HeartSource Clients: Case Studies

Columbia HeartSource has contracted with nine hospital clients throughout the northeastern United States.

Over the past eight years, its work with these programs has provided important experience in conceiving, planning, and initiating other cardiac surgery programs, and putting in place the correct skill mix to ensure a program's success.

New Programs

To date, Columbia HeartSource has built four new cardiac surgery programs from Certificate of Need (CON) to successful cardiac surgical service. Typically, each program has taken 12 to 24 months to proceed from the initial contract to the first surgery. While the programs share many similarities—renovation of operating suites, education of staff, recruitment of surgeons, training of perfusion teams, building of cardiology referral networks, and setting up the HeartSource database's management—each client is unique.

Mary Imogene Bassett Hospital, in Cooperstown, New York, is a 180-bed acute-care community teaching facility located northeast of Albany. The Bassett Hospital serves as the anchor facility of a network of 20 community healthcare centers and two smaller (40 beds each) acute inpatient facilities. Columbia HeartSource recruited two cardiovascular surgeons and trained all related clinical support personnel, including staffing for anesthesia, perfusion, nursing, the ICU, and the telemetry floor. Columbia HeartSource established Bassett's clinical care protocols and provided help building its cardiology referral network. Bassett staff were trained in the use of the HeartSource database, a key element in Columbia's strategy to keep programs safe and profitable. Where previously it had no cardiovascular surgical program, Bassett is now seeing upwards of 120 cases a year and is still growing. Bassett's initial contract period, from 2001-2006, has been renewed through 2008.

Bon Secours Maryview Hospital, located in Portsmouth, Virginia, is a 346-bed acute-care community hospital that provides specialty diagnostic and treatment services. Columbia HeartSource helped Maryview secure a CON in the face of fierce competition from a much larger hospital. The CON was approved in March 2003, and a master facility plan was completed by October 2003. Drawings went out to bid in February, and a contractor was approved in May. Construction began in September 2004. Columbia HeartSource assisted during these two years of strategic planning, including architectural review of a new wing housing state-of-the-art operating rooms for cardiac surgery and patient rooms, guidance for policy and protocol development, training support for clinical specialties, and recruitment of two Columbia-trained surgeons. The first open heart surgery took place in November. Maryview saw 60 cardiovascular surgical cases in its first six months of operation. Columbia HeartSource continues to provide oversight of the program's quality assurance process. Maryview's initial contract started in 2002 and runs to 2010.

Robert Wood Johnson University Hospital, located in Edison, about fifty miles from New York City, is New Jersey's largest free-standing, state-designated, acute-care children's hospital. In partnership with University of Medicine Dentistry of New Jersey-Robert Wood Johnson Medical School and Children's Specialized Hospital, Robert Wood Johnson University Hospital offers comprehensive pediatric specialties and subspecialties, including pediatric cardiology through Columbia HeartSource. Currently, a Columbia surgeon travels from New York City to Edison to perform surgery. By establishing the program and gradually increasing volume, the expectation is that Columbia HeartSource will soon be able to recruit a surgeon dedicated to the New Jersey program. In addition to providing surgical services at Robert Wood Johnson, Columbia HeartSource is also engaged in providing program leadership, evaluation of current services and staff, and supporting the institution's marketing efforts. The contract period runs from 2004 to 2007.

Columbia HeartSource is currently working on a fourth new program at Stamford Medical Center in Stamford, Connecticut, a suburb close to New York City. The Stamford Medical Center is a 305-bed acute-care community hospital that has a long standing educational partnership with Columbia University College of Physicians and Surgeons and a relationship with NewYork-Presbyterian Hospital. "When Stamford decided to pursue a Certificate of Need to perform open heart surgery, Columbia was the obvious partner," says CEO Brian Grissler. The CON application was submitted in October, 2005 and approved in December. HeartSource provided program development, including architectural review and renovation of existing space; recruitment of surgeons, a cardiac anesthesiologist, and support staff; and team training. The program's first surgery is projected for February, 2007. Grissler praises Dr. Eric Rose and the Columbia team for being "generous, flexible and insightful." Grissler says, "We went with Columbia because we wanted a first-class facility for our community." Columbia HeartSource will provide ongoing oversight of the quality assurance process for the contract period ending in 2010.

Stamford staff were able to visit two other Columbia HeartSource Community (CHSC) sites to witness first-hand, how being part of CHSC means gaining valuable opportunities and support.

Existing Programs

Hospitals experiencing challenges with their cardiac surgical programs have turned to Columbia HeartSource for help rebuilding their programs.

Arnot Ogden Medical Center is a 256-bed independent community not-for-profit medical facility located in Elmira, just south of the Finger Lakes region of New York State, and serves as a regional provider of a range of diagnostic, ambulatory, secondary, and tertiary care services. In 1999, when Arnot Ogden contracted with Columbia HeartSource, its cardiac surgical program needed to improve the quality of its surgical performance. In the initial contract, Columbia HeartSource offered strong leadership combined with clinical oversight, and recruited two new surgeons. In 2002, Arnot Ogden renewed its contract with Columbia HeartSource through 2007. The CHSC affiliation has enabled Arnot Ogden to create and maintain a robust quality assurance program with active clinical oversight and strategic program development support within its Arnot Ogden Heart and Vascular Institute.

Stony Brook University Hospital, in Stony Brook, New York, is an important component of one of the nation's pre-eminent academic medical centers and one of the leading public research universities. Its Heart Center integrates the cutting-edge research resources of the University and its Health Sciences Center with advanced clinical care provided by Suffolk County's tertiary hospital. Stony Brook contracted with Columbia HeartSource after the hospital's pediatric cardiac surgeon left the facility in 2001. Currently, a Columbia surgeon from New York City travels weekly to Stony Brook to provide leadership and oversight, and to perform pediatric cardiothoracic surgery. The contract runs through 2006.

Bon Secours St. Francis Hospital is a 257-bed facility located near downtown Greenville, South Carolina. St. Francis offers a complete range of comprehensive surgical and diagnostic services, and includes St. Francis Women's & Family Hospital as well as two outpatient surgical centers. St. Francis' pre-existing cardiac surgery program performed 200 cases annually. But the St. Francis program suffered when a competing hospital delivered an ultimatum to surgeons that they must drop their work at St. Francis or lose their privileges elsewhere. In 2003, St. Francis contracted with Columbia HeartSource, and by 2004, with two newly recruited, Columbia-affiliated cardiac surgeons in place, the St. Francis program was rebuilt. By 2005, it performed 230 surgical cases annually.

Recently named by HealthGrades as the best cardiac surgical program in the state, St. Francis continues to grow. In addition to recruiting two surgeons, Columbia HeartSource performed a comprehensive evaluation of the program's infrastructure, and has made recommendations regarding staffing, development of a quality assurance program and marketing efforts. In addition, HeartSource will assist in the development of a clinical trials program at St. Francis. The contract runs through June 2007.

The Valley Hospital, a 451-bed acute-care community hospital, is located in Ridgewood, New Jersey. Columbia HeartSource was engaged when the established cardiac surgical program at this hospital was facing program transition challenges. Columbia HeartSource has recruited one senior and one junior surgeon, and has taken over professional billing for cardiac surgery. It also provides continual practice review, has given guidance on clinical care protocols, and provides quality assurance programming and oversight. The contract period runs from 2003 to 2008.

Children's Hospital of the King's Daughters (CHKD), in Norfolk, Virginia, is the only free-standing full-service pediatric hospital in Virginia. Its patients come from a broad region that includes southeastern Virginia, the Eastern Shore of Virginia and northeastern North Carolina. The hospital is licensed for 186 beds and provides a full range of medical and interventional inpatient care, and surgery for children facing both common and complex illnesses and injuries. Upon the departure of a pediatric cardiothoracic surgeon that forced the institution to abruptly halt its cardiac surgery services, Columbia HeartSource was engaged to rebuild and restore the program.

Columbia HeartSource recruited a full-time surgeon who would receive back-up coverage from Columbia HeartSource Community affiliate program Bon Secours Maryview, in Portsmouth, Virginia and made recommendations for enhancing CHKD's infrastructure, staff, quality assurance program, and marketing efforts. The contract for this site started in 2006 and runs through 2011.