By Julie Budnik
How do you make a good thing better? This is the challenge that everyone confronts at some point in his or her personal or professional life. Stepping outside of a comfortable successful place not only takes courage, but also vision. Four years ago, the leadership team at WellStar Health System decided it was time for a big step.
Under the direction of former president and CEO Dr. Robert Lipson and current President and CEO Dr. Gregory L. Simone, along with a team of top cardiologists, cardiovascular surgeons and staff, WellStar Health System was successful in obtaining a certificate of need for an open heart and angioplasty program.Â The leadership team decided to present its application for a unique program that would establish a partnership with Emory Healthcare to provide a cardiac residency training program and provide the cardiac angioplasty services needed by the community but only available at Atlanta hospitals. Although initially opposed by two other hospitals, ultimately the state Supreme Court ruled in favor of the program and the building and physician recruitment process began. “It has been a great marriage,” says William Cooper, M.D., Medical Director of Cardiovascular Surgery at WellStar Kennestone Hospital and assistant professor of surgery at Emory. “The program has allowed Emory to link with core referral groups and with the second busiest ER in the state, WellStar Kennestone wouldno longer have to transport cardiac cases elsewhere from the northern corridor.” Prior to the agreement, cardiologists at WellStar Kennestone Hospital were driving to Atlanta to do interventional procedures, which was problematic, and patients who needed cardiac surgery were referred to Atlanta hospitals. Currently, cardiacÂ catheter-based interventional procedures are done at both WellStar Kennestone and Cobb hospitals with physician residents rotating through the program at four-month intervals. “As a provision of the program, we have cardiovascular surgeons to meet volume demands, a medical director, fellows, perfusion services and physician services,” says Pat Jansen, Vice President of Cardiac Services for WellStar Health System.
“We were the new kids on the block in the shadow of cardiac giants like Emory, St. Joseph’s and Piedmont,” says Dr. Cooper. “We had to overcome the infant against the veterans standing and prove that we could do this and do it well.” Although there were growing pains in terms of creating the infrastructure for the program, the staff and physicians stepped forward to make the open heart program a success. The program is currently rated in the top 10th percentile by the National Quality Forum for cardiac surgery nationwide. “We were very methodical in the process and put together a good plan for administration, finance, infrastructure and doctor buy-in and support,” says Dr. Cooper. Dr. Cooper studied other successful business models including the books The Southwest Airlines Way and Good to Great to discern key strategies for success.
The team at WellStar Health System has defined itself by offering a cutting-edge full-service cardiology program, with the exception of transplant services. The WellStar Health System cardiology program is providing a continuum of care to the patient population in northwest Georgia. Three of the hospitals within WellStar Health System, Cobb, Douglas and Kennestone, all accredited chest pain centers, combined have four labs, including one electrophysiology lab, two cath labs and one swing lab for cardiac and peripheral procedures.
Two-and-a-half years ago, WellStar Cobb Hospital had the opportunity to apply to be part of the Cardiovascular Patient Outcomes Research Team, which originated at Johns Hopkins Medical Center.Â The study began in an effort to determine if percutaneous coronary interventions (PCIs) could safely be performed without open heart surgical facilities being available on site. Out of a group of 25 hospitals, 10 were selected and WellStar Cobb Hospital was the only hospital that had cardiac surgery access within its own system at WellStar Kennestone Hospital. “We knew we could provide the needed services,” says Jansen. “We see a large volume of cardiac patients, and we are the sole acute care hospital in the areas where we are located.” Jansen does caution that it is critical that patients be assessed accurately to ensure that they are in the right facility if they are at higher risk.
In January 2009, two physician practices joined WellStar Health System: Cardiovascular Medicine (CVM) and Thoracic Surgery Associates. “We began to explore different ways we could work with WellStar and decided the best way was to join the system in order to form a service line, which would allow us to have more impact and give us the resources we needed to reach out to the community,” said Barry Mangel M.D., Chief Cardiology Officer and President of WellStar CVM.Â The 28 physicians and staff at WellStar CVM offer all forms of diagnostics, including echocardiography, nuclear studies, cardiac caths, coronary angioplasty and electrophysiology. “We are defined by the care we provide and the high level of service and quality of care we deliver across the spectrum.” In April 2009, East Cobb Cardiology joined WellStar CVM.
WellStar Health System was recently awarded the Better Performer distinction by the Medical Group Management Association (MGMA). “We were compared to like-sized groups across the country in areas like quality of care, practice management and cost effectiveness,” says Dr. Mangel. Additionally, WellStar Kennestone Hospital achieved the 100% Gold Standard for door-toballoon time established by the Center for Medicare and Medicaid Services (CMM) Core Measures for treating patients with heart attack in 90 minutes or less. The goal is to have patients’ arteries open as soon as possible to prevent heart muscle damage. Patients are metro atlanta m.d. news june 2009 | 19 assessed in the field by EMS with portable EKG equipment, which is then transmitted to ER physicians at WellStar Cobb or Kennestone hospitals. “We worked with EMS and emergency departments to makesure care was coordinated and the patient was on the way to the hospital with capability to open blocked arteries if needed,” says Jansen. “Everyone had their eyes open to a possible MI or need for angioplasty.” The average door-to-balloon time for WellStar Kennestone Hospital is now 55 minutes, well below the national standard of 90 minutes.Â Jansen also noted that they coordinate with the Emory LifeNet heliambulances that bring in patients from the north Georgia mountains and west Georgia.
The concept of a continuum of cardiac care for patients is ever present with the WellStar Health System physicians and staff. The cycle begins with primary prevention through community educational programs, which include health screenings, smoking cessation classes, stress management, CPR and first aid classes and cardiac health education. In the last few months, over 200 patients with risk factors were screened with a calcium CT scan and a significant number were identified as having asymptomatic heart disease. Getting the message out to young people about making healthy choices is a priority at WellStar Health System.Â “We recently had one of our doctors go to Paulding County High School and assess the entire ninth grade class for risk factors for heart disease,” says Dr. Mangel. “He talked to them about lifestyle, nutrition and exercise.”
Episodic and emergent care is of the highest caliber at WellStar Health System. An array of cutting-edge diagnostic tools are available, including EKG, CT scans, nuclear cardiology, EP studies and diagnostic cardiac catheterization, just to name a few. Once the patient is fully assessed by the medical team, a treatment plan is established to maximize a positive outcome. Treatments range from percutaneous coronary intervention, medical management, pacemakers and defibrillators to cardiac surgery. All of these treatments are available in house through the talented team of cardiologists and cardiovascular surgeons.
Once the patient is stabilized and treated, secondary prevention comes into play. Ultimately the health care team wants to be a partner in ensuring that patients return to their active lives and stay healthy. Through cardiac rehabilitation programs at three WellStar hospitals, registered nurses, rehab specialists and social workers are just a few of the professionals that help cardiac patients achieve their wellness goals. WellStar Health Place, a health and wellness facility on the WellStar Kennestone Hospital campus, has a stateof- the-art gym, pool and weight loss center supervised by highly qualified professionals. Patients can even enroll in a program that provides three meals a day so that caloric intake and weight loss may be carefully monitored. “We have a continuum of care, and we are trying to go from prevention to rehab,” says Dr. Mangel. “The patients who go through the rehab process have a wonderful experience and they are educated on the importance of exercise, diet, weight loss and smoking cessation.”
Cardiac medicine is steadily moving towards more minimally invasive procedures including artery take downs and valve surgeries.Â WellStar physicians are future focused on this concept. “I think what sets us apart is that 90% of our surgeries are off-pump or beating heart surgeries,” says Jansen. “Dr. Cooper prefers this method and has worked with it extensively.” WellStar Health System surgeons are also moving into the area of robotic surgery for valve cases. “WellStar is becoming physician led and physician driven,” says Dr. Mangel. “We have an awesome opportunity to build a successful program for the communities we serve.” Dr. Cooper believes that building a strong foundation is all about leadership and motivation. “You must have people at the top who are committed and you must have buy-in from the physicians,” says Dr. Cooper. “You can have the brightest and best, but without consolidation, leadership and community support, you will not be successful.” The thriving WellStar cardiology program is part of an integrated health care system led by over 400 physicians. “We are community citizens and want to improve the quality of life for our patients through world-class cardiology services, preventative care and education,” says Jansen. “We live our mission of providing the best care at the right time.” This talented group of health care professionals is poised to do just that.
The vision of WellStar Health System is to deliver world-class health care. WellStar, a not-for-profit health system, includes Cobb, Douglas, Kennestone, Paulding and Windy Hill hospitals; WellStar Physicians Group; Urgent Care Centers; Health Place; Homecare; Hospice; Atherton Place; Paulding Nursing Center; and WellStar Foundation. For more information, call (770) 956-STAR or visit www.wellstar.org.