The Performance Improvement Priority

Business Consult | In today’s healthcare market, health systems must be structured as efficiently as possible to deliver a superior patient experience and effectively utilize resources. Changing payment methodologies alone will quickly expose and aggravate inefficient practices and processes. As a result, organizations are critically assessing their ability to meet patient access needs, control costs, and demonstrate value. It’s safe to say that identifying issues and improving performance across ambulatory operations has never been more vital to an organization’s viability.

Pursuing performance improvement across the ambulatory enterprise can be particularly daunting for cardiologists, who have a variety of competing patient demands to balance on a daily basis (e.g., inpatient rounding, clinic visits, testing reads, call coverage). We know this from our experiences working with cardiology groups to help them overcome the operational obstacles they face. Instead of offering a consultant’s summary of the operational challenges cardiologists confront, steps to overcome them, and potential outcomes, we would like to illustrate these points by offering you a glimpse into a recent engagement with a midsize cardiology group aimed at assessing and addressing the operational issues it was experiencing. The hope is that you may identify with some of the challenges this group experienced and gain valuable insight into how to structure a cardiology group to thrive in today’s healthcare environment while providing a sustainable practice for the providers.

Cardiology Group Overview

An eight-provider cardiology group within a larger multispecialty organization recently reached out to us to conduct a performance review of the practice. The group was integrated with a health system and, as such, had multiple demands on its time that removed it from its ambulatory practice. Other key features of the group included:

  • Specialty Mix — There were eight total cardiology FTEs: one noninvasive, three invasive, and three interventionalists. The practice also had one nurse practitioner (NP).
  • Sites of Service — There were two outpatient clinics (one main location and another smaller outreach site), a noninvasive laboratory (NIL) at the main clinic, a hospital, and a cath lab.
  • Clinic Schedule — There were four cardiologists scheduled in the main clinic, supported by one NP, with an additional cardiologist practice at a smaller outreach location. The remaining cardiologists were performing other clinical duties as noted below.
  • Test/Image Interpretation — A single cardiologist served as reader of the day, overseeing and interpreting all tests and imaging studies ordered, regardless of which cardiologist placed the order. All interpretations were required to be completed within 24 hours.
  • Test Reads — A noninvasive cardiologist provided a minimum of 20 hours per week, conducting reads for tests completed in the on-site clinic’s NIL.
  • Hospital Rounding — All cardiologists rounded on their own inpatients, which typically required 10 to 12 hours each week to complete
  • Call Coverage — The group maintained a general cardiology call panel. All cardiologists participated in the general cardiology call.

Practice Assessment Findings and Solutions

It became clear throughout this assessment that several performance and provider deployment issues inhibited the practice’s overall operational effectiveness. The table below outlines the primary performance issues the assessment identified and the solutions we proposed to the group.

The Result

With opportunities for improvement identified, the group took action. By implementing some of our recommendations, the group was able to alleviate unnecessary demand on cardiology time for activities outside of the clinic, align non-provider staffing, and utilize available clinic and NIL capacities. In turn, the group increased its productivity and realized almost $1,000,000 in incremental net medical revenue with the same staff and expense structure. The changes not only improved financial performance but enhanced patient care. The providers are now more available to service patient needs and utilize a care team model that ensures greater access to and continuity of services.

Balancing the competing clinical demands on cardiologists’ time can be challenging and, without a thoughtful approach, may result in suboptimal performance and unmet patient needs. By utilizing a limited amount of data, setting performance targets, and taking a critical review of typical models of care, the ambulatory environment can become a much more effective component of a cardiology group’s clinical practice while simultaneously improving the patient experience.

For more information, contact Michael Duffy at

Keywords: CardioSource WorldNews, Ambulatory Care, Consultants, Cost Control, Delivery of Health Care, Health Care Sector, Health Resources, Inpatients

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