Practice Management: The Importance of the Cardiovascular Service Line in the Shift to Value

The Centers for Medicare & Medicaid Services is focused on incentivizing value-based, patient-centered care. This is a shift from the traditional fee-for-service physician payment model and will place the cardiovascular service line organizational framework front and center in how we deliver care to our patients. In this edition of STS News, Heather Smith, an STS Associate Member who serves on the Workforce on Practice Management, explains how the cardiovascular service line structure enhances value-based care.
--Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management

Heather Smith, RN, MJ
Revenue Cycle Director, Department of Surgery, and Business Director, Divisions of Cardiovascular, Thoracic, and Vascular Surgery, Clinical Practices of the University of Pennsylvania

STS News, Fall 2016 -- As health care reimbursement continues to shift from fee-for-service to a value-based model, organizations must continually evolve to ensure their success. Providing care in a value-based framework essentially requires delivering evidence-based, high-quality care in an efficient, cost-effective manner and being transparent about outcomes. In a 2010 article in The New England Journal of Medicine, Michael E. Porter, PhD suggested that value should be defined around the customer, set the framework for performance improvement, and be measured by outcomes and cost.

The cardiovascular service line (CVSL) is well-suited to optimize success within this newer reimbursement system. The CVSL model focuses on organizing care of the cardiovascular patient collaboratively across disciplines. It has helped to change the care model from one where disciplines worked side-by-side but independently, to one where they work in close partnership. It consolidates operations, marketing, finances, quality, and strategic planning into this focus on a single patient population.

The CVSL creates value by optimizing performance. It does this by guiding the development of evidence-based, standardized protocols by collaborating physicians. The CVSL can define and measure outcomes and cost and share the information across disciplines, rather than in silos, thereby influencing more of the care provided to patients. Because the CVSL also oversees marketing and strategic development activity, it also can strategically use its outcomes and cost data to attract and retain referring physicians and patients.

How to Adopt the CVSL

Changes to an organizational structure can challenge any organization. Creating a mission statement may seem unnecessary when groups have been providing care for a long time. However, a mission statement can help bring the team together around the change and unify the move to better care. Role clarity improves performance, so it is important to ensure roles are defined and clear to individuals and their coworkers.

Collaborating to create standardized protocols, establishing quality goals, creating clear, comprehensive, but concise dashboards, and ensuring clear communication across a widespread and large group can be difficult. Knowing the potential challenges and quickly addressing those that arise is important. The ability of the CVSL to focus on quality and cost of care will be rewarded as payment systems shift to reimbursing for value, rather than volume.