"Eight years ago, when we developed the heart center, we were trying to do something different," says G. William Dec Jr., MD, chief of the cardiology division within the Institute for Heart, Vascular and Stroke Care and co-director of the Corrigan Minehan Heart Center at Massachusetts General Hospital in Boston.
The heart center was formed to provide integrated, multidisciplinary care for the whole spectrum of cardiac conditions, explains Dr. Dec. Within the center, cardiologists, cardiac surgeons, cardiac anesthesiologists, cardiac radiologists and other specialists are divided into 12 teams, called integrated care programs, designed to focus on quality and best practices to best treat a set of conditions or a specific patient population.
The programs range from the Cardio-Oncology Program to the Heart Failure, Transplant, Circulatory Support Program to the Corrigan Women's Heart Health Program to the Heart Valve Program that was started two years ago.
"We selected these programs because we saw the demand for multidisciplinary care around these conditions, and we saw the business opportunity," says Dr. Dec. "These are all important areas for us — areas in which we would like to grow or maintain excellence."
Dr. Dec says the center has found success by providing this type of specialized multidisciplinary care. Under the center's current organization, "the physicians are able to come together to develop with the best care for each patient," he says. A patient at CMHC often sees multiple specialists during the same visit, and imaging procedures and surgical consults, if needed, are often able to be scheduled that same day as well. When the patient leaves, he or she has a personalized care plan in hand, rather than a handful of specialist referrals.
"It really is a better way to deliver care," he says.
Dr. Dec's experiences in developing the center and continuing the push toward excellence has revealed four helpful elements for any similar multidisciplinary center at a hospital.
1. Nonclinical and administrative support. "We have dedicated administrative committees to support the programs" at the heart center, says Dr. Dec. CMHC has a central marketing committee, an information technology committee and other sources of nonclinical support that allow the center to operate smoothly and allow the physicians to keep their focus on the patient.
2. Patient input. After meeting with leaders of the Massachusetts General's cancer center, CMHC instituted its own patient advisory council that has been "just a wealth of information," says Dr. Dec. The council meets one or two times per month with physician leaders from the center to discuss "what works, and what doesn't, within the specific programs," he says.
The meetings are valuable because the council members provide a complete picture of the patient experience. The council provides insight on all aspects of the center. "They tell us if people are able to get in, if there's a better way for us to be using the Internet to connect with patients, if there are issues with care coordination or with the billing process," Dr. Dec says.
"They really get into the nitty-gritty," he adds, which is especially important to physician leaders because "we tend to assume everything on the nonclinical side is running OK." Holding meetings with the patient advisory council and "discussing patients' experiences on a monthly basis is a good reminder of why we're doing [this patient-centered care structure] in the first place," says Dr. Dec.
3. Financial restructuring. CMHC is currently in the process of moving from a divisional billing structure to centralizing financial operations within the center.
"We're increasingly moving towards establishing cost centers that run throughout the institute, giving us more integration on financial side," says Dr. Dec. "Starting in fiscal year 2014, we'll be putting professional dollars into a pool, taking out money allotted for IT and other departmental support and then dividing the rest based on the teams doing the work."
Additionally, Dr. Dec says that a transition to a center like CMHC requires a financial restructuring to remove referral incentives that would create competition among team members. "All the physicians need to be working together in the programs," caring for the patient rather than protecting any personal financial interests, he says.
4. Physician and administrative champions. Dr. Dec stressed the importance of dedicated leadership committed to this new paradigm of care. "It takes strong leadership to ensure healthcare changes," he says, and to transition clinicians to a new model that provides high-quality care in a format that patients have come to expect and healthcare reform's bundled payments and patient satisfaction scores will soon demand.
"When you work at a successful medical center, there's always a sense of complacency," Dr. Dec says. It takes leaders to show the advantages of a new care delivery system and inspire providers to adjust and adapt ahead of the curve.
"When you have strong physician and administrative champions, it works," he says.
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