Conventional wisdom (and experience) tells us that radiologists and cardiologists don't like to play in the same sandbox. The relationship between the specialties has long been characterized by turf wars, competition and political wrangling. Yet, a new collaborative model is beginning to emerge across the radiology/cardiology spectrum—cardiovascular imaging, vascular medicine and cardiac cath labs. Indeed, external factors, including healthcare reform, reimbursement cuts and increasing health imaging scrutiny, may accelerate the development of partnerships and blur traditional boundaries between specialties and departments.
The benefits of collaboration are indisputable, according to the handful of brave pioneers who have developed strong collaborative programs. "Having a collaborative approach is more likely to lead to better outcomes, more appropriate utilization and streamlined testing—so that multiple tests are avoided when a single test can provide the answer," offers Peter L. Zwerner, MD, co-director of the Medical University of South Carolina Chest Pain Center in Charleston. The cumulative advantages include less radiation, less expense and less risk. Barry Katzen, MD, medical director of Baptist Cardiac & Vascular Institute in Miami, agrees, noting, "We're able to produce much more cost-efficient, high quality care."
At Brigham and Women's Hospital in Boston, the Carl J. and Ruth Shapiro Cardiovascular Center houses all non-invasive cardiovascular imaging technology and expertise in one location and under one organizational aegis. Its director, Marcelo F. Di Carli, MD, hopes to provide more definitive answers about the value of collaboration with a recently designed clinical trial that compares downstream testing and costs for the collaborative and traditional cardiovascular imaging models.
Collaboration advocates refer to the federal tea leaves as an indicator of what's around the corner. Discussing accountable care organizations (ACOs), vertical integration, patient-centered medical home and global capitation, Zwerner notes, "These are all buzzwords for 'play well in the sandbox or else.' We need to figure this out, or it will get legislated."
Collaboration, however, is much easier said than done. Few organizations have met with success, partially because the approach represents a monumental shift in practice models and requires physicians to shed their egos and share the wealth.
The writing on the wall
Baptist Cardiac & Vascular Institute formed in 1987 with a few fundamental principles. "We treat the circulatory system as a single organ—the pump and the pipes. This principle is integrated in care delivery and how physicians work together," explains Katzen. The institute's founders aimed to minimize turf battles and prove that a collaborative approach could benefit everyone across the enterprise. "Hidden in that statement is the fact that everyone does not always win equally," confides Katzen.
The MultiSpecialty Occupational Health Group (MSOHG) represents a more recent exemplar of multidisciplinary collaboration. Formed in 2005, the committee is comprised of physicians representing all major cardiac, radiologic and electrophysiological societies and aims to optimize the interventional laboratory. "Ultimately, the distinction between interventional radiology and interventional cardiology will disappear," predicts Lloyd W. Klein MD, professor of medicine at Rush Medical College and director of Clinical Cardiology Associates, both in Chicago.
Klein envisions the development of a vascular medicine team, with current approaches to peripheral vascular disease and carotid stenting performed by neuroradiologists serving as leading indicators of the new model.
Teamwork is at the heart of collaboration. Di Carli refers to the Brigham's cardiovascular imaging program as the imaging specialist-guided, patient-centric approach. "The new vision starts with the patient and the clinical questions presented by the referring physician. We take it from there and determine the best testing pathway, irrespective of how finances flow," he explains.
Take for example the 58-year-old