Virginia open-heart surgery programs establish unprecedented quality network

Five Richmond-area hospitals -- Chippenham Medical Center, Henrico Doctors’ Hospital, Medical College of Virginia Hospitals, Memorial Regional Medical Center and St. Mary’s Hospital – have joined the Virginia Cardiac Surgery Initiative (VCSI). The initiative is a voluntary consortium of 10 cardiac surgery physician groups and 17 hospitals throughout Virginia that have united in an effort to raise quality standards across the state.

VCSI members have agreed to collect and share clinical and utilization data on all open-heart surgery procedures performed in the state, including coronary artery bypass grafts and valve replacements. The group’s goal is to improve quality of care and patient outcomes by examining up to 50 specific clinical and operational issues.

"This project is the first such initiative in the country," says Joseph James Zocco, M.D., a Richmond surgeon associated with Cardiac and Thoracic Surgical Associates Ltd., a VCSI participant. "We hope that by comparing data and learning from each other, each hospital and surgery group will share best practices from each other, and ultimately, the Virginia residents will benefit all over the state. We are very excited about participating in this initiative."

Mark R. Bladergroen, M.D., another surgeon in the same group, adds: "The VCSI is a one-of-a-kind voluntary collaboration where all cardiothoracic surgery groups and hospitals offering open-heart surgery services have decided to pull together and share quality and outcomes information in a non-competitive environment. By doing so, we hope to raise the standard of care for cardiac surgery patients for the entire commonwealth of Virginia."

"This is an important and innovative initiative and an encouraging first step in forming a collaboration between all of the major medical institutions in the state," says Robert S.D. Higgins, M.D., associate professor of surgery and chairman of cardiothoracic surgery at Virginia Commonwealth University’s MCV Hospitals. "We look forward to working with other Virginia cardiothoracic surgeons in improving the delivery of surgical care throughout the state."

LBA Consulting Group, a national healthcare consulting company, will manage the data repository for VCSI. The 50 different indicators that are being tracked include mortality and complication rates, respiratory infections, hospital readmissions, post-operative strokes and average length of stay. The project will use data from the Health Care Financing Administration (HCFA), which administers the Medicare program, and from the Society of Thoracic Surgery database.

As a primary benefit for patients, each individual institution will set up its own global package price for each procedure. A global price is a set fee that encompasses all aspects of care, including the surgeon’s and consulting physicians’ services, hospital room charges, surgical supplies, post-operative care, medications and cardiac rehabilitation. The VCSI initiative aims to eliminate any confusion that could be caused by the traditional method of payment in which a patient receives and must pay detailed statements covering as many as a dozen different services. Typically, physicians and hospitals assume a tremendous amount of risk under global pricing because they will receive a set fee no matter how much it costs them to treat a patient.

This initiative will enable VCSI to develop and send an unsolicited demonstration application to HCFA for review during the first quarter of 2000. VCSI’s application is a natural evolution of HCFA’s original program that sought to confer a Center of Excellence designation on select heart-surgery programs.

The VCSI is already in the process of submitting data to establish baselines. Ongoing review and comparison will begin in 2000 and continue through 2002.