In two moves aimed at improving efficiency and patient care, Spokanes largest hospital has hired the Heart Institute of Spokane both to manage its cardiac services and, in a lesser role, to handle the admitting of patients who come to the hospital for outpatient cardiac care.


Early last month, Sacred Heart Medical Center began having the Heart Institute handle outpatient cardiac admitting in an effort to streamline that sometimes cumbersome process, says Michael Ward, a vice president at the hospital.


The Heart Institute, a separate health-care provider thats located just north of and is connected by skybridge to Sacred Heart, already works closely with the hospital, often performing outpatient procedures on patients who also receive care at the hospital. Up till now, such patients have had to go through the administrative admitting process twice.


We saw it as a way to better serve patients, says Ward. There was duplicative patient data. This eliminates a lot of bureaucracy.


Now, with only minor exceptions, all cardiac outpatientsboth those who come to Sacred Heart and those who come to the Heart Institutewill be admitted through the Heart Institute and then taken to the procedure room where theyll be cared for, either in the hospital or the institute. The new arrangement doesnt affect patient care or billing procedures, say both Ward and Michael Nowling, president of the Heart Institute.


The Heart Institute will be paid an administrative fee for handling the admissions, both executives say, though they decline to disclose the terms of the arrangement.


In the more sweeping move, Sacred Heart is to begin this week paying the Heart Institute to manage what the hospital calls its cardiac services line, a newly formed unit that spans a host of different departments.


The big Spokane hospital is organizing eight different major service lines in such a way that hospital personnel who may work in different departments but serve the same types of patients will now work together as a team and report, at least in part, to the same manager. The first such line to be created, nephrology (having to do with the kidney), was organized last month. Cardiac services is the second, and likely will be the only service line to seek outside management, says Ward.


Under the hospitals new contract with the Heart Institute, the institute will manage a service line that includes hospital personnel in cardiac catheterization labs, the coronary intensive-care unit, the cardiopulmonary transplant program, and the coronary-care nursing unit, as well as specialized coronary personnel in about a dozen other departments.


Though the four key departments in the service line will continue to have their respective managers, each manager now will report to the Heart Institute, says Ward. Cardiac-oriented personnel in other departments still will report to their department heads, but also will be team members in the new service line, he says.


We wanted to put it all under one manager, says Ward. Thats where we can pull all the team together and get everybody working toward the same goals.


Just as with the outpatient admitting contract, the management contract has no effect on who handles patient care, and how patient billings are done, Ward says. Sacred Heart, working with local physicians, will continue to be the provider of care within the hospital, and will continue to bill for those services. It will pay the Heart Institute an undisclosed management fee.


Ward says Sacred Heart has been organizing the cardiac service line since about August, and approached the Heart Institute earlier this year about managing the line because the hospital believed the institute had the management expertise it needed. We said, Who has the big picture from a management point of view, Ward says. The answer was, the Heart Institute.


The institutes Nowling says the two new contracts with Sacred Heart represent a natural evolution for the Heart Institute, which is a nonprofit corporation opened in 1991 by nine Spokane physicians groups and Sacred Heart.


He says the institute always has wanted to be right in the middle of things when it comes to cardiac patient care in Spokane, and Ward says Sacred Heart always has wanted the Heart Institute to be more involved in the hospitals cardiac services.


The new revenue streams dont hurt, either. Though Nowling says the Heart Institute has operated in the black on an annual basis since 1994, he adds that doing so has been very difficult. Because the institutes focus is so tightoutpatient cardiac care and cardiac researchit can be affected greatly by single, adverse swings in Medicare reimbursement rates. Also, providing such care is capital intensive, Nowling says.


The Heart Institute took a big step toward profitability in late 1993, when it was able to refinance $21 million in debt through bond sales guaranteed by Sacred Heart. Sacred Heart also owns the land beneath the Heart Institutes five-story, $13.5 million facility.


Though the two organizations have close ties, they remain separate, and the Heart Institute intends to pursue a role as an independent, communitywide organization, says Nowling.


He says the Heart Institute would love to develop contractual relationships with other hospitals, though they would have to make sense. The admitting of outpatients, for instance, works well with Sacred Heart because the two organizations facilities are connected by a skybridge, but might be more complicated with other hospitals. However, the management contract could be replicated anywhere, says Nowling, who adds that the institute is negotiating no such contracts currently.


If we can demonstrate value and all of it works, then there is nothing but good for everybody, he says.