Is Your Cardiovascular Program meeting Goals? by Marsha L. Knapik, RN, MSN, CCRN

• How easy is it to schedule a test or procedure?

• What is the backlog or waiting time to get a patient on the schedule for a test/procedure?

• How difficult or easy is it for patients to get to the facility, park their cars and get into the testing area?

• What is the patient flow between CV areas? What is the proximity of services to each other? What can be done in service areas to improve work flow for the

staff?

• Are there opportunities to remodel or relocate services to complement the program and provide for physical

plant changes and other space needs?

• Can scheduling be centralized to simplify the process for patients and physician offices?

• Can registration be decentralized to allow patients to proceed directly to the testing area without having to first visit a registration area?

• Are there communications systems in place to provide consistent and timely delivery of needed patient information

from one service area to another?

• What are the operating hours of each CV service and do they meet the needs of the patients? Do they meet the needs of the physicians?

Review these operational issues to determine if the program is meeting present needs and to anticipate any operational changes to meet future needs. Successful CV program services are easily accessible (for both patients and physicians), and are well organized, consistent and timely.

Personnel utilization and management

Health care personnel shortages almost everywhere in the nation dictate that special attention be given to reviewing how services are staffed. Is there adequate staff? Is there qualified staff? Is there the right mix of staff for the care that needs to be accomplished?

Examine the services provided and determine the number and types of health care personnel appropriate to provide the service. The scope of care provided by ancillary, technical and professional staff has changed dramatically over the last five to seven years. Some services previously provided by professional RN staff are now carried out by technical personnel. Ancillary staff now perform services previously provided by technical personnel. Revise your mix of personnel in each department to optimize use of staff.

Cross-training staff members also can help maximize use of personnel, so that staff from a less-busy department can help a busy service. This allows for flexibility in critical staffing situations. Be sure to pay sufficient attention to education, training and ongoing competencies of personnel when considering cross-training or when revising or adding to existing responsibilities.

Review staff turnover rates related to specific departments and determine why staff leaves. Departures may be related to the working environment (workload, physical plant, management expectations, work schedules) or strong demand for these people in the job market. With increasing competition for experienced health care providers, staff are being lured to new employment opportunities by higher salaries, bonuses, matching vacations and flexible schedules.

Financial considerations

As with any business endeavor, financial considerations are a priority.

Pay close attention to CV service operational budgets by examining budget variances and their causes. Technological advances related to CV care have been arriving fast and furiously. However, not all technologies are reimbursed or yet proven cost-effective. A tertiary care center often has an opportunity to capitalize on new technologies and draw market share by adding a new technology very quickly after its introduction and winning referrals from facilities that do not yet offer the service.

New, costly technology may prove too expensive for a smaller community-based program to provide without adequate reimbursement. When considering use of new technologies, evaluate all the critical factors related to cost and return on investment, including capital outlay, reimbursement, potential for positive outcomes, expected volume and use, and potential to draw market share. The CV program’s technology committee can review specific criteria for considering the use of a new technology.

Vendor contracts

All vendor agreements should be examined periodically to determine if the conditions of a contract require revisions to reflect changes in practice and use patterns. This same group should provide input and assist in planning for capital purchases or equipment replacements and upgrades.

Essential elements of successful CV service line programs are ongoing review of reimbursement levels, coding and billing procedures. All areas must periodically review regulations and HCFA requirements for changes in reimbursement, new or revised procedure codes and updates to APC codes.

Administrative departments must work closely with physicians to ensure that appropriate documentation supports the coding. Managers must also continually provide additions and deletions to the charge description master for billable items so that charges for new disposable supplies are not lost.

Although many hospital financial systems lack the ability to provide true cost accounting on each case, there are methods to determine average cost per case, cost per procedure and cost per service. Each CV service area should be able to identify and periodically examine those costs to determine any changes and their impact on the operational budget. It is the role of department managers to investigate methodologies to hold steady or decrease their costs per case.

Program marketing

CV services can amount to a significant portion of the hospital’s revenues, and therefore it is important to actively market the hospital’s full range of CV services both to consumers and to the physicians who refer or have the potential to refer patients to the program.

Successful CV programs are aware of their market share and actively engage strategies to not only maintain, but also grow that market share. The CV program strategic plan should act as a template for directing marketing activities to both consumers and physicians. Dollars must be allocated to this in either individual department budgets or in an overall CV program budget. The CV director must examine what marketing activities have occurred, their effectiveness and determine where next to direct those marketing dollars.

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BIO:

Marsha’s cardiovascular experience has included clinician, critical care educator, cardiac clinical nurse specialist and manager. Marsha received her R.N. Diploma from The Washington Hospital School of Nursing and her undergraduate degree from the Pennsylvania State University. She has a Masters Degree in Nursing with a Cardiovascular Clinical Specialty from the University of Pittsburgh.

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