Download Merging the Podiatry Practice with the Cardiovascular

Merging the Podiatry Practice with the
Cardiovascular Practice: A Win-Win Formula
Desmond Bell, DPM, CWS
First Coast Cardiovascular Institute
Jacksonville, FL, USA
President and Founder
The Save A Leg, Save A Life Foundation
Disclosures
Speaker’s Bureau:
• Organogenesis
• Derma Sciences
• Diatherix
PAD: The Unnoticed Health Crisis
Peripheral Arterial Disease constitutes “a health crisis that is largely
unnoticed” by the public and all too often physicians as well, but that’s
all about to changeDr. Mark Creager
2015 Presidential Address, American Heart Association
The PAD and CLI Epidemic
• PAD is the natural extension of
CAD, even though they are
technically different diseases, both
are clinical manifestations of
atherosclerosis
• PAD affects an estimated 200
million people worldwide
• US healthcare costs associated with
PAD account for $20 Billion per year
• The risk of Acute MI, Stroke, or
Cardiovascular death among
patients with PAD exceeds that of
patients with established
cerebrovascular disease
AHA: New Spotlight on peripheral arterial disease.
Jancin B. Cardiology News Digital Network. Dec. 2, 2015
Value Based Care
Procedure-driven fee for service
reimbursement is being phased
out in favor of performance based
reimbursement
Value Based Care
• “…overarching goal for providers,
as well as for every other
stakeholder, must be improving
value for patients, where value is
defined as the health outcomes
achieved that matter to
patients relative to the cost of
achieving those outcomes”
• 6 Components identified
Porter ME, Lee TH Harvard Business Review. Oct. 2013; 1-19.
Integrated Practice Units (IPUs)
• The first principle in structuring any • IPUs treat not only a disease but
also the related conditions,
organization or business is to
complications, and circumstances
organize around the customer and
that commonly occur along with it—
the need.
such as kidney and eye disorders
for patients with diabetes
• In health care, that requires a shift
from today’s siloed organization by
• IPUs not only provide treatment but
specialty department and discrete
also assume responsibility for
engaging patients and their families
service to organizing around the
in care—for instance, by providing
patient’s medical condition.
education and counseling,
• In an IPU, a dedicated team made
encouraging adherence to treatment
and prevention protocols, and
up of both clinical and nonclinical
supporting needed behavioral
personnel provides the full care
changes such as smoking cessation
cycle for the patient’s condition.
or weight loss
Porter ME, Lee TH Harvard Business Review. Oct. 2013; 1-19.
Integrated Practice Units (IPUs)
• In an IPU, personnel work
together regularly as a team
toward a common goal:
maximizing the patient’s overall
outcomes as efficiently as
possible
• They are expert in the condition,
know and trust one another, and
coordinate easily to minimize
wasted time and resources
• They meet frequently, formally
and informally, and review data
on their own performance
Porter ME, Lee TH Harvard Business Review. Oct. 2013; 1-19.
• Armed with those data, they work
to improve care—by establishing
new protocols and devising better
or more efficient ways to engage
patients, including group visits
and virtual interactions
• Ideally, IPU members are colocated, to facilitate
communication, collaboration,
and efficiency for patients, but
they work as a team even if
they’re based at different
locations
The Virginia Mason Model
• Virginia Mason Medical Center in
Seattle created an IPU for back
pain
• “Spine Team” pairs Physician board
certified in physical medicine and
rehabilitation with Physical
Therapist
• Patients with low back pain call a
central phone number, most seen
the same day
• Team members usually assess
patient during the initial visit
• Follow up care often done in
satellite locations
Porter ME, Lee TH Harvard Business Review. Oct. 2013; 1-19.
• Virginia Mason patients miss fewer
work days (4.3 vs. 9) per episode
than regional averages
• Need less PT visits (4.4 vs. 8.8)
• MRI use to evaluate low back pain
has decreased 23% since launch
• Have seen more new patients per
year (2,300 vs. 1404) under old
system with same number of staff
• Results have been faster treatment,
better outcomes, lower costs and
usually improving market share for
the condition treated
The Team Approach to Lower Extremity
Preservation has already been Validated
• Whether “Toe and Flow” or
“Plumbing and Drywall”, the
teaming of Podiatry with the
Cardiovascular specialties is
essential to lower extremity
preservation
• We must recognize and
understand each other’s skill sets
and they can optimally benefit
patients
The Lower Extremity Preservation Team
• Zayed et al reported results of a
retrospective analysis of 312
patients with diabetes and critical
leg ischemia and demonstrated a
reduction in amputation rate in a
multidisciplinary setting
• The team was composed of a
vascular and podiatric
surgeon, diabetologist, tissue
viability nurse, interventional
radiologist, and a radiology
coordinator
Sacramento SALSAL Chapter
Driver, Fabbi, Gibbons, et al: The costs of diabetic foot: The economic case for the limb salvage team.
Journal of Vascular Surgery, Volume 52, Issue 6, December 2010, Page 1751
Zayed, Hawala, et al. Improving limb salvage rate in diabetic patients with critical leg ischemia using a multidisciplinary approach
Int J Clin Pract, 63 (2009), pp. 855–858
The FCCI Model
• First Coast Cardiovascular
Institute, Jacksonville, FL
• Practice began as Cardiology
specialty practice
• Several interventionists within the
group prefer performing lower
extremity endovascular
interventions
• Cath lab on site as well as
hospital performed procedures
The FCCI Model
• Full vascular lab testing, including
nuclear stress, arterial and venous
• Over the past several years,
locations have increased to 12
throughout NE Florida
• 2 plus years ago, brought on
Podiatrists who specialize in wound
care and limb preservation
• Other services have grown to
include Sleep Study/Pulmonology,
Primary Care, Nutritionist, Nurse
Practitioners
The FCCI Model
Final Thoughts
• Organizing into IPUs makes
proper measurement of
outcomes and costs easier
• Organizations that progress
rapidly in adopting the value
agenda will reap huge benefits,
even if regulatory change is slow
• Measuring outcomes is likely to
be the first step in focusing
everyone’s attention on what
matters most
Porter ME, Lee TH Harvard Business Review. Oct. 2013; 1-19.
• Better measurement of outcomes
and costs makes bundled
payments easier to set and agree
upon
• With bundled prices in place,
IPUs have stronger incentives to
work as teams and to improve the
value of care.
Final Thoughts
• Merging of specialized practices,
such as cardiovascular medicine
with podiatry makes sense on
several levels
• It is the most efficient model where
lower extremity limb preservation is
concerned
• It is also the model that will be
rewarded as the reimbursement
shifts to Pay for Performance/Value
Agenda
• Slow adapters will not be remain
financially viable
Thank You!
Merging the Podiatry Practice with the
Cardiovascular Practice: A Win-Win Formula
Desmond Bell, DPM, CWS
First Coast Cardiovascular Institute
Jacksonville, FL, USA
President and Founder
The Save A Leg, Save A Life Foundation