7 Features Cardiologists Look for in Hospital Cardiology Service Lines

Healthcare reform's demands of higher quality and lower costs are forcing hospitals and physicians to find new ways to work together on patient care. Hospitals are taking different approaches for partnering with specialists, such as by acquiring practices, developing co-management relationships and establishing service line agreements. But what are specialists, such as cardiologists, looking for in a hospital?

Fellows vs. practicing cardiologists

Cardiologist fellows coming out of training have a different perspective on hospital employment than do cardiologists who have been working in private practice. Fellows tend to be more concerned about being accredited and having access to the volume of patients and resources necessary to gain experience, while private practice cardiologists tend to consider autonomy and control as more important in future employment, according to Jerome Hines, MD, PhD, chair of the American College of Cardiology's Council on Clinical Practice. "For fellows coming out of training, a service line is a foreign concept," he says. "They've really only been looking at the clinical side of cardiology, and not really on the business side of cardiology."

Dr. Hines describes seven features that make hospital employment and cardiology service line involvement attractive to established cardiologists, and also suggests what fellows should look for in a hospital cardiology program.

1. Reputation.

One of the first elements cardiologists consider when looking at hospitals as potential partners is the hospital's reputation. "More and more, hospitals, through various rating organizations, have their profile online for everyone to see. Since patients are looking at those websites, people seeking employment are aware they want to join a hospital or hospital system with a good profile, because that may attract patients and volume," Dr. Hines says.

2. Leadership.

Leadership opportunity is a critical feature for cardiologists, especially those coming from a private practice setting, in which they are accustomed to making the decisions. "As someone who's been in private practice and managed a group of 27 cardiologists with 80 or 90 employees, I look at a service line as an extension of my practice. What's important for me is the opportunity to work with my hospital counterparts to produce an excellent product," Dr. Hines says.

Service line governance
Giving cardiologists control of the cardiology service line enables them to more easily make changes to improve care, such as establishing care protocols and negotiating physician preference items. "To see the impact on delivery of care, you really need shared leadership with administrators and physicians," Dr. Hines says. "You need to go a step further in terms of cardiology, where we're seeing specific cardiovascular administrators becoming essential to a well-run service line." In contrast, not including cardiologists in service-line leadership could lead to frustration and disengagement with change initiatives at the hospital. "Hospitals that look at the administration of service lines as generic and hire someone to run several different service lines are not going to do as well as those hospitals or systems that realize that the cardiovascular service line needs its own vice president, infrastructure and leadership that includes physicians."

Hospitals can also make service line management attractive to physicians if they offer leadership training, as cardiologists typically do not receive this type of education in medical school, according to Dr. Hines.

3. Partnerships.

Token leadership roles are easily seen through. Cardiologists need to feel that they will be treated as true partners by a potential hospital employer. "As much as a hospital or hospital system can demonstrate to you that it is a true partnership, and what's good for you is good for them and vice versa, those assurances will go a long way in creating a good partnership," Dr. Hines says. In addition, hospitals need to demonstrate that employment brings value to cardiologists. For example, Dr. Hines says requiring physicians affiliated with the hospital to refer patients to other hospital-affiliated physicians will give employed cardiologists access to a larger patient volume.

"We've seen situations where a group can go into an integrated situation with a hospital and not be valued any differently than a non-employed group at the hospital," he says. "That's probably a red flag. That demonstrates that it's not really a partnership, it's just employment for the sake of the hospital gaining more revenue and not necessarily a partnership to provide better healthcare."

4. Group culture.

For cardiology practices integrating with a hospital as a group, maintaining the group's culture can allay some concerns about a loss of autonomy from hospital employment. "The [more] you can maintain the culture of your practice within an integrated system, the more successful you're going to be," Dr. Hines says. Retaining the ability to distribute revenue within the group and the ability to set call and vacation schedules is essential, according to Dr. Hines. In addition, participation in the hiring and firing of non-physician service line employees reflects a true partnership. Although most employment situations demand individual employment contracts, the ability to retain a group structure and a partnership mentality is also essential, Dr. Hines says.

5. Long-term strategy.

One aspect of a private practice that can be attractive to cardiologists in evaluating a hospital is the organization's horizon, and its long-term goals. "When we came into our practice, we were expecting to be in practice for 25 to 30 years," Dr. Hines says. "All the decisions we would make along the way as physicians, and as a board of physicians within the group, addressed that 25- to 30-year rolling horizon, because it was our group, our partnership; we were investing for our future." For example, the group would make an expensive investment, such as adopting an electronic health record or acquiring a nuclear imaging machine, because the group was looking at providing state-of-the-art care for patients and viewed it as a long-term investment.

In contrast, Dr. Hines says hospitals can sometimes have shorter horizons, which can be exacerbated by high turnover among hospital leaders and short-term cost pressures. "You don't want to be in a situation where you're being told by administration, 'No, you can't purchase that piece of equipment because it doesn't fit into our budget this year.' To have an aggressive service line, you need to have the same outlook as a practice," he says.

6. Information technology infrastructure.

Cardiologists also look for hospitals that have IT infrastructure that can capture cost and quality data needed to successfully manage a service line. This data also greatly affects the hospital's ability to present itself well, according to Dr. Hines. As mentioned above, cardiologists want to associate themselves with hospitals that have positive reputations. Hospitals that don't have the ability to manage the quality data that consumers and organizations look at to determine reputation may not be as attractive to potential cardiologist employees.

In addition, some private practices are ahead of hospitals in implementing EHRs and other technology. Cardiologists will look for hospitals with advanced IT capabilities because they will want to work for hospitals where they can achieve the same efficiency and have the same access to information as they did in private practice, Dr. Hines says.

7. Transparency.

Cardiologists value hospitals' transparency because it builds trust between the two parties, forming a foundation for a strong partnership. Hospitals that are transparent during the employment negotiation process with cardiologists are more likely to recruit them to the organization. "Ensure that the contract you eventually have is transparent and consistent with what you talked about during the courtship," Dr. Hines says. By being upfront about expectations, hospitals can attract the cardiologists best suited for the organization and retain them over time.  

More Articles on Hospital Cardiology:

Cardiology & Medical Necessity: How Your Hospital Can Avoid Heart-Related Investigations
3 Cardiology Employment Trends Post-Reform

Report: Only 35% of Cardiovascular Practitioners Work in Private Practice

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