• Program development
• Cost management
• Patient satisfaction goals
• CMS mandated requirements and
professional association best practice
standards
Conclusion
Figure 2 • Co-Management Institute Model.
willing to implement and maintain the
institute’s business structure, create a
transparent culture for information
sharing, and commit to a capital and operating budget to support the institute’s
infrastructure. The hospital should also
provide corporate services such as: payor
contracting, expert marketing, and information systems and decision support
systems. As the hospital and physicians
evolve, adherence to clinical, operational,
and service protocols and standards may
become more complex. Setting the standards up front and in the early phases
works well to establish the foundation
of basic operating rules, which is not to
say the terms cannot be adjusted as the
institute matures.
In fact, a collaborative model between
cardiologists and radiologists can and
should be flexible, changing as needed
as time passes. The model chosen be-
tween these or many other viable options
should be structured in a way that allows
for reasonable changes with agreement
from all parties. The best arrangement
contracts are the ones that have the
structure necessary to be sound, but the
fluidity necessary to remain relevant as
the program evolves and matures.
Many institutes are comprised of physicians representing all major cardiac,
radiology, vascular, and electrophysiology services with the aim of optimizing
the patient experience. Ultimately, most
institutes move beyond cardiovascular
imaging and move to create clinical platforms whereby interventional radiologists, cardiologists, and surgeons jointly
develop best practice protocols, policies,
procedures, and credentialing criteria for
all cardiovascular services, inclusive of all
interventional suites.
This is an unavoidable trend, driven
by the current healthcare environment
and by the fact that no one specialty has
the needed composite skills to clinically
build and financially support the hospital’s institute infrastructure. The future
is sure to produce even more challenges
as the blurring of roles continues. For
example, cardiovascular specialists may
seek to do renal angioplasty and endo-vascular procedures in the extremities.
Vascular surgeons and cardiologists may
be performing procedures that once fell
almost exclusively to the interventional
radiologist. On the other hand, radiologists may see their practices evolve to
more direct patient care through their
engagement in vascular clinics and outreach and also through cardiology and
vascular surgery clinical rotations.
No doubt the payors will begin to
demand a higher level of integrated
service and physicians and hospitals
will have to find a way to provide them.
Likewise, patients, who are increasingly
savvy about choosing healthcare, will no
doubt demand a more positive overall
care experience. Hospitals and physicians working together—regardless of
the model chosen—to achieve myriad
