Building Business: Adding New Imaging Service Lines

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The new vascular center at St. Joseph Hospital in Orange, Calif., now includes the Dr. Ty Cobb Cardiac Cath Lab Suite and Pediatric Cardiac Cath Lab Suite that opened in June 2008. Here at the dedication of the new facility are: Vice President, Operations Kevin Lundon; Heart and Vascular Center Executive Director Renee Mazeroll, RN, MSN; Cardiologist Ty Cobb, MD; and his wife, Rosie Cobb.
Community hospitals are a distinct and steadfast breed contending with multiple challenges as they grapple with 21st century care. Their budgets and infrastructures often pale in comparison to their larger peers. Access to capital is tight. Ambulatory care and imaging centers make for fierce competition. The economic recession brings additional challenges. “A lot of facilities are putting construction and major equipment purchases on hold,” shares Brock Slabach, senior vice president at National Rural Healthcare Association in Kansas City, Mo.

But the outlook is not wholly gloom and doom. The U.S. economic recovery package contains significant funding for healthcare IT, which could free up funding for other capital acquisitions. In fact, the long-term dynamics for expanding clinical service remain unchanged, says Slabach. That is, the long-range plan and strategic framework should steer expansions and additions.

Community hospitals that add new clinical services to better meet local needs can garner multiple benefits ranging including improved patient care and increased revenue. This month, Health Imaging & IT visits a pair of community hospitals that added new service lines to their portfolio to better meet local needs. Their business models provide a sound roadmap for other sites.

Community focus

At 525 beds, St. Joseph Hospital in Orange, Calif., is fairly large for a community hospital, but despite its recent growth, the hospital remains committed to its roots in the community. “We’re focused on the well-being of the community and recognize that prevention is as important as acute care,” explains Renee Mazeroll, executive director of cardiac, pulmonary and vascular services.

Five years ago, St. Joseph Hospital’s commitment to the community led to the development of new cardiac and vascular service lines. The multi-phase project started with a women’s heart center. Sticking to the prevention framework, the women’s center offers calcium scoring, sophisticated lipid panels, arrhythmia screening, peripheral arterial disease screening and risk assessment for sudden cardiac death. A vascular institute and new neuroradiology and interventional radiology services followed over the next few years. The flip side of prevention and screening is diagnosis and treatment; the hospital supports and facilitates care and treatment of cardiac diseases with state-of-the-art technology and imaging modalities.

St. Joseph Hospital adopted a timeline that tackled the largest holes in patient care first. “The literature pointed to differences in women’s needs, and we also knew there were opportunities to improve diagnosis and care of patients with vascular disease,” shares Mazeroll. The next phases followed patient care along the continuum.

Timelines for new service lines reflect national trends, while adhering to local needs. Take for example Maria Parham Medical Center in Henderson, N.C. The center deployed McKesson Corporation Horizon Medical Imaging PACS late in 2008 and plans to integrate digital mammography toward the end of 2009, followed by its cardiovascular lab in 2010. Bonnie Howell, director of imaging and cardiovascular services, explains how timing meets local needs. The hospital’s 50-member radiology group includes eight dedicated breast imagers, and all need access to digital studies. In addition, referring surgeons and oncologists also require access to images. In contrast, a single cardiologist reads cardiac studies, and referring providers typically want reports rather than images. Finally, at 30 studies daily, mammography volume doubles cardiovascular imaging volume. “The need for distribution of mammography images is greater,” sums Howell.

The other factor in the local needs assessment is competition. While community hospitals need to remain competitive in the local market, repeating a competitor’s offering is ill-advised. “I caution hospitals against duplication of services,” says Slabach. Questions to consider include:
  • Does the service line meet local gaps?
  • Is the offering distinct from other local providers’ programs?

Putting it together

St. Joseph Hospital’s massive project is based on a host of Siemens Medical Solutions imaging and IT products including Siemens Acuson 3D echocardiography system, Somatom 64-slice CT, syngo Imaging, Soarian Cardiology and Axiom Sensis hemodynamic reporting system. The hospital secured the best possible pricing by soliciting bids from multiple vendors, investing in a mix of refurbished and new equipment and eventually partnering with a single vendor.

Maria Parham Medical Center continues to phase in its new cardiac service lines. In phase one, the center replaced a legacy RIS with McKesson Horizon Radiology Manager, which communicates with the HIS. It upgraded the network with a one gigabit fiber backbone and a 100 megabit desktop connection to support digital image traffic. Cardiac results are available electronically via McKesson Paragon WebStation portal. The center also plans to upgrade cardiac imaging equipment to DICOM-compatible systems as it pursues its vision of integrating images and EKGs into PACS.

Although the right mix of imaging and IT solutions are vital, staffing plays an equally critical role. “The technologist really makes the difference. Staff can make equipment sing (or not),” shares Mazeroll. “Deploying new technology without an appropriate staffing plan is short-sighted,” adds Slabach. For example, a new MRI system requires an appropriately trained MRI technologist and radiologist to support the scanner.

The St. Joseph Hospital project included a beefed up training portion with additional onsite education repeated in key intervals after the deployment. One week of offsite training does not create a superuser, says Mazeroll. Repeated training and support are critical to the ultimate success of a project. St. Joseph Hospital further motivates staff with a clinical ladders program to encourage cross training and professional development. Such grow-your-own expertise programs are especially important in locales with a tight labor market, says Slabach.

IT comprises another critical piece of the staffing puzzle. The St. Joseph CVIS team includes a programmer, networking expert and PACS administrator to focus on cardiac IT needs and interface with the hospital IS department.

Clinical and economic payoffs

Four years into its project, St. Joseph Hospital has seen impressive results. It screened 5,000 people for cardiac conditions in four years. In the first 18 months of vascular disease screening, the program found nine men with undiagnosed, asymptomatic abdominal aneurysms. In the first four years after the inception of the women’s heart program, the hospital saw a consistent drop in the severity and acuity of women admitted for heart attacks. In addition, outpatient cardiac volume increased by 121 percent over baseline by year three. At the same time, with inpatient cardiac volumes dropped. “Overall, the positive contribution line to the hospital budget is $3 million,” sums Mazeroll.

Maria Parham Medical Center also realized gains since integrating cardiac results into its web portal. “Finding the paper chart was always a struggle. Now the information is at the physician’s fingertips,” reports Howell. In turn, fewer double studies are ordered, and patient care is accelerated with timelier clinical decision-making.

The roadmap

Adding new service lines is a challenge at any time, but focusing on the end goals and attention to detail make the difference. St. Joseph Hospital relies on a multi-disciplinary executive committee to plan program development and maintain focus on quality outcomes. Sound planning and leadership not only lift new clinical lines off the drawing board, but also build solid, successful and quality programs. Other key factors include savvy vendor partnerships and robust staff development. The end results include healthier communities; efficient, satisfied clinical staff and an enhanced bottom line.