January 31, 2000 - Richmond, Virginia - An alliance of Virginia hospitals and surgical groups have formed the Virginia Cardiac Surgery Initiative (VCSI), in an unprecedented effort to raise quality standards and ratings across an entire state. Consisting of every open-heart surgery program and Cardiothoracic surgical group in the Commonwealth of Virginia with the exception of Veterans Administration hospitals, VCSI members have agreed to collect and share clinical and utilization data on all open-heart surgery procedures performed in the state. While Virginia's quality, as measured by mortality or death rates, is equivalent to the national average, the Initiative feels that sharing data will further improve quality and provide for better outcomes. VCSI's Quality Initiative is also important as it supports the group's goal of conducting an unsolicited, "waiver-only" demonstration with the Health Care Financing Administration (HCFA).
HCFA's original Medicare Participating Centers of Excellence program sought to recognize quality programs by conferring a Center of Excellence designation to a select institution. The Virginia Cardiac Surgery Initiative endeavors to raise the bar of quality across institutions by promoting a collaborative atmosphere where participants share data and adopt best practices. All participants will share quality and outcomes data through a statewide clinical repository with tracking and analysis capabilities necessary to support the unsolicited demonstration. This data repository will support VCSI's goal of striving for clinical excellence while concurrently examining resource utilization and efficiency issues. LBA Consulting Group, a national healthcare consulting company, will be managing the data repository and will assist the VCSI in achieving its goals.
Virginia Cardiac Surgery Initiative hospitals are optimistic that their combined efforts, in conjunction with the Cardiothoracic surgery groups, will further elevate the quality of care across the state. Dr. Irving Kron, Chief of Thoracic Cardiovascular Surgery at the University of Virginia explained, "Virginia is the first state where all the open-heart programs have collectively and voluntarily organized in order to raise the standard of quality care for open heart surgery. We anticipate that when the unsolicited demonstration application is reviewed, HCFA will see the value of granting and supporting the Initiative in its efforts. We expect the application to be submitted to HCFA during the first Quarter of 2000 and are optimistic for its approval." The data collected in Virginia should be of great interest to cardiac surgeons and healthcare providers throughout the nation as they attempt to measure the impact of changes in the Medicare system. This initiative could provide a highly utile model nationwide; however, even if HCFA chose not to accept the application, the VCSI is committed to its quality focus and will continue to examine important clinical issues.
"This is an effort to develop a common goal and develop some benchmarks," says Lenox D. Baker, M.D., of Mid-Atlantic Cardiothroacic Surgeons, Ltd., of Norfolk. "Our first priority is to look at best practices, with the goal of reducing complications. We believe this will raise quality standards statewide and reduce mortality."
Baker says surgeons at Sentara Norfolk General Hospital and Sentara Virginia Beach General Hospital have participated in a similar program at the local level for five years.
Jeff Rich, M.D., also of Mid-Atlantic Cardiothoracic Surgeons, says since these "Center of Excellence" programs were established locally, there has been a "dramatic improvement in the quality of care, while reducing in-hospital length of stay and mortality. Overall results have been so impressive, we have earned national attention and have been recognized as one of the top 50 cardiac surgery programs in the United States."
"Riverside Regional Medical Center and the Cardiac Surgeons are dedicated to high standards of care and advancing our program. We have been participating in the planning stages of this project for the past 2 years. We're excited about the initiative and the potential benefits to our patients. We have been active in tracking the results of our program and hope that this will be an opportunity to participate in Quality Outcomes tracking on a Statewide level," says Paul L Evans, Jr. M.D., of Tidewater Thoracic and Cardiovascular surgical group in Newport News.
The demonstration will also test the efficacy of an all-inclusive fixed price methodology. Each individual institution will submit a unique, fixed global payment for all hospital and physician cardiac surgery services. This simplified pricing methodology would benefit HCFA, Medicare beneficiaries, hospitals and physicians. With HCFA's acceptance of the demonstration, the quality objectives and global pricing will allow an examination of the effects of hospital and physician-aligned risk regarding quality of care and patient satisfaction. This is particularly important as global pricing promotes closer collaboration between hospital management and physicians on issues that impact quality.
All quality information will be shared internally for quality review purposes and support of the HCFA demonstration only. The VCSI is already in the process of submitting data to establish baselines and ongoing review. Comparisons are expected to begin in 2000.
The Virginia Cardiac Surgery Initiative is a consortium of all hospital open-heat programs and cardiothoracic surgery groups in the Commonwealth of Virginia. Their purpose is to raise the bar on quality care for all citizens of the Commonwealth.
Inova Alexandria Hospital
Carilion Roanoke Memorial Hospital
Chippenham & Johnston Willis Hospitals
Inova Fairfax Hospital
Henrico Doctors Hospital
Lewis-Gale Medical Center
Lynchburg General Hospital
Mary Washington Hospital
Medical College of Virginia Hospitals
Riverside Regional Medical Center
Sentara Norfolk General Hospital
University of Virginia Health Sciences Center
Sentara Virginia Beach General Hospital
Winchester Medical Center
Bon Secours Memorial Regional Medical Center
Bon Secours St. Mary's Hospital
MCV Cardiac Surgery
Cardiovascular and Thoracic Association, LTD
Cardiovascular Surgical Associates
Lynchburg Cardiothoracic Surgery
Cardiovascular and Thoracic Surgery Associates, PC
Cardiac and Thoracic Surgical Association, LTD
Mid-Atlantic Cardiothoracic Surgeons
Virginia Cardiovascular Surgery
Tidewater Thoracic and Cardiovascular
University of Virginia Thoracic Cardiovascular Surgery