Cardiac Care Center assistant manager Maureen Kane, RN, (left) and Christine Coyne, director, produce frequent reports as part of the center’s ongoing JCAHO compliance.

In 2001, physicians and administrators at Hahnemann Hospital, in Philadelphia, were facing a serious dilemma. They knew that not only was the problem serious, but it needed to be dealt with swiftly and effectively.

Outpatients were arriving early in the morning at the hospital and sometimes leaving late in the afternoon, tired, disgruntledand without having undergone the procedure for which they had presented.

These were patients who had come to the hospital for diagnostic cardiac catheterizations. After fasting for 24 hours and probably being anxious for much longer about undergoing the procedure, they all expected to be seen within a reasonable amount of time. However, the reality of performing such a diagnostic procedure in a hospital setting, where trauma patients and interventional cases must take precedence, was making the visit a nightmare for low-risk outpatients who were sometimes asked to return another day after waiting for hours to be seen.

The solution came in the form of a dramatically different model, the product of brainstorming among three proponents: Mark F. Victor, MD, medical liaison and clinical professor of medicine at Drexel University, Philadelphia; Joseph Stern, regional director for Southern Medical Corporation (SMC); and Michael Halter, CEO of Hahnemann Hospital. They began by questioning the current status of diagnostic cardiac catheterizations: Why not perform them in an exclusively outpatient setting? Why not create a freestanding facility that would specialize specifically in those procedures? Why not let it be physician-owned?

The Pennsylvania Department of Health considered the proposition cautiously (freestanding cardiology facilities are allowed in several other states but not yet in this one), but after 2 years of negotiation, Stern, Victor, and Halter earned a qualified victory: the center could be built as a demonstration project.

“The goal was to change the entire dynamic of this niche, by creating a paradigm for driving low-risk patients toward a high-tech yet nonemergent setting that would be an extension of the physician practice,” explains Victor. “Ultimately, the state embraced this concept.” Thus was born the Cardiac Care Center, LLC.

“Compromising on quality was never a consideration,” says Stern. “We simply wanted to focus on what had traditionally been an underserved segment of the patient population. We wanted to create a quiet environment in which patients would have a private room and could have their family around them, and yet offer state-of-the-art equipment and highly efficient care.” Another opportunity presented by the freestanding setting was education, says director Christine Coyne. “Here we are able to focus more on teaching patients about their medicine, diet, and change-of-life issues such as exercise and elimination of smoking. In a larger, more hectic environment such instruction is much more difficult.”

“Hahnemann Hospital is basically just a landlord,” explains Stern. “They leased the space to the center for the fair market value. Although the two facilities are not affiliated, their proximity to each other is convenient for the physicians and their patients who need interventions. Instead of taking a ride in an ambulance, patients can be transported down the hallway and up in the elevator and be in the hospital operating suite, if it becomes necessary.”

The Cardiac Care Center is managed by SMC, a subsidiary of Tenet Healthcare. SMC manages the daily operations and the hiring of staff members. Marketing is primarily by word-of-mouth; more than 99% of the patients are so satisfied with the care they receive at the center that they say they would return and would refer others to the facility. The center also has a Web site ( ) that explains its background and patient-centered philosophy and describes the catheterization procedure and facility amenities.

“The center opened in February 2003, and we have performed 1,150 procedures since then. We have an enormously dedicated team of technicians and nurses, and we are all proud of the facility and what we have accomplished,” says Victor.

The satisfaction of patients and staff members is the key to the success of the Cardiac Care Center experiment. “You can’t fool patients. If you have an unhappy staff, you have unhappy patients. But if the staff is happy, the patients are, too,” Victor asserts.

“Of the projects I have been involved in, this is the one I am most proud of,” he explains, “because it involved a group of physicians who were empowered to reengineer the environment in which they work. They were able to use their experience and own ideas to create and maintain an efficient work flow in a setting that would be more beneficial and ideal for the patients as well as themselves.”

Seleen Street Collins is a contributing writer for Decisions in Axis Imaging News.