Having an experienced staff on board is just one piece of puzzle. Electrophysiology labs performing ablations should maintain a high volume for proficiency. The NASPE Policy Statement provides information on success of ablation procedures as related to volume.

Today, most institutions do not require board certification in Clinical Competency in Electrophysiology (CCEP) as a credentialing requirement. However, CCEP recommends applicants should have met board requirements as described on AHA journal Circulation website.5 Respondents to CCEP Training Program Directors’ Survey uniformly indicated that two years were required to achieve training in all aspects (diagnostic and therapeutic) of CCEP.1 Additionally, there is general consensus among EP practitioners that one year of specialized training in EP is needed to gain knowledge and technical skills necessary to become proficient in EP. In addition to general cardiology fellowship training, Clinical Competency Electrophysiology Training Program Directors’ Survey1 indicates that a minimum of 90 cases are required to acquire clinical competency in ablation. Furthermore, NASPE Ad Hoc Committee1 on catheter ablation recommends that a physician be primary operator on >= 30 procedures, including 15 accessory pathway ablations.

Not surprisingly, majority of EP physicians are located at high-volume academic centers. According to NASPE website,6 state of California has most EP physicians at 161, while Wyoming has only one. More rural areas suffer a dearth of these specialists, and patients must often rely on referrals from their cardiologists to be evaluated at tertiary centers. The wait time to see these highly demanded specialized EP cardiologists can be two months or more. The Cardiovascular Roundtable7 notes that while number of electrophysiologists has doubled between 1996 and 2001, number of patients receiving EP therapy remains small due to an EP physician workforce being unable to meet demand.

In conclusion, hospitals must consider a number of clinical issues when deliberating feasibility of implementing a full-service EP program. Having open-heart surgery back-up on site is one of most important considerations and must be carefully thought-out. Offering open-heart surgery can be a very expensive proposition, and often there are regulatory challenges and barriers to entry. Twenty-five states require hospitals to file Certificate of Need (CON) applications for acute care services. Each of these states has established a specific criterion for clinical and/or financial threshold that would trigger need to file CON application, but all require an application for open-heart surgery at this time.

States also have established Department of Health Regulations that vary within each jurisdiction. Some states require hospitals to make notification of new services, and others will review services on inspection tours.

Gathering information from clinical resources, developing financial projections, and researching state-specific regulations regarding EP and open-heart surgery are all essential elements of a thorough due diligence. Preparation and presentation of all available information to stakeholders — including hospital administration and medical staff — will set stage for a well thought-out decision that will meet patients’ needs with a successful, high-quality EP program.

This article was written by Marsha MacIntyre RN, BSN, consultant, and Barbara Sallo, President of Health Care Visions, Ltd., a cardiovascular consulting firm based in Pittsburgh, Pennsylvania. The firm brings extensive knowledge and expertise in this area of clinical care. Health Care Visions, Ltd. has assisted a multitude of hospitals in all phases of cardiovascular programs for market assessments, program assessments and feasibility studies to business planning and implementation.

The TCTM is population from which a cardiovascular program could reasonably expect to draw patient referrals. The TCTM geographic area usually reflects distance that individuals will travel for sophisticated heart care. The TCTM methodology is supported with a consideration for geographic and social barriers, physician referral patterns, outreach efforts, and planned growth and practice expansion opportunities.

Once TCTM is determined, a thoroughly planned and well-executed marketing effort can be undertaken. The tried and true marketing processes that are associated with successful organizations are recommended with a distinct focus on cardiac clinical services. The elements identified most often as essential to positive results are:

1.Develop a plan. It is estimated that only approximately 60 percent of all businesses work from a plan with predetermined, measurable goals. 2.Evaluate efforts and results. Business and industry report very few marketing projects are measured for outcomes and community responsiveness. 3.Spend time and energy in defining measurement standards. Many organizations can’t define “good” marketing and document a Return on Investment (ROI). 4.Research market. Who better to ask how you could better serve than those who access care as well as those who are in TCTM but travel to another facility for cardiac services that are already available at your hospital.

The best way to master changing market forces that healthcare providers are experiencing is to focus on core competencies and strive to be “best” both clinically and financially. The key to success is identifying exactly what clinical services will be provided and benchmarking to measure results. This encompasses integrating marketing and many facets of hospital operations. Once accomplished, communicating (marketing) to your community (TCTM) through a service-specific marketing effort can reap new patient volume and achieve financial goals in cardiovascular services.