By Sue Anderson, MBA

We are in an era of unprecedented investment in cardiologist integration. In fact, most of you reading this column are probably now under the employ of hospitals. Despite investing considerable cash in physician integration strategies, hospitals and health systems still struggle to effectively leverage the knowledge and expertise that cardiologists possess in cardiovascular service line development and management. Many of you are caught dangling between the role of clinician and the role of administrator, unsure what influence you have in building the cardiovascular service. Furthermore, private practice physicians don't want, and can't afford, to be left on the outside looking in.

So, what's the answer? Hospitals need to promote the role of the cardiologist to one of leadership within the cardiovascular service line structure. And cardiologists need to proactively pursue leadership opportunities, not wait for them.

Creating a Culture of Physician-Led Governance and Accountability
The governance structure is the linchpin of the service line, and physicians are the key to an effective governance structure that aims to promote improvement in cost, quality, and access. Programs are finding that promoting a culture of physician-led governance, coupled with strong administrator support, is critical for successful service line development and alignment.

Why? Optimal service-line decision making cannot occur in administrative bubbles. For instance, the introduction of a TAVR program requires a high degree of coordination and collaboration between cardiologists and surgeons that many administrators may not understand. Forming a governing body around an inclusive structure—consisting of physician leaders (both hospital-employed and those in private practice) and administrators—gives everyone a seat at the table and allows for decisions that address the interests and goals of all stakeholders.

The types of decisions to be made are just as important as actual involvement in the decision-making process. A cardiologist recently shared a story with me about his lengthy involvement in decisions regarding the size and placement of the logo on his lab coat. Governance shouldn't be an illusion. Physicians accept leadership roles to affect meaningful change, not to waste time on small operational details. A governing body, then, needs clout within the organization and should report to—and have the support of—executive leadership to cement importance and maintain accountability for service line performance.

Involving Physicians in Service Line Management
Management models for cardiovascular service lines can take numerous forms, yet too often default to an administrator-led structure. In recent years, however, top-performing hospitals have begun to favor the physician-directed or dyad management structures. These models are powerful in elevating the role of the physician, driving alignment, and incentivizing performance. Since many physician recruits are interested in having leadership positions, it also may be easier to attract top physician talent under this model.

Aligning Incentives
While hospitals and physicians ultimately want to do what is in the best interests of patients and the service, financial interests also play a key role. As one cardiologist recently told me, "When we say it's not about the money, it's really about the money." Bringing together the interests of cardiologists and the hospital involves expanding opportunities for service line leadership and involvement, and for aligning financial incentives. In an upcoming column, we will more fully discuss the numerous ways to successfully align incentives, but building these incentives around quality, efficiency, and the patient experience brings hospitals and physicians together in developing a robust cardiovascular service line.

Position Your Organization for Long-Term Success
Demonstrating a commitment to you, the physician, is essential because cardiovascular services contribute heavily to overall profitability for most hospitals and health systems. Those organizations that give a great deal of control to physicians in governance and management of the cardiovascular service line, and work proactively to develop and nurture physician leaders, will be best positioned for success.

For more information, Sue can be reached at sanderson@ecgmc.com.