performance, provides coaching,
feedback and recognition on job performance on an ongoing and timely basis. Drives employee selection and ensures
employees are orientated to the organization, business unit and position.
8. Budget Management: Prepares/assists in the annual budget and monitors budget for monthly variances. Identifies,
recommends and implements changes that will improve productivity and/or financial performance.
Education: Bachelor's degree in Business Administration, Healthcare Administration, or related field or equivalent
combination of experience and education required. Master’s degree preferred.
Experience: Three years of management in a health care related field or medical management with clinic experience. Two
years of progressive management experience required.
Competencies: Manager of Manager Competencies. Also: Change Management, Coaching, Decision Making, Lean
Consulting, Analytical Thinking, Systems Thinking
1) Pseudonym. Source: Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 29
Spectrum of Sophistication for Service Line Characteristics
Source: Cardiovascular Roundtable research and analysis.
Key
Consideration
Stage 1
(Basic)
Stage 2
(Intermediate)
Stage 3
(Progressive)
Strategy for
Service Line
Optimization/
Reorganization
Executive mandate; service line
not accountable for strategy
Ad hoc team within service
line accountable for owning
reorganization
Comprehensive, strategic approach to
reorganization: multidisciplinary design
team accountable to a distinct timeline,
executive buy-in, rollout plan,
communication strategy
Service Line
Purview
Inpatient-focused; cardiology,
surgery, vascular report to
separate departments; no
overview of physicians or
outpatient services
Medical/surgical or
heart/vascular report to
unified (though inpatient-
based) service line
Medical/surgical and heart/vascular report
to unified service line; service line spans full
care continuum and sites of care; includes
inpatient and outpatient sites, physicians
Leadership
Model
Sub-service lines (e.g.,
cardiology, surgery, vascular)
report to separate leaders
Dedicated service line
administrator
Dyad or triad leadership structure (service
line administrator with physician partner)
Administrative
Role
Service line administrator
responsible for operations
Service line administrator
responsible for operations
and strategy
Service line administrator responsible for
strategy; support staff assists with
overarching operations
Physician
Involvement
Medical directorships focused
on quality, clinical protocols;
alignment model may limit
broad involvement by
physicians
Physicians selectively
involved in service line ad
hoc committees and
taskforces, but in small
numbers or only with
incentives from leadership
Physician leadership cascades throughout
service line; participate in strategy and
management
Matrix
Relationships
Parties act independently with
little communication
Joint committees or point
person acts as liaison
between parties
Parties have clearly delineated roles;
responsibilities and accountable parties
defined; participation in hiring, performance
evaluations, etc.
Governance/
Committee
Structure
Ad hoc committees formed to
address specific challenge
CV steering or executive
committee
CV steering or executive committee sets
strategic vision; operational committee
responsible for implementing strategic plan;
task forces strategically formed according
to strategic plan
Strategic Plan Ad hoc strategies developed
just-in-time; multiple plans
developed by sub-service lines
or by individual hospitals in
system; service line plan may
not align with hospital-wide plan
Strategic plan developed for
heart and vascular services;
remains inpatient- and
growth- focused
Joint annual strategic plan developed
across all heart and vascular inpatient and
outpatient services; cascades from hospital
or system strategic plan; data-driven and
comprehensive
Finance/
Budgeting
Sub-service lines have separate
budgets and/or budgets remain
with traditional departments
Joint budget across all
heart and vascular services
Joint budget across all heart and vascular
services; unified profit and loss statement
allows visibility across all CV services
Metrics/Data
Tracking
Service line tracks metrics that
are required by CMS and that
enable service line viability
Track clinical, financial,
operational metrics
according to contemporary
issues (e.g., AUC);
participate in registry
reporting
Meet all requirements of stage 2, and track
leading indicators; predict and monitor
metrics anticipated to become required by
regulatory agencies; communicate service
line progress via dashboard
©2014 The Advisory Board Company advisory.com 30
Spectrum of Sophistication for Program Profiles
Source: Cardiovascular Roundtable research and analysis
Profile
Description
Stage 1
(Basic)
Stage 2
(Intermediate)
Stage 3
(Progressive)
Uniting Under
a Service Line
Structure
CV services fragmented
across department of
medicine, department of
surgery; no common
administrative structure,
strategic plan, or budget
Non-invasive
cardiology and cardiac
surgery under one
administrative
structure; heart and
vascular under one
administrative structure
All CV sub-service lines report through
one administrator, have a united
strategic plan, and a dedicated budget
Reorganizing
Around CV
Diseases
Ad hoc or standing
committee focused on
specific diseases, e.g.,
heart failure task force
Select disease
center(s) with narrow
focus on high impact or
highly scrutinized areas
Comprehensive disease-based
approach with entire CV infrastructure
supporting disease-based care delivery
Orienting
Toward
Outpatient
Care
Inpatient-focused CV
service line administrator
has little direct authority
over outpatient services or
CV physicians; relies on
matrix relationship with
ambulatory business unit
and/or department of
physician relations
Outpatient services
and/or CV physician
practices report to CV
service line
administrator
CV services report through ambulatory
business unit; CV service line
administrator has accountability across
the care continuum
Scaling Across
Sites
Hospital CV service line
administrators report to
hospital executive with no
coordination at the system
level
Committee structure
brings together
hospital-level CV
service line
administrators on a
need-be basis
System-wide CV organizational
structure coordinated across all
campuses, sites of care; strategic plan
conducted for system-wide service line
and cascades to individual sites
Promoting
Care Delivery
Redesign
CV service line oversees ad
hoc teams that are
responsible for carrying out
risk-based payment projects
Individual or team
permanently tasked
with care
transformation, risk-
based payment projects
CV service line reports to department
of care redesign
©2014 The Advisory Board Company advisory.com 31
Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)
Who/What/When (WWW) Form
1) Date the task was initiated.
2) Date by which the task must be completed.
3) Person who is responsible for ensuring the task is completed on-time.
4) Color indicates progress towards on-time completion; written status
indicates current status regardless of expected completion date.
Date1 What When2 Who3 Status4
1/1/14 Develop SHVI Practice Policies
& Procedures Manual 12/31/14 VP of Clinic Operations Ongoing
Status Color Key
On-track to be completed on-time
Risk of not being completed on-time
Not on-track to be completed on-time
Directions: Use this chart to track completion of assigned tasks for all direct and indirectly reporting service line
administrative and physician leaders. Use color-coding of status to indicate progress towards completion by expected
deadline. Chart is useful for both tracking the progress of service line projects and the yearly performance of direct and
indirect reports within the service line organizational structure.
Source: Carolinas HealthCare System, Charlotte, NC;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 32
Texas Health Resources
Heart and Vascular Leadership Council Charter
Source: Texas Health Resources, Arlington, TX.
Summary
Vision: Texas Health Resources (THR) and its physician leaders/partners share a vision of making North Texas the
vanguard of high quality heart care for the state, and an exemplar of cardiovascular excellence for the nation. We desire
that all patients in our service-reach receive the same high-quality care, regardless of their location.
Principles: We have agreed on the principles that will guide our mutual efforts to achieve this aspiration. It is our
expectation, as we learn to work together more closely and collaboratively, that above all else, these agreed-upon
principles will endure and guide us. They are:
• Patient Care and Quality - We jointly desire to have undisputed and unequalled excellence in heart and/or vascular
patient care and to be the first choice for patients and referring caregivers.
• Transparency – We are committed to openly sharing the data which must necessarily inform the strategic and tactical
decisions that physician leaders are expected to make on behalf of THR.
• Trust – We understand that trust will be born out of actual experience with each other. We will work together to find
mutual solutions, thereby learning and growing in a trust-based relationship.
• “We” – THR and the Partnering Physicians recognize the value and interdependence of success across all partners. We
will work to construct structures and processes that enhance that value.
Purpose: We recognize the need to engage and empower physician leaders in a new framework for making strategic and
tactical decisions regarding the development and differentiation of the Heart & Vascular service line at the system level.
To that end, the Heart and Vascular service line is organized to give physicians meaningful decision-making authority in
strategic planning, business development, quality/performance improvement, technology assessment and value analysis.
Roles/Responsibilities of the Service Line organization:
• Driving Quality/Clinical Performance Improvement across the system
• Re-designing and implementing new clinical models of care and care pathways/protocols that will be adopted for THR
system-wide
• Master planning of Service-Line strategy
• Fostering clinical research and innovation
• Partnering with nursing and other clinical and administrative leadership in support of service line performance
improvement
©2014 The Advisory Board Company advisory.com 33
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Source: Texas Health Resources, Arlington, TX;
Cardiovascular Roundtable interviews and analysis.
Heart and Vascular Service Line Operating Guidelines
The purpose of this document is to record the intent and details of the discussions held during the co-creation and
implementation of a system-level management model for the THR Heart & Vascular Service Line.
This document addresses the following items:
• Introduction and Mission of the H&V Service Line – Describes the overall intent and mission of the Service Line.
• Principles of the H&V Service Line– Outlines the founding principles of the H&V Service Line and its goals.
• Governance – Defines the initial membership of the Service Line bodies, leadership and decision rights, and core
operating committees.
Introduction and Vision of the Heart and Vascular Service Line
The H&V Service Line is an organization within Texas Health Resources health system. It is open to all practicing
physicians who desire to be involved and agree to follow the management model in providing heart and vascular care to
patients in North Texas. It is not intended that this Service Line be exclusive to employed physicians of THR, but rather to
include and embrace all who desire to join with us in creating the service to patients in our area.
Texas Health Resources and its physician leaders/partners (“Partnering Physicians”) share a vision of making North Texas
the vanguard of high quality heart care for the state, and an exemplar of cardiovascular excellence for the nation. We
desire that all patients in our service area receive the same high-quality care regardless of their location.
Principles Bringing Us Together that Will Guide our Relationship
We have gathered together to discuss the principles, structures and processes that will guide our mutual efforts to achieve
this aspiration. It is our expectation, as we learn to work together more closely and collaboratively, that these agreed-upon
principles will endure and guide us.
Patient Care and Quality
• We are embarking on this endeavor in order to deliver the highest quality and highest value to the patient. We desire to
have undisputed and unequalled excellence in patient care and make this Heart and Vascular Service Line (individually
and collectively) the preferred choice of patients and referring caregivers.
• We agree to cooperate for the greater good. When facing difficult decisions, we will always default to what is best for the
patient, even if it means THR or Partner Physicians must face unforeseen challenges. We will work together, fairly and
quickly, to remedy any situations that disadvantage practicing physicians or THR.
• Physician leadership is essential in the design of patient care. Our watch words are “physician-led, professionally
managed.” We are in strong agreement that there is a significant difference between physician leadership and
physicians as advisors, and we choose to empower physician leadership. To that end, we agree that physicians will lead
the development and deployment of the appropriate clinical and operational processes important to caring for our
patients.
Transparency
• We are committed to “open book” discussions, including financial and operating performance of the service. We
recognize that there are some data we cannot legally share, and we will act with integrity.
• We will use data in the design, evaluation and improvement of patient care models in the pursuit of evidence-based
medicine. We are committed to achieving top-decile or best-practice levels of performance in our chosen metrics,
including quality of care and clinical outcomes, patient satisfaction, cost-effectiveness and efficiency.
• We will be open, direct and respectful with one another in all our conversations.
©2014 The Advisory Board Company advisory.com 34
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Trust
• We understand that trust will be born out of actual experience with each other as we pursue and live these principles.
We seek that trust.
• We recognize that as we form structure and process around these principles, we may stumble. We choose to trust each
other, and will work together to find appropriate and mutual solutions, thereby learning, growing and continuing in a trust-
based relationship.
“We”
• We (THR and Physician Partners) will collaborate on key decisions and create clarity about what those are.
• We recognize the value and interdependence of success across all other stakeholders (physicians, physician groups,
hospitals, nursing staff, affiliated partners, etc.). We will work together to build structures and processes that enhance
that value.
• We seek appropriate representation and input from all stakeholders.
• We recognize the value of both the local leadership in a market, and the system leadership overseeing multiple
locations. We will always seek solutions that place authority at the right location.
• We agree on the need to design a relationship and operating model that is enduring, flexible and nimble, and allows for
discussion and conflict resolution. We will be adaptive to change as the business of healthcare evolves.
Governance
This section explains the mechanisms and structure that will be used for decision making in the H&V Service Line.
Council
The Council is established to engage and empower physicians in a new framework for making strategic and tactical
decisions regarding the development and differentiation of the Heart & Vascular services for Texas Health Resources. It is
the intention of THR and the Partnering Physicians that the Council never become an advisory board, but that meaningful
decision-making authority reside with the Council for system-level issues that are described in this charter.
The responsibilities of the Council include:
• Quality/Clinical Performance Improvement, including analyzing outcomes/ process/ efficiency/ satisfaction. In this regard,
it is expected that the Council make clinical process and protocol decisions that will be endorsed and implemented inside
the hospitals by local hospital medical staffs through administrative and physician leaders.
• Re-designing and implementing new clinical models of care and care pathways/protocols that will be adopted for THR
system-wide.
• Data mining and decision support. The infrastructure (databases and analysts) for this will be provided by THR.
• Master Planning of Service-Line Strategy, including without limitation:
– Deployment of new programs/services
– Growth/business development strategies
– Priorities for capital resource allocation
– Technology management/value analysis
– Branding and marketing strategies
• Clinical research and innovation.
• Education of the clinicians and other caregivers.
• Creating a research infrastructure (using structures already in place) to support/extend activities of practicing PIs.
• Partnering with nursing and other clinical and administrative leadership in support of the service line. Source: Texas Health Resources, Arlington, TX;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 35
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Source: Texas Health Resources, Arlington, TX.
Local Leadership is critical and central to the success of the H&V Service Line and its responsibilities include:
• Playing an integral part in communication between the Council, local administration and physicians. Local service line
leaders facilitate communication between local and system participants, as well as assist local physicians and
administration around activities such as:
– Implementation of “Better Practices”
– Credentialing and peer review
– Creating a culture of patient safety and interdisciplinary collaboration
– Clinical innovation
– Local market management
– Physician manpower planning
– Physician engagement and alignment
• Decisions around the structure and selection of local physician leadership as well as local physician engagement and
alignment practices will remain at the local level.
It is critical, and an absolute expectation, that physician leadership on the council ensure it fairly reflect the viewpoints of
the medical staff it represents. These leaders can use existing or establish new processes or structures to engage and fully
represent the multidisciplinary viewpoints of their facility. If no good processes or structures exist, local leaders are
expected to use whatever means are required by their staff to ensure that fair and proper representation is achieved.
Examples could include using existing multidisciplinary conferences, attending existing subspecialty meetings, one-on-one
conversations, group discussions, and the like. The role of the local physician leaders and council representatives in
creating an open, transparent culture of trust and partnership cannot be overstated.
Local representatives are selected by the H&V physicians at their facility using a process the local facility determines. It is
an expectation that the local representative be interested, dedicated and highly qualified for the work, as the job will take
time. The council overall seeks adequate representation from all subspecialties and may ask for local leaders to consider
this in their selection criteria.
Note: the physician representatives for the first council board will be selected from the founding members who helped draft
this charter and these operating guidelines. They will be elected initially on a staggered term basis (five elected for two,
five for three years. We will use random selection to determine which) so that the entire council does not turnover in any
given year. Thereafter, all council representatives are elected for two-year terms, with a three term maximum.
The Council is led by a Chair and Vice-Chair. The Chair and Vice Chair are physician members of the Council at large,
and the Council determines the powers that these two positions may exercise. It is intended that the Chair and Vice Chair
lead in accordance with Council direction, and have authority to make decisions consistent with that direction.
The Chair and Vice Chair should periodically report to the THR Executive Committee, the Presidents Council, Chief
Quality Officers Council (CQOC), Chief Nursing Officers Council (CNOC) and System Performance Committee (SPC) to
update them about the performance, requirements and direction of the service line, and to participate in discussions that
impact the development and differentiation of the Heart & Vascular Service Line.
The Council is comprised of both voting members and non-voting members as follows:
Voting members of the Council include:
• Ten practicing physicians (independent or part of Texas Health Physician Partners)
– Two from Texas Health Presbyterian Dallas
– Two from the Texas Health Harris Methodist co-management agreement participants (Fort Worth, Southwest, Azle,
Cleburne, Stephenville)
– Two from Texas Health Arlington Memorial Heart Hospital
– One from Texas Health Harris Methodist HEB
©2014 The Advisory Board Company advisory.com 36
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Source: Texas Health Resources, Arlington, TX.
– One from Texas Health Presbyterian Plano
– One from Texas Health Presbyterian Allen
– One from Texas Health Presbyterian Denton
• Representatives of THR leadership
– Senior EVP, System Alignment and Performance
– Executive Vice President, Chief Clinical & Quality Officer
– Executive Vice President, Chief Strategy Officer
– One hospital president/zone operations leader
– One representative from Chief Nursing Officer Council
Non-voting members include:
– System Heart and Vascular Service Line Administrator
– One representative from THR Finance
– One representative from Information Technology
– Local service line administrators from the larger institutions (Dallas, Fort Worth, Arlington)
The council meetings will be open meetings for all THR medical staff, and all are invited to attend. There may be occasion,
for reasons of confidentiality, that the council has executive sessions that deal with private matters (such as business
growth plans that are confidential, or personnel issues where closed meetings are required).
Minutes from council meetings will be kept and made available to THR Medical Staff.
Council representatives will be compensated fairly and legally for the time they spend on their responsibilities. These
reimbursement rates will be agreed on by the council and THR.
Restrictions placed upon council representatives by medical staff bylaws are to be adhered to. If not covered by those
bylaws, it is understood that members of the council should not and cannot hold leadership positions in competing health
systems.
The Council, each quarter or as needed, will sponsor a discussion to address how well the H&V Service Line is performing
to its aspirations. This meeting will explore and solve any issues of governance, fairness, culture, and founding principles.
While we hope for no conflict, we realize that conflict and confusion may arise and this meeting is intended to address
these issues and ensure that we build relationships of trust, collaboration and fairness.
Chair and Vice Chair Responsibilities
The Service Line will have a single Chair and Vice Chair elected by the physician members of the council. Both must be
physicians. Terms of office will be two years. There will be a three term maximum.
The Chair and Vice Chair work closely with the H&V Service Line Administrator, who does much of the work required by
the Chair and Vice Chair.
The responsibilities of the Chair and Vice Chair include without limitation:
• Report bi-annually to the THR Executive Committee and Presidents Council about strategy, progress and plans for the
H&V Service Line.
• Report bi-annually to the President’s Council and CQOC on establishing goals and standards and performance against
those goals and standards. Report annually on performance against plan to the physicians who work within the H&V
service line.
• Ensure policies of the council are implemented and assessed for impact.
• Develop Council agenda, lead Council meetings, and direct Council attention to the most critical issues requiring
leadership attention.
©2014 The Advisory Board Company advisory.com 37
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Source: Texas Health Resources, Arlington, TX.
• Ensure effective collaboration across the physician practices and the hospitals to achieve meaningful improvements in
clinical quality outcomes and attainment of core measures.
– It is expected that this collaboration will be led by members of local hospital physician leadership who are also
members of the H&V Service Line Council.
• Lead Council meetings.
• Lead a process for the Council to appoint the H&V Service Line Administrator, in conjunction with THR and participate
and provide input into the annual performance evaluation of the individual.
Heart and Vascular Service Line Administrator
The H&V Service Line Service Line Administrator manages and helps in all matters needing administrative attention, and
is responsible for operationalizing the strategic and tactical decisions made by the Council, coordinating with local service
line administrators where they exist. The H&V Service Line Service Line Administrator will be a strong counselor and
collaborator with the Chair, Vice Chair and Council.
The H&V Service Line Administrator is appointed by the Council with input from THR.
The H&V Service Line Administrator reports both to the Council (primarily for operational guidance and leadership) and the
THR SEVP of System Alignment and Performance (primarily for administrative support and career management issues).
We subscribe to a “two to hire, one to fire” philosophy. THR SEVP of System Alignment and Performance and the Council
(as a body) must agree to hire an individual, but either can request a new administrator.
Example of duties and responsibilities include:
Operations
• Implement C&V service line strategy through the local Service Line Leadership, including
– Coordinate with hospital, medical and other leaders on operational issues.
– Ensure collaboration across the physician practice and the hospital to drive improvement in clinical quality outcomes
and attainment of core measures, especially those required under payer contracts (via Quality Committee – see
below).
– Work with Marketing Team/Business Development to create service line marketing and community outreach to grow
volumes.
Financial performance
• Construct financial analysis for the Heart and Vascular Service Line. Provide financial analysis support in the ongoing
effort of the H&V Service Line improvement efforts.
• Gather input for capital expenditure requests from hospitals as input for H&V Service Line planning.
Council Committees
The Council has four committees that are vital to the clinical and operational success of the H&V Service Line. Additional
committees or task forces may be formed and discontinued at the Council’s discretion. Each committee will be led by a
chair or co-chairs. The chair or co-chair position must be held by a current member of the Council.
It is intended that the committees also include members of the physician community not directly involved in the Council.
These may include hospitalists, pulmonologists, and the like, who are critical to quality and care design, as well as non-
physician committee members appointed ex officio to provide additional subject-matter expertise and administrative
support for the fulfillment of the committees’ goals and objectives.
The committees are expressly intended to provide strong leadership and direction in matters under their scope.
Implementation of the committees’ actions should acknowledge the need to link and align activities and recommendations
with THR existing forums, recognizing the need for the support and cooperation of many others to execute effectively.
©2014 The Advisory Board Company advisory.com 38
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Source: Texas Health Resources, Arlington, TX.
Quality, Safety, and Outcomes Committee
This committee focuses on cardiovascular care quality and outcomes improvement. It is responsible for institution-wide
cardiovascular measures adoption, tracking, reporting and improvement.
Specifically, the Heart & Vascular Quality, Safety and Outcomes Committee is responsible for:
• Monitoring new, changing and retired quality and outcome measures for the service line
• Identifying & recommending additional heart and vascular measures in addition to those required by regulatory agencies
and payers
• Reviewing provider, entity and system performance on select heart & vascular care process and outcome measures &
recommending ways to improve or maintain desired levels of performance
• Educating and communicating process and outcome performance to clinical, administrative and support staff in the heart
and vascular service line and key support services
• Working collaboratively with entity and system medical, nursing, management & support staff to reduce practice variation
and improve process and outcome performance in the service line
• Identifying ways to simplify care processes and/or reduce the costs of care to realize THR aspirations to provide
exceptional care at competitive costs
Members will be determined by the Council, and should include:
• Chair of the committee selected from among the Council
• THR EVP, Chief Clinical & Quality Officer
• Staff member, Clinical Informatics – Data Analysis & Measurement (CI-DAM)
• Information Technology expert
Technology Management and Value Analysis Committee
This committee focuses on technology and charting future opportunities in Heart and Vascular innovation. This committee
will also identify opportunities for achieving efficiencies (physician preference item supply costs, processes), and
optimizing investments to achieve maximum ROI.
Core responsibilities include:
• Assume a rigorous and standardized technology adoption process
• Identify strategies for managing physician preference item supply costs
• Monitor industry technology trends and develop strategies for service line innovation
Members will be determined by the Council, and should include:
• The Chair of the committee selected from among the Council
• THR Information Technology expert
• Finance expert
©2014 The Advisory Board Company advisory.com 39
Texas Health Resources
Heart and Vascular Leadership Council Charter (Cont.)
Strategic Planning and Business Development Committee
This committee focuses on defining the pathway for the H&V Service Line to achieve leading market position in North
Texas, and the footprint of strategic facilities and services to achieve the aspiration.
Core responsibilities include:
• Define the market share and service scope goals for the THR system as a whole
• Define the roles of each THR facility in the provision of H&V care to achieve the goals
• Work with the H&V Service Line Administrator to review/prioritize any hospital or system budget requests
Members will be determined by the Council, and should include:
• The Chair of the committee selected from among the Council
• The local Heart and Vascular Service Line Directors
• Heart and Vascular Service Line Administrator
• THR EVP & Chief Strategy Officer
Research , Innovation and Education Committee
The Research, Innovation and Education committee for the Heart and Vascular Service Line is charged with identifying,
assessing, prioritizing, seeking funding for, and supporting innovative translational research activities within the service line
scope. Research efforts endorsed by the committee should improve patient care; create new knowledge relative to
cardiovascular health and wellness or new insights into disease processes and their diagnosis and treatment; and
enhance the recognition of the investigators and participating institutions. The types of research may be local, regional or
national in scope and may include clinical drug, device or protocol trials; innovative diagnostic or therapeutic investigations;
patient education; and other subjects relevant to the patient populations served.
The committee is encouraged to foster cross-entity research within THR and seek external collaborators who bring
expertise or other assets that enhance the likelihood of success.
The committee will also address critical issues of education required by the Service Line.
Responsibilities include but are not restricted to:
• Identifying, assessing, prioritizing the THR Heart and Vascular Research activity
• Seeking funding for research
• Publishing research results
• Developing or selecting system-wide CME programs for Heart and Vascular clinicians
• Coordinating training of THR employees in Heart and Vascular Service Line processes and intentions
Administrative support for approved service line research activities will be provided through THRE and when appropriate
will require THR IRB review and approval.
Members will be determined by the Council, and should include:
• The Chair of the committee selected from among the Council
• President, Texas Health Research and Education (THRE)
Source: Texas Health Resources, Arlington, TX;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 40
Ervin1 Health Care
Physician-Hospital Strategic Plan Crossover Update Form
Source: Building the Integrated Clinical Enterprise, Medical Group
Strategy Council, The Advisory Board Company; Cardiovascular
Roundtable research and analysis. 1) Pseudonym.
President’s
Update
Operations,
Technology, Research Recruitment Marketing
Program
Development Growth
Hospital 1
Sample physician group
activities in Hospital 1
service area:
Facility expansion;
pursuit of new
technology; local
physician involvement
in clinical trail research
Sample physician
group activities in
Hospital 1 service
area:
Offering contract to
newly recruited
physician;
extending existing
contract
Sample physician
group activities in
Hospital 1 service
area:
Marketing service
line offerings with
inpatient
component
Sample physician
group activities in
Hospital 1 service
area:
Opening new heart
failure clinic
Sample physician
group activities in
Hospital 1 service
area:
Outreach to
physicians in new
community.
Hospital 2
Hospital 3
Hospital 4
Hospital 5
©2014 The Advisory Board Company advisory.com 41
Select Metrics for CV Physician Practice Dashboards
CV Physician Practice Performance Metrics Pick List
Source: Building Actionable Performance Dashboards, Medical
Group Strategy Council, The Advisory Board Company;
Cardiovascular Roundtable research and Analysis.
Care Sustainability
Delivering financial and operating results that support reinvestment in clinical capabilities and growth
Practice Financial Indicators
Revenue
• Total revenue per provider FTE
• Total visits by specialty
• Total ancillary, lab and procedure volumes
• Net revenue per visit
• wRVU per encounter
• Contribution margin ratio
Source of Revenue
• Point of service collections versus target
• Percent of contract value at risk
• PMPM revenue as a percent of patient revenue
• Payer mix
Costs
• Percent of practices meeting budget
• Total investment expense per provider FTE
• Total overhead expense per provider FTE or per wRVU
• Labor expenses per wRVU
• Labor costs as percent of total operating expenses
• Physician compensation as percent of total operating expenses
• Costs per episode for procedural or episodic bundle, per provider
• Compliance with medication formulary
Revenue Capture
• Revenue cycle index (inclusive of indicators below)
• Gross days in accounts receivable
• Percent of accounts-receivable in AR > 90 days
• Collections as percent of net revenue
• Net collections per provider FTE or per wRVU
• Time of service collections as percentage of net revenue
• Bad debt (monthly) as a percent of net revenue
• First pass clean claims rate
• Coding compliance accuracy rate
©2014 The Advisory Board Company advisory.com 42
Select Metrics for CV Physician Practice Dashboards
CV Physician Practice Performance Metrics Pick List (Cont.)
Source: Building Actionable Performance Dashboards, Medical
Group Strategy Council, The Advisory Board Company;
Cardiovascular Roundtable research and Analysis.
Care Sustainability (continued)
Delivering financial and operating results that support reinvestment in clinical capabilities and growth
Practice Operational Indicators
• Total encounters (monthly or weekly) per provider FTE by specialty
• Total wRVUs (monthly or weekly) per provider FTE by specialty
• No-shows as percent of scheduled patients
• New patient encounters as percent of total
• Patient satisfaction scores
• Staff FTE per 10,000 wRVU
• Staff expenses per 10,000 wRVU
• Panel size per provider FTE
• Percent of patient hours scheduled versus target
• Productivity of sites with independently practicing APPs versus those without APPs
• Worked hours per unit of service
• wRVUs per patient encounter by specialty
Maximizing Patient Access
• Time to second/third available appointment for each practice and specialty
• Percent of urgent same day appointment requests scheduled
• Time from PCP referral to specialist appointment
• No-show appointments as percent of total
• New patient encounters as percent of total encounters
• Percent of patient visits in extended clinic hours versus target
• Percent of patient waiting less than 15 minutes from arrival to physician visit
• Call volume per scheduler
• Customer service and scheduling call abandonment rate
• Online patient portal usage versus target
Maximizing Physician
Engagement and Referral
Retention
• Physician portal and dashboard usage versus target
• Percent referrals retained in group
• Percent of professional billings at system facilities
• Percent referrals documented in EMR versus target
• Patient satisfaction and likelihood to recommend versus target
Physician and Staff Stability
• Physician annual turnover rate
• New physician candidate offer to acceptance ratio
• Physician satisfaction/engagement scores
• Physician participation in group forums (committees, all-staff meetings)
• Employee annual turnover rate
• Employee satisfaction/engagement scores
©2014 The Advisory Board Company advisory.com 43
Select Metrics for CV Physician Practice Dashboards
CV Physician Practice Performance Metrics Pick List (Cont.)
Source: Building Actionable Performance Dashboards, Medical
Group Strategy Council, The Advisory Board Company;
Cardiovascular Roundtable research and Analysis.
Care Outcomes
Ensuring clinical performance reflects best-in-class quality, reliability, safety, and excellent patient experience
Care Quality Metrics
• HCAHPS quality indicators
• Meaningful use and PQRS quality indicators
• Ideal diabetes care composite metric
• Ideal CHF care composite metric
• Other physician quality of care metrics available for key specialties on request
Readmissions
• 30-, 60- and 90-day HF, AMI, CABG readmissions rates for medical group patients
admitted
• Percent patients with care team follow-up visit scheduled/completed within 3 days post
discharge
• Percent patients with post-discharge medication reconciliation
Care Standard Penetration
• Percent care pathways with physician-approved care standards in place
• Percent of patients participating in care registries, by condition
• Physician compliance with care standards, percent by specialty
• Percent visits with medication reconciliation completed and documented
• Percent of patients with self-management documented
• Percent of charts reviewed by peers versus target
• Peer review disagreement rate
Care Management
Managing chronic conditions, activating well individuals in health maintenance,
and delivering appropriate preventive services for all assigned patients
Care Utilization
• Hospital admissions per 1000 patients for at-risk populations
• ED visits per 1000 patients for at-risk populations
• Per-Member Per-Month cost of care (if operating under risk contracts)
Care Coordination Process
and Infrastructure
• Utilization of cross-specialty care protocols
• Peer satisfaction with handoff communication
• Percent physicians active on EMR
• Percent patient visit records closed by physician
• Time to patient notification of abnormal lab or diagnostic test
Patient Engagement
• Percent of patients authenticated on electronic patient portal
• Percent of patients logging in to patient portal
• Number of e-visits or electronic communications with care team
• Percent patients with self-management goals documented
• Use of shared decision-making tools for target populations
©2014 The Advisory Board Company advisory.com 44
Questions to Assess Best Metrics for Physician Compensation Plans
Compensation Incentive Metric Selection Diagnostic
Source: Building Actionable Performance Dashboards, Medical
Group Strategy Council, The Advisory Board Company;
Cardiovascular Roundtable research and Analysis.
Metric Screen Questions Yes No
Accessibility of
Data
1. Is the data for this metric collected through an automated system? □ □
2. If not, can someone collect and report the data within a few hours? □ □
3. Is the system capable of calculating and reporting the results for this metric? □ □
Frequency of
Tracking
1. Can this metric be tracked at least once a month? □ □
2. Can this metric be tracked frequently enough to
inform action? □ □
Reliability of
Data
1. Is the metric calculated by an automated system? □ □
2. If not, can you be certain the reported data are accurate? □ □
3. Do physician leaders trust the data for decision making? □ □
Communicability
of Concept
1. Is this metric easily explained to and understood by physicians and other
stakeholders? □ □
2. Do physicians leaders agree with the definition of the metric? □ □
3. Are physician leaders aware of the importance of tracking this metric? □ □
4. Do physician leaders understand how performance on this metric impacts
organizational goals? □ □
©2014 The Advisory Board Company advisory.com 45
Colorado Systems of Care
Medical Neighborhood Score Card
Source: Colorado Systems of Care/PCMH Initiative;
Cardiovascular Roundtable research and analysis.
©2014 The Advisory Board Company advisory.com 46
Kaiser Permanente Southern California Region
CV Complex Case Conference Charter
Source: Kaiser Permanente Southern California Region, Pasadena,
CA; Cardiovascular Roundtable interviews and analysis.
Purpose:
The Complex Disease Case Conference committee shall be responsible for overseeing the identification of suitable
members for coordination and initiation of case conferences aimed at developing a comprehensive plan of care to
address the individual needs of the member.
Responsibilities include:
• Identification of patients appropriate for case conferencing
• The scheduling, coordination, and implementation of individualized case conferences
• Review of patient medical records
• Development of a comprehensive plan of care that is documented via electronic medical record
• Promotion of the most efficient use of available resources to ensure timely, quality, coordinated care delivery in the
most suitable setting
• Identification and referral of potential quality issues
• Ensure compliance with organization and regulatory requirements
• Provide timely information to the appropriate provider following case conference
• Identify lead physician for the management of the case discussed
Limits of Authority:
The committee may utilize any of the following to carry out its functions:
• Form ad hoc sub-committees
• Make recommendations on matters related to effective management of the patient’s medical and social issues
• Make adjustment to the medication regimen with or without the presence of the primary physician
• Request information from other committees, departments, and/or individual staff members
Frequency of Meetings:
This committee may meet as often as necessary to carry out its business but shall meet at least monthly.
Voting Rights:
All members are voting members.
Appointment of Members and Term of Office:
Physician members will be appointed by the chief of service. There is no term limit for members of the committee.
©2014 The Advisory Board Company advisory.com 47
Kaiser Permanente Southern California Region
CV Complex Case Conference Charter (Cont.)
Membership Composition:
• Facilitator (utilization management/quality management chair, hospitalist)
• Hospitalist
• Nephrologist
• Cardiologist
• Primary care
• Case managers (hospital, heart failure, ESRD1)
• Continuing care (palliative, hospice, home health)
• Social services
• Quality
• Pharmacy
• Emergency department/Urgent care
Ad hoc: Department administrators, pulmonologist, bioethicist, other MDs
Source: Kaiser Permanente Southern California Region, Pasadena,
CA; Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 48
Catholic Health System
Sample PCP-Specialist Service Agreement
Source: Catholic Health System, Buffalo, NY;
Cardiovascular Roundtable interviews and analysis.
Catholic Medical Partners Referral Agreement
This agreement outlines the referral agreement between __________________________and
_____________________________ for pre-consultation exchange, formal consultation, and co-
management of chronic disease or illness. The purpose of this agreement is to provide a
framework for better communication, coordination of care and the safe transition of care between
primary care and specialty care providers to eliminate waste and excess costs of health care, as
well as optimizing patient health.
The Primary Care Provider (PCP) and the Specialty Care Provider (SCP) agree to collaborate in
the care and treatment of patients as set forth below.
The PCP agrees to send referrals that include a reason for the referral, any thought process that
might have come with that reason, clinical information including diagnosis (problem list),
pertinent diagnostic test results, medication list, allergy list, and time frame within which the
referral is requested.
The SCP agrees to respond to immediate requests within 24 hours, priority requests in 2-3 days,
and routine requests within 2-3 weeks. The SCP also agrees to send all new clinical information
back to the PCP along with care recommendations.
Below the PCP and SCP choose which type of Referral Transitions they agree upon. Check all
that apply.
Types of Care Management Transition
1. Pre-consultation exchange – Communication between PCP and SCP to:
Answer a clinical question and/or determine the necessity of a formal consultation
with the SCP
Facilitate timely access and determine the urgency of referral to SCP
Facilitate the diagnostic evaluation of the patient prior to a SCP assessment
2. Formal Consultation (Referral for Advice): A request for an opinion and or advice on
a discrete question regarding a patient’s diagnosis, diagnostic test results, procedure,
treatment or prognosis with the intention that the care of the patient will be transferred
back to the PCP after one or a few visits. The SCP would provide a detailed report on the
Dx and care recommendations and NOT manage the condition. This report may include
an opinion on the appropriateness of co-management. The SCP is responsible for
communicating with the patient on any diagnostic test results until the SCP transitions the
patient back to the PCP.
©2014 The Advisory Board Company advisory.com 49
Catholic Health System
Sample PCP-Specialist Service Agreement (Cont.)
Source: Catholic Health System, Buffalo, NY;
Cardiovascular Roundtable interviews and analysis.
3. Co-Management for Chronic Disease/Illness– Where both the PCP and SCP providers
actively contribute to the patient care for a medical condition and are responsible for
defining their responsibilities for communication with patient, drug therapy, referral
management, diagnostic testing, and patient follow-up . The PCP continues to receive
consultation reports and provides input on secondary referrals and quality of life and
treatment decisions issues. The PCP continues care for all other aspects of patient care
and new or other unrelated health problems and remains the patient’s first contact.
This agreement outlines expectations between the PCP and the SCP. It does not, in any way,
limit the patient’s freedom to select his/her physician of choice or make a self-referral to a
provider of the patient’s selection.
Pertinent Diagnostic and Referral Information:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Approvals
Primary Care Physician/Practice
Authorized Name: ___________________________________
Title: ______________________________________________
Signature: __________________________________________
Date:______________________
Specialist Care Physician/Practice
Authorized Name: ___________________________________
Title: ______________________________________________
Signature: __________________________________________
Date:_________________________
©2013 THE ADVISORY BOARD COMPANY • ADVISORY.COM
Service Agreement Compendium
Compendium Available Online
Access the Cardiovascular Roundtable’s online library
of sample service standards by clicking here
Source: Cardiovascular Roundtable research and analysis.
©2013 THE ADVISORY BOARD COMPANY • ADVISORY.COM
Referral Guideline Compendium
Compendium Available Online
Access the Cardiovascular Roundtable’s online library
of condition-specific referral guidelines by clicking here
Source: Cardiovascular Roundtable research and analysis.
©2014 The Advisory Board Company advisory.com 52
Intermountain Healthcare
HF Advanced Therapy Risk Assessment Tool
1) Pseudonyms.
Room Patient1
Month,
Day,
Year
of ARRIVAL
TIME
SYMPTOM BNP
>200
DIURETIC
LAST
24 HOURS
EF
<= 40
PRIOR
CMS
HF
PRIOR
PRIMARY
OR
SECONDARY
MAWDS
1001 Smith April 5, 2014 WEAKNESS 1 1 0 0 0 Yes
1002 Vierra April 5, 2014
BLEEDING,
ACUTE RENAL
FAILURE
1 0 0 0 0 No
1001 Hines April 6, 2014
WEAKNESS/
HYPOTENSION,
RENAL FAILURE,
ANE
1 0 0 1 1 No
1004 Jones April 6, 2014
DIFF
BREATHING/
CHF, PNA
1 1 0 0 0 Yes
1005 Potts April 6, 2014 CONFUSION/
ALOC, SEPSIS 1 1 0 0 0 No
1002 Fry April 6, 2014
GENERAL
WEAKNESS /
PNEUMONIA
0 0 0 1 1 No
1004 Starr April 7, 2014 DYSPNEA/
HYPOXIA, CHF 1 1 0 0 0 Yes
HF DX1
Risk
Readmission
Risk
Mortality
Risk
HOSPITAL ROOM MAWDS TIME PERIOD
LDS Hospital
McKay-Dee Hospital
Riverton
UVRMC
Valley View Medical Center
1001
1002
1003
1004
1005
(All)
(No)
Yes
Prior 2 days
Prior 3 days
Prior 7 days
REPORT UPDATED ON: April 7, 2014
This report lists patients admitted to your facility within the last 2 or 7 days and who were diagnosed with HF in the past, or had a BNP>200 in the
past 48 hours, or had Diuretics ordered in the past 48 hours. This report is not intended to be a comprehensive list of all patients in your facility with
heart failure, not is it intended to give any indication of the patient’s current condition.
Low Medium High NLP
HIGH HIGH
HIGH HIGH
HIGH HIGH HIGH
HIGH HIGH HIGH
HIGH
HIGH HIGH
HIGH HIGH MED
LOW
LOW
LOW LOW
LOW
HF PATIENT LIST
Source: Intermountain Healthcare, Salt Lake City, UT;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 53
Intermountain Healthcare
High Blood Pressure Management Two-Page Flashcard
Source: Intermountain Healthcare, Salt Lake City, UT;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 54
Intermountain Healthcare
High Blood Pressure Management Two-Page Flashcard
(Cont.)
Source: Intermountain Healthcare, Salt Lake City, UT;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 55
Intermountain Healthcare
High Blood Pressure Management Care Process Guidelines
Full Guidelines Available
Full high blood pressure management care process guidelines
available by clicking here.
Source: Intermountain Healthcare, Salt Lake City, UT;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 56
AtlantiCare
Heart Failure Care Model
Source: AtlantiCare, Egg Harbor, NJ. Cardiovascular
Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 57
Intermountain Healthcare
PCP Follow-Up Checklist for HF Patients
7 Day Follow-Up Guide
Heart Failure with reduced ejection fraction
Heart Failure with preserved ejection fraction Etiology of Heart Failure: CAD/MI, Valvular, Electrical Abnormalities (A fib), Kidney Disease, Pulmonary HTN, OSA/Hypoxia, Illicit Drug Use, Drug Induced (Adriamycin), etc. Weight: Discharge Weight __________________ Today’s Weight _____________________ Sitting BP and HR: ______________________ Standing BP and HR: ______________________ Saturation Level: ______________ NYHA class I-IV ____________________ Lab Review BNP/CMP Review Medications: Medication Adherence Understanding of dosing instructions and why they are taking it Afford Medications? Any medications that can be DC’d? Patient Education: MAWDS provided in hospital? Did the patient bring their self-care diary? Daily weight and BP? Following sodium restriction (2 gram)? Following fluid restriction (2L)? Does the patient know when to call provider for change in symptoms? Heart Failure Specific Questions: DOE/SOB Orthopnea PND Edema Chest pain/pressure Palpitations Bloating Nausea/Decreased appetite Lightheadedness Syncope Activity tolerance
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Completion of Physical Exam: Lung Sounds, Heart Sounds/Gallup, Jugular Venous Distension, Edema Follow Up Plan:
If new diagnosis of HF: should be seen at least every 2-3 weeks until maximum medications titration completed (HFrEF, LVEF <40% titrate ACEi or ARB and BB)
If chronic HF, determine frequency of visits based on risk
F/U testing (echocardiogram, functional capacity) 3 months after maximum HF medication titration
Plan to optimize comorbidities
For persistent LVEF <35%, refer to EP
For persistent LVEF <25%, consider referral to the HF clinicSource: Intermountain Healthcare, Salt Lake City, UT;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 58
Bon Secours Health System
Nurse Navigator Job Description
Source: Bon Secours Health System, Richmond, VA; Cardiovascular
Roundtable interviews and analysis.
Title: Patient Navigator RN
Department: Medical Group
Reports to: Clinical Supervisor/Clinical Operations Director/Practice Manager
FLSA: Non-exempt
1) Primary Function/General Purpose of Position
The Patient Navigator RN works predominantly within Practice Groups to facilitate care of complicated chronic disease
patients with multiple co-morbid conditions. The Patient Navigator RN communicates with physicians, nurses, all
departments within the hospital facilities, and community resources to expedite medically appropriate cost-effective
care. The Patient Navigator RN applies clinical expertise for the medical management of patients in the community to
assess the health care needs to provide community resources and referrals.
2) Employment Qualifications
a. This position requires an RN degree and a current Commonwealth of Virginia Nursing License
b. Baccalaureate degree preferred.
c. At least 2 years nursing experience in community nursing, critical care or emergency department experience
preferred.
d. Proficiency in basic computer skills, including the ability to maneuver within a Microsoft Windows environment.
3) Essential Job Functions
a. Manages the case load of patients with chronic disease under the direct supervision of a physician.
b. Improves health care access and promotes client knowledge and behavior change.
c. Facilitates the transition of care from post hospitalization, ER discharges, nursing home, or assisted living facilities.
d. Communicates with inpatient hospital staff to facilitate post-hospitalization follow-up.
e. Identifies service delivery problems and potential for effective case management.
f. Develops and implements case management plans to maximize health care outcomes and facilitate wellness.
g. Utilizes resource manual for case management.
h. Assist medical group with coordinating care of the uninsured/unassigned patient and facilitates referrals.
i. Manages specialty clinics as needed and performs POC testing according to OSHA guidelines (i.e. Coumadin Clinic)
j. Maintains annual mandatory competencies and requirements for job description.
k. Documents all communication with patient in electronic medical record.
l. Communicates with hospital case managers and inpatient nurse navigators to facilitate transitions of care.
m. Assess patients via telephone or in-person applying critical thinking skills to facilitate proper level of treatment.
n. Participates in quality improvement projects.
o. Educates patients/families/caregivers on medications, chronic disease management, and follow-up appointments.
p. Maintain chronic disease registries to ensure closing gaps in care.
q. Complies with insurance requirements for disease management.
Patient population served: Infant (0-11 months), Pediatric (1-12 years), Adolescent (13-17 years), Adult (18-79 years),
Geriatric (80+ years)
4) Other Job Functions
Potential travel and flexibility with schedule
©2014 The Advisory Board Company advisory.com 59
Bon Secours Health System
Nurse Navigator Job Description (Cont.)
Source: Bon Secours Health System, Richmond, VA; Cardiovascular
Roundtable interviews and analysis.
5) Working Conditions
The individual performing this job may reasonably anticipate coming into contact with human blood and other potentially
infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective
equipment and devices, and learn the policies concerning infection control.
6) Office Equipment Used
Computer, fax, copier, telephone
7) Physical Requirements/Hazards
Activity Some Frequent Work Position%
Lift 0-50 lbs. X Sitting 80%
Carry 0-50 lbs. X Walking 10%
Push 0-50 lbs. X Standing 10%
Pull 0-50 lbs. X
Stoop, Kneel
Crawl
Climb
Balance
Physical Requirements Hazards
Manual dexterity (eye/hand
coordination) Use of Latex Gloves
X Perform shift work Exposure to toxic/caustic
chemicals/detergents
Maneuver weight of patients Exposure to moving mechanical parts
X Hear alarms/telephone/tape recorder Exposure to dust/fumes
Reach above shoulder Exposure to potential electrical shock
Repetitive arm/hand movements Exposure to x-ray/electromagnetic
energy
Finger dexterity Exposure to high pitched noises
Color vision Exposure to communicable diseases
Acuity – far X Blood-born pathogen exposures
Acuity – near Gaseous-risk exposure
Depth perception
X On call
©2014 The Advisory Board Company advisory.com 60
Bon Secours Health System
Nurse Navigator Job Description (Cont.)
Source: Bon Secours Health System, Richmond, VA; Cardiovascular
Roundtable interviews and analysis.
8) Working Conditions
This document does not create an employment contract, and employment with Bon Secours Health System is “at will.”
Nor is this document an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions
associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the
right to revise the essential and non-essential functions of the job at any time or require that other or different tasks be
performed when circumstances change (i.e. emergencies, changes in personnel, workload, rush, jobs or technical
developments). Management will attempt to give reasonable notice prior to revising a job function or requiring
performance outside of this description.
9) Bon Secours Mission, Values, Customer Orientation, and Continuous Quality Improvement Focus
It is the responsibility of all employees to learn and utilize continuous quality improvement principles in their daily work.
Consistent with the Company’s Code of Conduct, all employees are responsible for extending the mission and values of
the Sisters of Bon Secours by understanding each customer, treating each patient, staff member, and community in a
dignified manner with respect, kindness, and understanding and subscribing to the organization’s commitment to quality
and service.
Employee Signature: Date:
Approvals
VP of Clinical Operations Date
Chief Operating Officer Date
Administrative Director Human Resources Date
©2014 The Advisory Board Company advisory.com 61
Bon Secours Health System
Cross-Continuum HF Workflow
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 62
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 63
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 64
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
©2014 The Advisory Board Company advisory.com 65
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
1) After hospitalization for ADHF
2) All patients new to the practice who have a diagnosis of HF
3) Patients returning from cardiology office visit or procedure
4) NOTE: All HF patients to be seen by their cardiologist every 6 months &
ALL newly diagnosed HF patients MUST be referred for cardiology evaluation
INTAKE to Bon Secours
Medical Group (HFNN
to assign NYHA class)
EF ≥ 50% EF < 50% Diastolic HF
(HFpEF) Systolic HF
(HFrEF)
EF ≤ 35% 35% < EF < 50% EF ≤ 25%
ICD/CRT? NYHA
Class III-IV AHFO Referral
for stratification
and therapy
recommendations
LVAD and/or
transplantation
Palliative Care Consult
for Chronic Disease
Management
AF Rate > 100
Anticoagulation
HTN
Continue
current meds
BP control
Rate/Rhythm
control Persistent EF ≤ 35% after
treatment for 90 days
(NICM) or 42 days after MI
NYHA
Class I-II ICD/CRT
Referral
To BSMG
Edema Continue meds
Start or increase
diuretic Tx
Add or adjust
loop diuretic.
See diuretic
titration algorithm
Consider Ambulatory
Diuretic Center Refer to Cardiology/AHFC
for risk stratification and
further therapy
Add or adjust loop
diuretic. See diuretic
titration algorithm
Peripheral Edema
Dose titration of meds based on
HR/Systolic BP/Sx.
Palliative Care Consult for
Chronic Disease Management.
ACE-I
or ARB
Beta
Blocker
Aldosterone
antagonist
After
ACE-I
or ARB
Titration
After BB
Titration
Double ACE-I/
ARB dose every
2 weeks to max
by BP, Sx, or
dose limit
Double Beta
Blocker dose
every2 weeks to
max by BP, Sx,
or dose limit
Use Eplerenone
12.5-25 mg daily
or Spironolactone
12.5-25 mg daily
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Poor or
Inadequate
Response
Poor or
Inadequate
Response
Gary R. Zeevi, MD, FACC
Diagram A – Outpatient Heart Failure Flow Diagram Page 5 of 8
©2014 The Advisory Board Company advisory.com 66
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Titration & Management
Diagram B – Titration and Management
Beta Blocker Therapy ACE-I or ARB Therapy
Contraindications:
1) Severe of uncontrolled asthma
2) Bradycardia without pacemaker
3) Hypotension with a systolic BP < 100
Contraindications:
1) Severe persistent cough
2) Angloedema or rash
3) Pregnancy
4) CKD with creatinine > 3 or
acute creatinine rise > 0.6 mg/dL
5) Bilateral renal artery stenosis
Consider
Cardiology
Referral
Titrate approved BB heart failure drugs
every 2 weeks:
Carvedilol 3.125mg BID to 25mg BID or
Metoprolol succinate 12.5mg to 200mg Q daily or
Bisoprolol 1.25mg to 10mg Q daily
Target Reached
(systolic BP ~ 100 and
HR > 50 and <60)
Monitor monthly X 3
with labs then every 3 months
Monitor monthly X 3
with labs then every 3 months
Titrate ACE-I Drug every 2 weeks:
Lisinopril 2.5mg to 40 mg daily or
Enalapril 2.5mg to 20mg daily or
Ramipril 1.25mg to 10mg daily or
Captopril 12.5mg to 50mg daily
or other ACE-I
Or Titrate ARB Drug every 2 weeks:
Losartan 25mg to 100mg daily or
Valsartan 40mg to 160mg daily or
Candesartan 4mg to 32mg daily
or other ARB
Target Reached
(systolic BP ~ 100)
If creatinine < 2.5 mg/dL and K+ < 4.5:
Add epleronone 25mg daily or
Spironolactone 12.5-25mg daily
No No
No
Yes
Yes Yes
No
Gary R. Zeevi, MD, FACC
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
Page 6 of 8
©2014 The Advisory Board Company advisory.com 67
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Diagram C – Symptomatic Heart Failure Management Algorithm
Titration Symptom
Algorithm
Asymptomatic
(no edema) Current HF
Symptoms
1) Start with ACE-I / ARB and titrate to
max tolerated
2) Add Beta Blocker to max tolerated
3) Add aldosterone blocker
Start or increase
diuretic therapy.
See diuretic titration
algorithm
Continued
Class III or IV
HF symptoms
Referral to
the AHFC
Continue to adjust doses
and consider referral to
ADO and/or Cardiology
Target Systolic BP ~ 100 +/-5
Target HF 50-60
Target max Creatinine increase
~ 0.6mg/dL or K+ max of 5 – If adding
ACE-I, ARB, or Aldosterone blocker
or if up-titrating diuretic
Signs of Intolerance
1) Dizziness, especially on arising
2) Worsening renal function
3) Confusion
__________
Worsening Heart Failure
Decrease dose
to last tolerated Continue therapy
Drug Titration
Inadequate
response
Appropriate
response
Inadequate
response
Good
response
No
response
Gary R. Zeevi, MD, FACC
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
Page 7 of 8
©2014 The Advisory Board Company advisory.com 68
Bon Secours Health System
Cross-Continuum HF Workflow (Cont.)
Diagram D – Diuretic Titration Algorithm
Diuretic Titration Algorithm
Evidence of Volume Overload:
Dyspnea with Exertion, Orthopnea,
Peripheral Edema > or = 1 +
or Weight Gain > 3 lbs. in 3 days
Furosemide Bumex Torsemide
40 mg po
daily
80 mg po
daily
40 mg twice
daily
1 mg po
daily
2 mg po
daily
2 mg po
twice daily
20 mg po
twice daily
20 mg po
daily
10 mg
daily
If no response to first titration, attempt
a second drug at level two and titrate
Recheck BMP, Mg 2 weeks after
each dose change, then continue
to monitor per HF protocol
Gary R. Zeevi, MD, FACC
Refer to Clinical Pharmacist
Specialist, Ambulatory Diuretic
Center and/or Cardiology
Adequate response
to titration Inadequate response
to titration
Level 1 Level 1 Level 1
Level 2 Level 2 Level 2
Level 3 Level 3 Level 3
REFERENCES:
Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guidelines. Heart Failure Society of America. Journal of Cardiac Failure. Vol
16, No 6 2010. Pgs 245-539.
Source: Bon Secours Health System, Richmond, VA;
Cardiovascular Roundtable interviews and analysis.
Page 8 of 8
©2014 The Advisory Board Company • advisory.com • 29594
advisory.com 69
Supporting Evaluation of Key Site Characteristics, Feasibility of Redistribution
CV Services Site Audit and Redistribution Guide
Source. Cardiovascular Roundtable research and analysis.
Facility Name:
Address:
Contact Information:
Key Contact:
Contact Information:
Date of Last Audit:
Service Service (cont.) Service (cont.)
SECTION 1: CV Services Provided at this Site
Service/
Modality Room Vendor Model Age Functionality
Service
History
SECTION 2: CV Technology Inventory (list individual pieces of equipment)
Service/
Modality CY 2012 CY 2013 CY 2014
Percent Change
2012-2013
Percent Change
2013-2014
SECTION 3: CV Volumes (either by modality or service, combined inpatient and outpatient)
©2014 The Advisory Board Company • advisory.com • 29594
advisory.com 70
INSERT SITE NAME
CV Services Site Audit and Redistribution Guide (Cont.)
Source. Cardiovascular Roundtable research and analysis.
Service/
Modality
2013 Total
Market Volume
2018 Total
Market Volume
2023 Total
Market Volume
5-Year Change
2013-2018
10-Year Change
2013-2023
SECTION 4: CV Volumes Forecast (access the CV Inpatient and Outpatient Market Estimators
for local market forecasts)
Service/
Modality
2013
Revenue
2013
Direct Costs
2013
Contribution Profit
Percentile
Performance,
Direct Costs
Percentile
Performance,
Contribution Profit
SECTION 5: Financial Performance (access the Hospital Benchmark Generator for additional
metrics, service-specific benchmarks and to compare to similar organizations)
SECTION 6: Payer Mix
Medicare Medicaid Commercial Self-Pay Other
Payer Mix
SECTION 10: Patient Demographics (use this section to describe key patient demographics
served by this site or other demographic-related factors that may impact service offerings)
©2014 The Advisory Board Company • advisory.com • 29594
advisory.com 71
INSERT SITE NAME
CV Services Site Audit and Redistribution Guide (Cont.)
Source. Cardiovascular Roundtable research and analysis.
SECTION 7: Market Analysis
Strengths Weaknesses Opportunities Threats
Affiliates
Competitors
Affiliated Practices/Hospitals
Name/Distance:
Name/Distance:
Competitor Practices/Hospitals
Name/Distance:
Name/Distance:
SECTION 8: Site-Specific S.W.O.T. Analysis (access the CV Services Strategic Planning Template for
additional assistance in conducting a S.W.O.T. analysis)
Strengths Weaknesses Opportunities Threats
Functions Number of Staff FTEs Shifts Cross-Trained?
SECTION 9: CV Staffing (include clinical and administrative roles)
©2014 The Advisory Board Company • advisory.com • 29594
advisory.com 72
INSERT SITE NAME
CV Services Site Audit and Redistribution Guide (Cont.)
Source. Cardiovascular Roundtable research and analysis.
SECTION 10: Operating Characteristics
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Facility Operating Hours
Peak Operating Hours
SECTION 11: Access and Availability (list service or modality in the column header, add other key metrics
of accessibility or operational efficiency as desired)
Time to First Available Appointment
Time to Third Available Appointment
Patient Wait Time
No-Show Rate
SECTION 12: IT Operability
Vendor,
Version
Age,
Service History
Functionality
(Basic, Advanced)
Hospital
Interoperability?
PACS
Reporting
CVIS
Billing/Registration
EMR
Other
Section 13: Utilization and Capacity (indicate the service or equipment’s utilization as a percentage of
maximum capacity, based upon maximum volume potential related to availability, efficiency, staffing, etc.)
Service/Modality/
Room Current Utilization Maximum Capacity Percent Utilization
Capacity/
Utilization Target
©2014 The Advisory Board Company • advisory.com • 29594
advisory.com 73
INSERT SITE NAME
CV Services Site Audit and Redistribution Guide (Cont.)
Source. Cardiovascular Roundtable research and analysis.
SECTION 15: Additional Comments
SECTION 14: Redistribution Considerations
N/A
Strong
Negative
1
Negative
2
Neutral
3
Positive
4
Strong
Positive
5
Inventory Management
Utilization and Capacity
Finances
Growth Strategy
Physician Relationships
Competitive Position
Patient Access
Staff Culture
Please rate the impact of redistributing CV services based upon the following criteria, with “1” representing “Significant
Negative Impact” and “5” representing “Significant Positive Impact”.
©2014 The Advisory Board Company advisory.com 74
Understand Organizational Readiness Before Redeploying Resources
CV Consolidation Readiness Self-Assessment
Previous Consolidation Steps Taken Yes No Unsure
How autonomously do the CV programs currently act? Are there certain
services and/or operations where they function more independently
than others?
Can past experiences within the CV service line or outside of the CV
service line be referenced as exemplary processes of consolidation? Or
alternatively, pitfalls that should be avoided during consolidation?
Stakeholder Receptivity Yes No Unsure
Are physicians aware and supportive of system or service-line specific
goals for service consolidation?
Are frontline CV staff (e.g., nurses, technicians, ancillary support) aware
of and comfortable with service consolidation? Are there local political
considerations (i.e., unions) that must be engaged?
Are administrative staff (e.g., directors, managers) aware of and
supportive of CV service consolidation? Will certain positioned be
retained or eliminated as part of the consolidation effort?
Is the community aware and supportive of CV service consolidation?
Are community preferences for location and accessibility accounted for
in the plan to consolidate?
Are there certain key stakeholders that need to be more engaged than
others? What will be required to secure buy-in and alignment with these
individuals?
Post-Consolidation Integration Yes No Unsure
Is there a comprehensive plan in place that details post-consolidation
integration steps (e.g., staffing models, training, infrastructure changes,
etc.)?
Is there sufficient capacity to accept greater volumes, or will new
capacity be required? If new capacity is needed, what resource
commitment (e.g., capital, construction, technology) is required?
Source: Cardiovascular Roundtable research and analysis.
©2014 The Advisory Board Company advisory.com 75
Evaluating CV Partnership Considerations
CV Partnership and Affiliation Diagnostic
Clinical Capabilities Yes No Unsure
Do we have outstanding facilities, technology, and/or staffing
needs to remain competitive and offer high-quality care?
Is CV specialist physician recruitment a significant challenge
now or in the foreseeable future?
Is the quality performance of a potential partner at least
equivalent such that partnership augments patient care,
quality outcomes?
Market Considerations Yes No Unsure
Is the market or region consolidating?
Will partnership afford new growth, case mix enhancements
across the next 3 to 5 years?
Is there a risk of a competitor partnering with this institution?
Does the potential partner have strong brand recognition
among the population, referring physicians?
Culture and Integration Yes No Unsure
Is the culture of the institution similar to that of our hospital?
Are our physicians comfortable referring to and working with
physicians from the other hospital?
Are there aligned expectations for integration, timeframe,
accountability, and key performance indicators?
Do we have the necessary resources to ensure IT integration,
interoperability across organizations?
Source: Cardiovascular Roundtable research and analysis.
©2014 The Advisory Board Company advisory.com 76
Helping to Evaluate Whether Telecardiology is Right for You
Telecardiology Program Opportunity Assessment
Source: Cardiovascular Roundtable interviews and analysis.
Conditions Guiding Indicators Yes No Unsure
Do you have surrounding rural markets with an underserved CV
population?
Are PCP or other local providers requesting access to CV specialist
support?
Is constant physician outreach travel reducing access to care in your
PSA1?
Are you losing market share to a competitor in closer geographic
proximity?
Is there a high prevalence of CV chronic disease?
Is target population aging, adverse to travel?
Is patient profile generally receptive to technology enabled care?
Does the potential market have a significant Medicare population?
Are you in a state that has private payer coverage for telehealth?
Does your target market for telehealth meet the Medicare eligibility
requirements?
Is costly physician outreach travel a burden to your bottom line?
Patient
Financial
Market
©2014 The Advisory Board Company advisory.com 77
Key Metrics to Evaluate the Success of a Telecardiology Program
Telecardiology ROI Metric Pick List
Source: Cardiovascular Roundtable research and analysis.
Performance
Category Metric
Patient Access Time until first available virtual visit appointment
Average virtual visit appointment time
No-show rate for virtual visit
Patient Experience Patient satisfaction score
Average saved patient travel time
Utilization Average number of virtual visit appointments, per site
Average number of virtual visit appointments, per physician
Growth Number of appointments, new patients
Number of appointments, existing patients
Number of referrals for downstream services
Cost Management Average saved travel time per physician
ED utilization among patients receiving virtual visits
30-day readmission rate for patients receiving virtual visits
Appropriate utilization
©©2014 The Advisory Board Company • advisory.com • 29594 advisory.com 78
The Guide for Assembling the Accessible CV Network
Discussion Guide
Source: Cardiovascular Roundtable research and analysis.
1) To what extent does your CV strategic plan account for improvements to patient access? How important is enhancing
CV patient access relative to other identified priorities?
2) How does your hospital or health system’s strategic goals (e.g., becoming a destination acute care center, focusing
on population health management) align with your CV access strategy?
3) What role does the “retail movement” have in defining your institution’s CV access strategy? Are there certain patient
demographics or services that are more “access-sensitive” than others?
4) How is your institution positioning it’s CV service offerings in anticipation of a greater number of limited payer
networks, accountable entities, and direct contracts with employers? How important will access be relative to other
goals, such as maintaining low costs, optimizing quality, etc.?
5) Are your CV services deployed in the right locations? Are there instances in which you’ve made a decision around a
CV service or technology investment where it was not as successful as you anticipated? If so, what could have been
done better to secure a better return on investment?
6) What are your institution’s primary obstacles to CV service realignment? Do you believe you have the tools necessary
to make data-driven, objective decisions? How much of a role does market competition and the desire to offer a
comprehensive CV service portfolio (at whatever cost) impact your program investment decisions?
7) Is your institution partnering with other local providers to offer a CV service? Is this a jointly operated program? If you
are not partnering, is this a strategy worthy of consideration, especially for more resource-intensive CV services?
What opportunities/challenges would you foresee in entering a partnership or affiliation model with another provider?
8) How important is CV physician outreach and providing coverage to your CV program performance? How much
volume/revenue does this represent? Does this make your more or less inclined to provide CV outreach services?
9) Is there a distinct value proposition that your CV program and physicians can provide to garner outreach business?
What opportunities/challenges do you foresee in securing new partners and sustaining these partnerships over time?
10) What role do you think telecardiology can play at your organization? Are physicians and/or patients expressing
interest in this service? What resource commitment do you think is needed to start a program?
11) To what extent do you believe CV should have more of an “upstream” presence at patient points of entry (e.g., PCP
offices, standalone EDs, retail clinics, etc.)?
12) Are certain sites, CV services, or staff more or less suitable for having more of an “upstream” presence? Do your
patients value a “one-stop-shop” experience where they can receive primary and CV care all in one location? What
opportunities/challenges do you foresee in offering this type of collocated model?
13) Do you find that CV patients are willing to shop more for certain services if they are able to receive them in a
convenient, timely manner? How do patient expectations for timely care impact your access strategy? Do you believe
that your infrastructure and CV clinics are capable of accommodating these demands?
14) How much additional capacity do you believe exists in your CV clinic schedule to accommodate more patients? Is
there extra availability that can be identified through reduced variation, better scheduling systems, or more efficient
operations? Are physicians/staff receptive to seeing greater CV clinic volume?
15) How can you best leverage an accessible CV network to secure business to emerging “gatekeepers” of patients?
Does an optimized network make your more attractive? How might you leverage this strong foundation to better “sell”
your CV services to purchasers (e.g., payers, employers, physicians, patients)?
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