Developing effective invasive cardiology services. Guideline report

Diseases of the heart are the leading cause of death and the major reason for days stayed in the hospital and discharges from the hospital. Nearly 1 million Americans died last year from cardiac disease, and over 60 million suffer from some form of cardiac disease. Conservatively stated, 300,000 cardiac surgeries and 600,000 cardiac catheterizations are performed annually, and the number is rising. Therefore, heart disease is understandably big business for hospitals and physicians. The organization of cardiac delivery systems is changing dramatically, primarily as the result of advancements made in the nonsurgical treatment of cardiac disease. The balance of power is shifting from cardiac surgery to cardiology, resulting in political and economic consequences for hospitals. Cardiac diagnosis is also undergoing a transformation, as less invasive procedures increase in sophistication. As hospitals consider their options in this market and observe physicians, medical groups, and alternative delivery systems providing competing services, the strategic alternatives become confusing and decidedly difficult. This report is written as a guide to assist hospitals in understanding the technological forces underlying the changing market and the effect these changes will have on the ownership, organization, and structure of delivery systems and, most specifically, on the delivery of cardiovascular services. Because of the tremendous interest in invasive cardiology services and the significance of the financial, organizational, and quality commitment involved in the delivery of invasive cardiology services, this guideline report addresses primarily those services. Noninvasive technologies also are addressed because of their importance to a cardiology program, the magnitude of the technological changes taking place, and their potential impact on the diagnosis and treatment of cardiac disease. The report begins with a discussion of the general planning issues that provide the foundation for the development of an effective cardiology program and details the methodologies and practices necessary to implement the planning process. Included are market assessment and financial planning models, which contain sample reports and provide conceptual and factual starting points for market-specific planning in such areas as demographic and market research, equipment costs, staffing considerations, and pricing alternatives. In addition to strategic, financial, and market planning issues, the report addresses the clinical factors involved in the operation of a cardiology department.(ABSTRACT TRUNCATED AT 400 WORDS)