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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


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.

http://www.advisory.com/Research/Cardiovascular-Roundtable/Resources/2014/2014-2015-National-Meeting-Resources/The-playbook-for-optimizing-CV-org-and-leadership-structures


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.


http://www.advisory.com/~/media/Advisory-com/Research/CR/Events/Meeting/2014/Diagnostic for Determining CV Service Line PurviewFinal102414.docx

©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



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




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.


http://www.advisory.com/~/media/Advisory-com/Research/CR/Events/Meeting/2014/Cardiovascular-Roundtable-RASCI-Starter-Kit_Final.xlsx


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.

http://www.med.umich.edu/cvc/cvcpotentialteam.pdf






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,




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,



Covenant Health

Director of Cardiac Services Job Description

Source: Covenant Health, Lubbock, TX;


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.


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;




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


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





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


• 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





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


• Manage the fiscal and other resources to meet the budget targets


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




Carolinas HealthCare System Sanger Heart and Vascular Institute (SHVI)

Heart and Vascular Institute President Job Description

Source: Carolinas HealthCare System, Charlotte, NC;


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.



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.





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.


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.





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.


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.





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.


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


• 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





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





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.





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.


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


• 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.




Mercy Hospital Springfield

Medical Director of Heart Failure Services Job Description

Source: Mercy Hospital, Springfield, MO;


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.



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.





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




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



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



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


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



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.




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



Heart and Vascular Leadership Council Charter (Cont.)

Source: Texas Health Resources, Arlington, TX;


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.




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;






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





– 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.





• 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.





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


• The Chair of the committee selected from among the Council

• THR Information Technology expert

• Finance expert




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



• 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.



• President, Texas Health Research and Education (THRE)

Source: Texas Health Resources, Arlington, TX;



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


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



CV Physician Practice Performance Metrics Pick List (Cont.)




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



CV Physician Practice Performance Metrics Pick List (Cont.)




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


Questions to Assess Best Metrics for Physician Compensation Plans

Compensation Incentive Metric Selection Diagnostic




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? □ □


Colorado Systems of Care

Medical Neighborhood Score Card

Source: Colorado Systems of Care/PCMH Initiative;

Cardiovascular Roundtable research and analysis.


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.


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.


Catholic Health System

Sample PCP-Specialist Service Agreement

Source: Catholic Health System, Buffalo, NY;


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.


Catholic Health System

Sample PCP-Specialist Service Agreement (Cont.)

Source: Catholic Health System, Buffalo, NY;


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:_________________________


Service Agreement Compendium

Compendium Available Online

Access the Cardiovascular Roundtable’s online library

of sample service standards by clicking here


http://www.advisory.com/research/cardiovascular-roundtable/resources/2014/2014-2015-national-meeting-resources/cv-specialist-partnerships


Referral Guideline Compendium

Compendium Available Online

Access the Cardiovascular Roundtable’s online library

of condition-specific referral guidelines by clicking here


http://www.advisory.com/research/cardiovascular-roundtable/resources/2014/2014-2015-national-meeting-resources/cv-specialist-partnerships


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;




High Blood Pressure Management Two-Page Flashcard





High Blood Pressure Management Two-Page Flashcard

(Cont.)





High Blood Pressure Management Care Process Guidelines

Full Guidelines Available

Full high blood pressure management care process guidelines

available by clicking here.



http://www.advisory.com/~/media/Advisory-com/Research/CR/Resources/2014/NMS-resources/B/Intermountain-HBP-Guidelines-2014


AtlantiCare

Heart Failure Care Model

Source: AtlantiCare, Egg Harbor, NJ. Cardiovascular

Roundtable interviews and analysis.



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;



Bon Secours Health System

Nurse Navigator Job Description

Source: Bon Secours Health System, Richmond, VA; Cardiovascular


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



Nurse Navigator Job Description (Cont.)



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



Nurse Navigator Job Description (Cont.)



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



Cross-Continuum HF Workflow

Source: Bon Secours Health System, Richmond, VA;




Cross-Continuum HF Workflow (Cont.)








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




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




Page 6 of 8




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




Page 7 of 8




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


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



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.



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)


advisory.com 70

INSERT SITE NAME

CV Services Site Audit and Redistribution Guide (Cont.)


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)

http://www.advisory.com/research/cardiovascular-roundtable/tools/2010/cardiovascular-inpatient-market-estimator

http://www.advisory.com/research/cardiovascular-roundtable/tools/2010/cardiovascular-outpatient-market-estimator

http://www.advisory.com/research/health-care-advisory-board/tools/2014/benchmark-generator


advisory.com 71

INSERT SITE NAME



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)

http://www.advisory.com/research/cardiovascular-roundtable/tools/2011/cardiovascular-services-strategic-planning-template


advisory.com 72

INSERT SITE NAME



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


advisory.com 73

INSERT SITE NAME



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”.


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?



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?



Helping to Evaluate Whether Telecardiology is Right for You

Telecardiology Program Opportunity Assessment


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


Key Metrics to Evaluate the Success of a Telecardiology Program

Telecardiology ROI Metric Pick List


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


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)?

Appendix - Advisory › - › media › Advisory-com... · • Regional Medical Director Job...

Documents

Transcript of Appendix - Advisory › - › media › Advisory-com... · • Regional Medical Director Job...