Lynn B. McGrath, MD, is Vice President of Medical Affairs at Deborah Heart and Lung Center. He performed cardiac surgery at Deborah for nearly three decades. Deborah is a member of the Quality Institute’s Provider Council.
Heart and lung surgery is changing swiftly — both in the operating room and in the way this complex care is reimbursed. Let’s start with changes in surgery. What are you seeing?
We’ve seen what I would call a tectonic shift in the past decade. Heart surgery used to always mean performing a sternotomy, placing the patient on the heart-lung machine and stopping the heart. The patient experienced a long recovery. Now a lot of both lung and heart surgery can be done with minimally invasive incisions. Anesthesia has improved over the years. We are able to wake patients up sooner and often get them out of bed the evening of their surgery. They can be walking around by post-operative day two. Getting patients moving creates a better sense of wellbeing. They can go home sooner. Cynics may say this is just about saving money. But it’s best for patients to ambulate and leave the hospital more expeditiously. We also can perform more heart surgery without stopping the heart, thus reducing complications. We just completed our 100th transcatheter aortic valve replacement (TAVR) procedure, where we can insert an aortic valve by entering an artery in the groin and threading a catheter with a new valve into the heart. Previously, this would have required open-heart surgery. At Deborah, we have pioneered minimally invasive surgical techniques in New Jersey. Some of these methods included performing beating heart surgery, so that the heart does not need to be arrested. We were also leaders in performing mini-incisions for surgery on the aortic valve and the mitral valve. These are just some of the changes we are seeing in advanced cardiac surgical protocols.
Medicare and other payers are moving toward value-based care. Are reimbursement changes transforming delivery?
It is having an impact. But what’s value? Value means being reimbursed for quality care and good outcomes, not necessarily for the number of procedures performed. Patient satisfaction and superb results will be key to reimbursement. We know we need to make sure operations start on time, that patients do not spend too long on breathing machines and that their pain is appropriately managed. We are seeing progress with reducing rates of infection and neurological events. We are making sure patients go home following a normal convalescence and with everything they need to avoid a readmission. These are the metrics that CMS and other third party payers are looking for. It all relates to doing good work and achieving patient satisfaction.
What about the possibility for bundled payments?
We know that cardiac care is expensive and we expect to see bundled payments impact on cardiac care at some point in the future. We do a lot of high-risk, highly technical procedures at Deborah, and we are preparing for payment changes by continually working to improve efficiency while keeping quality very high.
We keep reading about hospital consolidation and so-called medical merger mania. Deborah is independent and bucking the trend. How are you doing it?
Deborah has been around since the 1920s and we’ve always been innovative with our care protocols and have a strong brand in New Jersey. Our Board wants us to maintain the current clinical policies, procedures and protocols that over the years have worked well for us and for our patients. We have the highest patient satisfaction score for all acute care hospitals in the State, according to an independent survey. We have a four star CMS rating for both our inpatient and outpatient care, which puts us in the top 22 percent of American hospitals. I would not say that our Board and Administration is unwilling to talk to other organizations, as we do so on a daily basis. But we want to maintain our current independent approach because we are clearly doing something right. We have a high case mix index, which means that we perform a lot of high-risk procedures. We provide good care and have superb patient satisfaction. We don’t want to see any of that erode. Although we have not consolidated with another organization, we do collaborate with many hospitals and healthcare providers in the region. For example, Deborah affiliated with an area hospital to offer emergency services on our premises. Deborah also works with area providers to bring our own cardiac, vascular and pulmonary specialists and services out into the community. It is a win for the patients.
Many of your physicians are on your staff. How does that model benefit patients and your hospital?
All of our core physicians — our cardiologists, cardiac surgeons, anesthesiologists, vascular surgeons, pulmonologists and others — are full-time salaried employees. At big general hospitals you may have 1000 physicians or more on their staffs. We have the luxury of handpicking our physicians and then we support them with the resources they need. They like working here and develop their expertise with the highly technical procedures we provide. We’ve had many physicians and surgeons here for 20 years or more. Physicians at other institutions may be splitting their time between two or three different hospitals. They will do a procedure in one hospital and then run to another hospital. Our physicians only work here and they develop a team that stays with them. I have performed cardiac surgery for 30 years. I had the same scrub nurses with me for three decades. We believe this model leads to better outcomes and patient satisfaction. When multiple specialists are needed to care for a patient, our patients truly benefit from our team approach. Having our whole team right here ensures the best comprehensive treatment plan for each patient. We find this focus on patient-centric management makes for greater patient and physician satisfaction because doctors get to focus on what they love and what they do best – care for patients.