The Heart of the Matter

HealthTrust members demonstrate clinical excellence with Cardiac COE accreditation

Conemaugh Memorial Medical Center in Johnstown, Pennsylvania, is located in a very rural area of the state. Patients often have to travel great distances for cardiac care, says Genevieve Everett-Sigwalt, M.D., a cardiologist with Conemaugh Memorial Medical Center. Before they invest in making the trip, patients want to know they’ll be getting comprehensive, quality care.

To help make this pledge to patients, Conemaugh Memorial Medical Center sought accreditation to become a cardiac Center of Excellence (COE). In late 2018, the hospital earned the HeartCARE Center Award, which is a national distinction from the American College of Cardiology (ACC). It was the first hospital in the southwest region of Pennsylvania and the fifth hospital in the nation to receive this award.

CMS proposes change to rule in the CV space

The Centers for Medicare & Medicaid Services (CMS) has proposed changes for next year regarding payment rates and regulations for the Hospital Outpatient Prospective Payment System. These proposed rule changes would shift reimbursements to the outpatient setting, which will force cardiovascular service lines to deliver care, despite shrinking margins.

Patrick Bridges, RCIS

Patrick Bridges, RCIS, MBA, a former Clinical Director for HealthTrust, says that under this proposed rule, CV procedures that have historically been done in the hospital setting—such as coronary stent and cardiac rhythm device implant procedures—would instead be done in an outpatient setting.

“Hospitals will be forced to make a decision: Either pivot from the current strategy of advanced hybrid procedural rooms toward an outpatient ASC joint-venture strategy, or do nothing at all,” Bridges says. “If hospitals choose to carry on as usual, they will miss the opportunity to minimize the impact of the shift in procedural landscape.”

The major concern regarding this proposed rule change, Bridges explains, is that these traditional interventional cardiac procedures generate a significant amount of revenue for a hospital.

Shifting these typically high-margin procedures out of the hospital could put a tremendous amount of financial stress on an organization. Adopting this proposed rule and moving certain procedures out of the hospital would require a significant shift in strategy, Bridges says.

Regardless of how a hospital interprets the proposed rule, Bridges says it’s wise to pivot on the strategy and be proactive. “If they’re not proactive, the potential loss of the service line revenue could have a major impact on the organization as a whole.”

“Having that designation lets patients know that it’s a place they can come to that’s worth the ride. It has all of the team members they need in order to get care for various cardiac issues from one facility,” says Dr. Everett-Sigwalt, who is also a HealthTrust Physician Advisor.

The value of the COE accreditation

In 2015, over 40% of Americans had at least one cardiovascular (CV) condition, a number that is expected to reach nearly 50% by 2035, according to the American Heart Association (AHA) Cardiovascular Disease Burden Report. In 2016, cardiovascular disease (CVD) cost the U.S. healthcare system $555 billion, according to the same report. This cost is projected to reach $1.1 trillion by 2035.

Medical costs for CV conditions and related procedures are skyrocketing. In order to keep up with rising demand while offering patients the best care possible, many healthcare facilities, like Conemaugh Memorial Medical Center, are pursuing cardiac COE accreditation. Not only can being a COE help a facility refine and improve its service line, but it also gives community members confidence that they’re accessing the best care possible for their CVD.

There is no standardized term for defining a COE, nor is there an official governing body, says Kimberly Wright, RN, AVP of Clinical Data Solutions at HealthTrust. The AHA, The Joint Commission, the ACC and several different independent companies (such as the Accreditation for Cardiovascular Excellence) have COE accreditations. In addition, insurance companies, such as Aetna, Cigna and Blue Cross Blue Shield, have their own COE accreditations.

Because there are many different cardiac COE accreditations, it’s important for facilities to do their due diligence by selecting an accreditation that is not only well recognized, but one that also fits their hospital’s unique needs. Wright says that regardless of which certification a hospital pursues, the accreditation process itself is valuable, as it allows a hospital to have a discerning, objective outsider look at where improvements could be made.

“It allows you to have an external eye come in and look at your program objectively, comparing it against the standards and helping you identify where you might have gaps and where you could improve or standardize care,” she says.

Reliability, credibility & accountability

Being accredited as a COE has a number of benefits, Wright explains. It helps hospitals have a service line approach, establish interdisciplinary collaboration between the various physicians and units, monitor their outcomes, and improve long-term results due to often mandatory participation in databases and registries.

Community Health Systems’ (CHS) Commonwealth Health Heart and Vascular Institute at Regional Hospital of Scranton, Pennsylvania, was named an inaugural recipient of the HeartCARE Center Award in 2018. Lynn Simon, M.D., MBA, Chief Medical Officer and President of Clinical Operations at CHS, says cardiac accreditation has always been a priority for CHS. In fact, the health system has 111 ACC accreditations across 88 hospitals.

Dr. Simon says pursuing these accreditations is a priority for CHS, because having that service line framework demonstrates a commitment to making sure certain standards are met—not only related to physicians, the infrastructure and the cardiac services offered, but also standards as they relate to clinical outcomes.

“I think in some markets, having certain certifications or accreditations provides a nice public perception—both for the community and with payers—related to the commitment to the service line and the commitment to quality,” Dr. Simon says.

What Is the HeartCARE Center Distinction?

Learn more at cvquality.acc.org/accreditation

Two HealthTrust member hospitals, Conemaugh Memorial Medical Center and Commonwealth Health’s Regional Hospital of Scranton, were inaugural recipients of the distinguished HeartCARE Center Award from the ACC. To be awarded this accreditation, a facility must:

Have earned two CV accreditations from the ACC
Participate in a National Cardiovascular Data Registry (NCDR) or have earned a third accreditation from the ACC
Have a minimum of two ACC Member CV champions
Participate annually in at least one of the following:
- The ACC Quality Improvement Clinical Toolkit
- The ACC Quality Improvement Campaign
- Conduct public reporting in an eligible NCDR registry
- Submit an abstract related to quality of care to an ACC conference
- Submit a manuscript related to quality of care to a peer-reviewed journal

In addition, facilities that offer cardiothoracic surgery must publicly report their surgical outcomes to the Society of Thoracic Surgeons (STS).

She believes having that third-party, objective accreditation offers an additional credibility factor for a hospital. “It’s not just this hospital talking about how good they are, but they actually have a national organization that has put its stamp of approval on the program,” she says. “I think that adds to the reliability and credibility consumers want.”

In addition to its status as an inaugural recipient of the HeartCARE Center Award, CHS’ Commonwealth Health Heart and Vascular Institute at Regional Hospital of Scranton was the first in its market to achieve various other accreditations, such as the Cardiovascular Center of Excellence designation with the AHA. It was also the first in the nation to receive Cardiac Catheterization Lab Accreditation from The Joint Commission.

Striving toward clinical excellence through COE accreditation, Dr. Simon says, has improved both the internal and external perception of the hospital. “The hospital has been very active in the space, and I think it’s been great as far as promoting itself in their market,” she says.

Preparing for CV accreditation

HealthTrust offers several CV services for its members, including cardiac care redesign and cardiac on-site assessments.

The Cardiac Care Redesign team, which Wright leads, goes into HealthTrust member hospitals and assesses their CV service line as if it were being accredited by a governing body, such as The Joint Commission or the ACC. The goal of these HealthTrust services is to prepare hospitals for accreditation should they ever want to pursue it.

“We look at their outcomes, structure and processes they have in place to identify any gaps they might have,” Wright says. “And then we assist them with tools and guidance to help implement the things they don’t have so that if they do want to pursue accreditation, they’re better prepared.”

For more information on HealthTrust care redesign and on-site assessments, contact Kimberly Wright at kimberly.wright@healthtrustpg.com