CSA of Atlanta
By Julie Budnick
Traditionally, cardiology practices have been hospital based, with diagnostic procedures being performed in house and often at the mercy of emergency cases.
For nonemergent patients, this has meant longer wait times or possibly having a procedure cancelled altogether. Physicians become frustrated as they see their already tight schedules further delayed, and patients have increased anxiety at a time when they are already stressed. What is the solution? This was the question before the Atlanta Cardiology Group (ACG).
There was an obvious need for an outpatient facility offering a variety of diagnostic procedures. In October of 2000, ACG addressed this need by opening their own outpatient cardiac cath lab in a hospital outpatient building. The practice also decided to obtain accreditation of the new lab with the Joint Commission, an accreditation carried by hospital cath labs. Vicky Carroll, R.N., formerly of ACG and currently Director of Operations for Cardiovascular Services of America (CSA) of Atlanta, assisted in the Joint Commission preparation and obtaining the initial and subsequent Joint Commission accreditations.
In February of 2004, a new concept emerged in Atlanta when CSA officially entered into a partnership agreement with ACG, which is now part of the Piedmont Heart Institute. ACG made the move to Piedmont Hospital in 2007 under the direction of Dr. William Knapp, Medical Director of the CSA cath lab and managing partner of ACG.
The physicians and staff at ACG realized that a partnership with a national company, CSE, originally conceptualized at Vanderbilt University Medical Center, was the perfect solution. The CSA model would provide substantial cost savings and a beneficial patient experience apart from the hospital setting. Independent control, improved efficiency and a more predictable workflow were just a few of the benefits of partnering with CSA.
According to CSA’s corporate website, “CSA acquires, develops and operates outpatient cath labs and CT angiography suites in partnership with cardiology groups. By partnering with cardiology practices to develop outpatient facility-based services, CSA helps expand the volume of patients treated, deliver cardiovascular services more efficiently and improve patient outcomes.”
According to CSA, ” … facilities are operated as a partnership between cardiology groups and CSA. Our physician partners focus on providing clinical care. CSA staffs clinical support personnel and provides billing, collections, financial reporting, accreditation, administrative management and oversight of clinical services.” In the case of CSA of Atlanta, 51% ownership is held by CSA with the remaining 49% being held by Piedmont Heart Institute. Although CSA charges less than hospital-based labs for similar procedures, there is no reduction in total revenue because staff and space are used more efficiently, scheduling is predictable and a targeted range of procedures are offered rather than the entire gamut.
CSA of Atlanta was honored in 2001, 2005 and 2008 with being one of the few freestanding cath labs to achieve accreditation from the Joint Commission for meeting and exceeding national standards for quality health care. In September of 2008, CSA of Atlanta, the Piedmont Heart Institute and Piedmont Hospital Cardiovascular Imaging Center joined forces to open a new state-of-the-art freestanding office on the corner of Hammond Drive and Peachtree Dunwoody Road.
The new facility currently has the ability to accommodate a patient volume of approximately 150-200 patients per month in the cath lab. The staffing ratio is above average and consists of three R.N.s, one LPN and one medical assistant for seven patient rooms. In addition, two techs and one R.N. staff the cath lab during the procedures.
“In the clinical area, we have it set up like an ICU, with the nurse’s station in the center surrounded by seven individual rooms divided by sliding glass doors, with room for the patient’s family members and television sets for the patients and their family.” Carroll goes on to compare the experience to air travel today. “We can all get on a plane and take a trip, but you can have the experience of waiting in a crowded gate with many other people or you can go in to the Crown Room where there are nice sofas, televisions and a quiet environment without incurring additional costs. Which would you prefer?”
Unlike a hospital cath lab, the CSA facility is not open on holidays or weekends, so the staff is consistent and does not change. “We’ve tried to make a better and more comfortable enviroment for the patients with less anxiety,” says Carroll. The attention to detail and quest for a better patient experience put CSA and Piedmont Heart Institute at the leading edge of patient-centered medicine.
In terms of technology, the cath lab features a new Toshiba Infinix state-of-the-art cath lab. The new lab is equipped to do multiple studies including cardiac, peripheral vascular and cerebral. “Vascular physicians can use the labs as well, and an added benefit is being able to perform two separate procedures in a single case – for instance, imaging the heart and the peripheral vasculature,” says Carroll. Carroll is quick to emphasize that the lab does not perform diagnostic procedures on patients that should be in a hospital setting, and if the physician feels that the patient should be moved to the hospital, the close proximity to Piedmont makes that transition seamless for the patient and their family.
“The new offices have exceeded expectations,” says Dr. Knapp. He goes on to say that patient satisfaction has markedly improved because of the ease of access. No longer do patients have to deal with the inevitable parking issues that most hospitals have and the complication of navigating a hospital campus. “Our office is large and full service and the patients can be dropped off right at the front door,” says Dr. Knapp. Of particular importance is that “patients no longer get bumped for diagnostic procedures by last-minute hospital emergency cases,” says Carroll.
Carroll is getting the word out to the medical community about the benefits of scheduling procedures at CSA of Atlanta’s new standalone facility. While obviously patients are the first priority, Carroll is seeking out specialists who can benefit from the labs where they will never be bumped by an emergency procedure. “Doctors can block a schedule and know that they will be doing caths at a specific time and day,” says Carroll. The added incentive of not being exposed to common hospital infections cannot be overlooked in this time of rampant methicillin-resistant staphylococcus aureus (MRSA) and other infectious agents.
CSA of Atlanta believes that their new concept will continue the success it has enjoyed since opening. In fact, a second shell for an additional lab has been constructed and will be built out as demand increases.
The medical profession will continue to have growing pains, and change will be imperative to compete in today’s marketplace. More and more procedures are shifting to outpatient settings, where care is personalized and higher-end amenities are offered while cost containment is achieved for the patients and the insurance companies. Patients are well informed about their health care choices and are looking for quality care in a quality environment. Offering the best possible experience for patients and physicians, CSA of Atlanta has become a leader in determining the direction of invasive diagnostic cardiology in the future.