Launching a TAVR Clinic: Tips for CVSL Leaders

CVForward > Thought About Launching a TAVR Program?

E. Kristine Hammer

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Take a random sampling of cardiovascular team members from across the country. Now ask them whether their facility is likely to launch a transcatheter aortic valve replacement (TAVR) program. You’ll probably hear some similar responses:

No way. We could never do that here.

We’re a for-profit hospital.

Our patient population is mostly indigent.

We’d never recoup the investment.

Our administrators won’t sign off on that.

For every compelling “pro” to launching a TAVR program—meeting a critical need in your community, adding to your facility’s reputation, improving patient outcomes—there’s a seemingly insurmountable “con.”

And that con has a whole bunch of dollar signs in front of it.

An uphill battle

Starting up a TAVR program
E. Kristine Hammer, RN, BSN
Director Cardiovascular Procedural Service Line
Osceola Regional Medical Center, Kissimmee, FL

No one appreciates this uphill battle more than E. Kristine Hammer, Director, Cardiovascular Procedural Service Line at Osceola Regional Medical Center in Kissimmee, FL. At her hospital, approximately 60% of the patient volume is comprised of an indigent population. Nevertheless, the center wanted its patients to benefit from the cutting-edge technologies of a TAVR program. So she approached leadership at the system level for a win-win solution. Here are the steps she took to make a TAVR program a reality for her center.

Benefits of investing in a TAVR program:

STEP 1:
Identify your champions

Thinking in threes

The first step to a successful TAVR program launch is lining up committed individuals—team members who will shepherd the process from inception to completion. “We knew that a TAVR program is multifaceted,” Ms. Hammer says. “It involves medical, marketing, financial, and community aspects; so we decided on a 3-pronged approach to selecting our champions.” She recruited:

A physician champion: a medical thought leader who can explain and advocate for all the clinical aspects of TAVR. “They must be prepared to give lectures, completely know the criteria—including possible complications—as well as spearhead all training initiatives.”
A leadership champion: a seasoned expert in promoting the program both internally and externally. Ideally, this can be a Director of Procedural Services or VP of the CVSL. Ms. Hammer outlines their requirements: “They need to know community demographics, the finances and infrastructure involved, as well the competition. You need 40 cases in 2 years to keep your program running, and that’s hard to do if other institutions are seeking the same patients as you.”
A “navigator” champion: successful TAVR programs rest on “mining” a sufficient amount of patients to sustain profitability. “Navigators lead the search for patients. They serve as a liaison between surgeons and physicians. And they must be completely familiar with CMS guidelines. They walk the pavement to get people through the door.”

Champion Qualities

What makes an effective champion? Ms. Hammer sees it as a combination of pedigree and personality. “For a physician champion especially, they must be respected among their peers and have a history of solid clinical results. They need complete dedication—a willingness to do dinner meetings and weekend workshops. They also need a talent for pushing the envelope without alienating people.”

Finding your champions

How do you begin the search? Ms. Hammer sees several approaches.

STEP 2:
Build your case

Once Ms. Hammer had her champions lined up, it was time to start crafting a persuasive story to management for launching a TAVR program.

“All hospitals want you to show them the money,” Ms. Hammer says. “You need to make a business case or management won’t want to invest the resources.”

Building your case

On choosing a champion
E. Kristine Hammer, RN, BSN
Director Cardiovascular Procedural Service Line
Osceola Regional Medical Center, Kissimmee, FL

Her approach went far beyond showing simple income from TAVR procedures.

Build out your ancillary story: show the often-unrecognized places where TAVR may make a financial difference. “We pushed for the fact that TAVR would grow ancillary business like CT scans, valves, etc., as well as reduce readmission rates.”
Find examples: research pioneering TAVR programs to help you forecast the impact on your institution. “We reached out to other facilities to see the kind of results they were achieving,” Ms. Hammer says. “We must have talked to 20-30 physicians to evaluate the impact TAVR had on money, volume, and ancillary increase. It really helped us build our presentation.”

The approach

On building your case
E. Kristine Hammer, RN, BSN
Director Cardiovascular Procedural Service Line
Osceola Regional Medical Center, Kissimmee, FL

Keep your surgeons happy: be ready to show surgeons that they will not be underutilized. “Valves were the key to this,” Ms. Hammer says. “Our forecasted increase in valve replacement let the surgeons know that they would still be doing surgery.”
Rely on your vendors: equipment manufacturers have vast ammounts of knowledge regarding reimbursement and financial data for their products and are ready to lend their expertise. Use them.
Don’t forget staff satisfaction: TAVR benefits staff as well as patients. “Our research showed that TAVR delivered higher rates of physician engagement and staff satisfaction, and that made the case for increased retention of valuable workers.”

STEP 3:
Present to leadership

The champions were assembled. The data gathered. Now Ms. Hammer faced her biggest hurdle: presenting her TAVR case to management in hopes of a green light and essential resources. Ms. Hammer recalls her game plan:

Postscript

While it took a total of 10 months from concept to completion, the results were gratifying. Not only did the approved plan deliver significant increases for other service lines, but also a benefit that Ms. Hammer finds particularly rewarding: “To date, we have had zero mortalities and only 1 complication in our TAVR program. And that complication was quickly and successfully resolved.”

And ultimately, those are the results that matter most of all.

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