Spokane Journal of Business

Getting to the HEART of a program

Sacred Heart launches cardiac institute, acquires big surgical group

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Sacred Heart Medical Center & Childrens Hospital says the recent launch of Providence Heart & Vascular Institute of Spokane and acquisition of a big cardiovascular practice here are part of an effort to make sure it stays on the cutting edge of cardiac care.

With the opening of the institute, the hospital now has a new center for excellence for cardiovascular care, enabling it to focus resources on that clinical area, says Gerard Fischer, a vice president at Sacred Heart. Other such centers at Sacred Heart include the Childrens Hospital and the Providence Neuroscience Center.

The nonprofit hospital intends for the new cardiovascular institute to help manage and shape the future of its cardiac services, Fischer says. Meanwhile, its acquisition of the cardiovascular practice, Northwest Heart & Lung Surgical Associates PS, should help ensure the long-term stability of cardiac care in the Inland Northwest, as growing demand for services is expected to outstrip the supply of physicians in coming years, he says.

Sacred Heart has always had a strong cardiac program, and we want to continue to serve the region as a resource in that clinical area, Fischer says. If we keep moving in the right direction, theres no reason we cant be a world-class heart hospital comparable to the Mayo Clinic, Cleveland Clinic, and the Texas Heart Institute.

Sacred Heart claims to perform twice as many cardiovascular procedures as any other hospital in Washington state.

The Providence Heart & Vascular Institute, which opened in January, is a collaboration between the hospital and eight physicians groups in the Spokane area. Those groups include about 80 doctors in the fields of cardiology, cardiothoracic surgery, vascular surgery, pediatric and congenital surgery, and mechanical heart and transplant surgery.

The institute is managed by a 13-member executive leadership council. That leadership structure is intended to help foster better communication and understanding between the hospital and the physicians groups regarding management of day-to-day operations and strategic long-term planning of cardiac services, Fischer says.

In the past, physicians havent put aside the time to do this formally, and the hospital has shown variable interest, says Dr. Andrew Boulet, a cardiologist with Spokane-based Heart Clinics Northwest PS and chairman of the council. We have both stepped up to the plate and feel we can accomplish a lot more, a lot better.

Sacred Heart started looking into the forming of the institute two years ago while doing a strategic planning for its cardiac services, Fischer says. Hospital officials received feedback from doctors who said they wanted to be more engaged in the management of cardiovascular services at the hospital. After looking at various models in nonprofit hospitals across the country, hiring consultants to study the issue, and meeting with physicians, the hospital devised a management-services agreement, which the eight physician groups then signed.

Its a rare model for nonprofits, says Kris Becker, a registered nurse and director of the cardiac service line at Sacred Heart. This puts us all on the same page for decision making.

Before the executive leadership council was formed, Sacred Heart tried to involve doctors in shaping the direction of its cardiac services program by including them on numerous committees, Becker says. Attendance was poor at committee meetings, partly because the doctors were busy with patients. Plus, each doctor represented his or her interests, so the group lacked cohesiveness, she says.

Before, we would make decisions and at times they werent welcomed or they werent understood, Fischer says. Now, theyre getting more insight into how the hospital operates.

Representatives from each of the physicians groups, as well as from Sacred Heart, are members of the executive leadership council and attend meetings twice a month, he says. Sacred Heart pays them to participate. The council will create a vision for cardiac services at the hospital and will devise and look at ways to implement a strategic plan. Council members also are involved in the institutes budgeting and will help identify priorities for the hospitals cardiac services so resources can be allocated accordingly, Fischer says.

We wanted to create an environment that continues to foster an innovative spirit, he says. This way, theres more collaboration on and more support for the decisions that are made.

Boulet says the institute is fostering a more collegial spirit among physicians.

Were operating off the idea that well be better if we build up the people around us, Boulet says. We want to stay on top of our game, and this helps us keep our edge. The ability to communicate better with others gives us a better end product.

He adds, Its been tedious, but we seem to come to better, more global decisions that people are on board with. Our goal is to make the facility a place where we want to practice, and employees want to work, and patients want to come to.

Boulet says the cooperation among physicians also will help further research efforts here. For instance, doctors from different physicians groups could work together to get more patients involved in clinical trials, he says.

Thus far, participation at each council meeting has been nearly 100 percent, Becker says. Sacred Heart plans to have a checkup meeting this month with the council to get members views on the new arrangement. Eventually, standard procedures and protocols for cardiac services will be implemented so that hospital staff members and physicians follow the same guidelines for care, she says. Currently, procedures can vary a bit depending on the preferences of different physicians, she says.

Expanding programsSacred Heart has devoted to cardiac services roughly 100 beds, six operating rooms, four cardiac catheterization labs, three electrophysiology labs, and 300 full-time employees, Becker says. It claims that several of its programs, including minimally invasive robotic heart surgery, complicated heart cases, pediatric heart care, mechanical hearts, and heart transplants, are unique in this region. Those programs have been growing strongly, and the institutes executive leadership council might consider expanding them in the future, Fischer says.

The main hub of the new institute is located in the former Heart Institute of Spokane building, which is just north of Sacred Hearts main building on the South Hill. The Heart Institute, founded in 1991, was a nonprofit provider of cardiovascular care, education, and research. Sacred Heart acquired the organization in 2004 and changed its name to the Providence Medical Research Center.

Sacred Heart plans to install new signs soon at the five-story, 106,000-square-foot structure to reflect the change, Fischer says. Currently, two independent cardiac-catheterization labs and the main offices of five cardiac physicians groups operate in the building, which is filled to capacity, he says. Sacred Heart is evaluating the need for more capacity for its clinics and the possibility of building additional medical buildings on its campus, he says.

The hospital hopes to implement the same kind of management-services agreement concept in other clinical areas in the future, although the details of those arrangements would vary, Fischer says.

This is an experiment, he says. There are a lot of other specialties that we want to replicate it for.

Fischer declines to disclose how much money Sacred Heart has invested in the institute, but says its main costs have been consulting and legal fees and the payments to members of the executive leadership council.

AcquisitionSeparately, Sacred Heart acquired the assets of Northwest Heart & Lung Surgical Associates on March 1. The practice, which was started here in 1952 by Dr. Ralph Berg Jr., has 46 staff members, including 10 cardiothoracic surgeons. Surgeons there perform roughly 1,100 procedures a year at Sacred Heart and 400 surgeries a year at other hospitals, including Deaconess Medical Center and Kootenai Medical Center.

Fischer declines to disclose the terms of the sale.

Fischer says the physicians group proposed the buyout to hospital officials as a way to provide financial stability to the practice in the short term and to ensure that the Spokane region would have enough cardiac doctors in the long run. Part of what spurred the medical practice to approach Sacred Heart was that one of its doctors, Leland Siwek, who is one of the worlds leading cardiac robotic surgeons, was being recruited aggressively by two competitors.

They told us that if their group falls apart, we will all have to work to put it back together, Fischer says.

Having a strong base of cardiac physicians will become increasingly important as the pipeline of those doctors dries up nationally, he says. An aging population is putting increasing demand on cardiovascular services. Meanwhile, a large number of cardiovascular specialists are expected to retire in coming years, while fewer medical students are choosing to enter that field, Fischer says. As a result, competition for physicians will heat up, and regions with strong bases of cardiac care will be the most attractive to highly coveted recruits, he says.

Everybody with cardiac services programs will be scrambling for doctors, and theyll be trying to take them from someone else, Fischer says. Youre going to see a lot of consolidation of programs.

Now that Sacred Heart worked to solidify its base for cardiac care by acquiring Northwest Heart & Lung and opening the new institute, its able to focus on staying on the cutting edge of technology, improving the quality of its care, and expanding the geographic region it serves, he says.

Contact Emily Proffitt at (509) 344-1265 or via e-mail at emilyp@spokanejournal.com.

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