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Just over 18 months ago, the tenuous “ties that bind” the heart programs of Saint Thomas Hospital and Vanderbilt University Medical Center came unbound.

In the wake of the upheaval, each program was clearly changed. Physicians who had practiced at one location or the other switched allegiances. A long-held teaching partnership disappeared. And both hospitals were forced to rethink their roles in the regional and national marketplace.

In speaking with physicians at Vanderbilt and Saint Thomas, it’s easy to see that there is still a great deal of professional and personal respect between the two, but, make no mistake, these former allies are now clearly competitors.

Both have launched aggressive marketing campaigns utilizing print and broadcast media to tout the benefits and strengths of their respective programs. In one Vanderbilt Heart Institute commercial, the voiceover says, “Yesterday’s best place for treatment may not be today’s” — a clear reference to Saint Thomas’ long history of cardiac care and a call for consumers to do their homework in the new practice environment.

For its part, Saint Thomas has focused on the clinical growth that has come as Mid-State Cardiology, based at Baptist Hospital, and the Heart Group, based at Saint Thomas, have joined forces to create the state’s largest private cardiology practice. In matters of the heart, their leadership pointed out, more is more with volumes playing a significant role in outcomes.

Their “one” campaign draws attention to the top rankings from HealthGrades and Thompson (formerly Solucient). It also plays off the fact that two longstanding practices have come together to serve the region with years of experience focused on one heart at a time.

Nashville Medical News had the opportunity to sit down with leadership from both heart institutes to discuss their perspectives on the history of their respective programs and what lies ahead.



Saint Thomas Heart Institute

Known for decades as the leader in cardiovascular care, Saint Thomas Hospital’s program was shaken up when two of its three cardiology groups left or disbanded in 2006. Reaching a fork in the road, the program could either accept whatever happened, or retool, realign and re-emerge.

Not surprisingly, they chose the latter.

Although Baptist and Saint Thomas are part of the four hospitals that come under the umbrella of Saint Thomas Health System (STHS), for the most part each operates independently. The shakeup in heart practices, however, afforded the opportunity to combine expertise and bring together different parts of the health system to operate as one team.

An alliance was first created this past October between the Heart Group and Mid-State Cardiology Associates to form a new entity branded Saint Thomas Heart, the largest private practice in the state. More recently, Mid-South Cardiology in Lebanon has also joined the group.

“The marriage of the two practices was a nearly ideal kind of thing because we had a similar approach to the practice of medicine … very high quality, patient-driven, service-driven kind of approach … and we didn’t really compete in many places,” said Dr. George H. Crossley, III, president of Mid-State Cardiology Associates based at Baptist Hospital.

The 49 physicians in the combined practice see more than 130,000 patients annually in a 69-county region that encompasses not only Middle Tennessee but also parts of southern Kentucky and northern Alabama. By spring another two physicians are expected to join the group.

Officials with STHS said this exciting joint venture comes on the heels of the system posting its strongest financial numbers in four years: a net income of $95.5 million for the 12 months ending June 30, 2007. Although open heart procedures decreased from FY 2006 to FY 2007, following a national trend, other procedures saw significant jumps. Inpatient intra-cardiac or coronary artery procedures at Baptist and Saint Thomas rose from a combined 5,929 to 7,831 during the last reporting period. The 32 percent inpatient increase was complemented by a 47 percent increase in the outpatient setting.

“Our volume really jumped last year. We saw a large number of patients who simply didn’t want to leave Saint Thomas when the other group split up,” said Dr. Howard T. Walpole, Jr., chief physician officer for Saint Thomas Heart and interim chief of cardiac services.

In addition to the private cardiology practice, the brand “Saint Thomas Heart” spans the entire spectrum of services (including surgical), clinics and chest pain centers throughout the network.

Saint Thomas Heart has a strong regional presence with 10 accredited chest pain centers and another three whose accreditation is in process (Hardin Medical Center, Lincoln Medical Center and Monroe County Regional Hospital). The chest pain network extends as far west as Henry County Medical Center and as far east as Cumberland Medical Center. There are also two joint-venture catheterization labs in Crossville and Gallatin (Cumberland and Sumner Regional), plus a network of 25 clinics spanning 20 counties.

Walpole, who has recently shifted his focus from the Heart Group, for which he was managing partner for a decade, to the bigger picture issues of the combined practice, said while it’s important to focus on the future, it must be done in the context of the storied history of Saint Thomas’ heart program.

“When you really look back at the history of this place for the last 30 or 40 years, it was built as the clinical heart center for Middle Tennessee,” he explained. “We did the first angioplasty. We did the first heart transplant. So many of the early clinical ‘firsts’ were done here for Middle Tennessee, and consequently the quality numbers and the volume here have rivaled all the other major hospitals in the country including the Mayo Clinic and Cleveland Clinic just to name a couple of them.”

While the clinical focus has not changed, Walpole said the business model has had to be revised … not just for Saint Thomas Heart but for medical practices around the country.

“The milieu of medical practice has changed in the last 20 to 30 years,” he said of the constant struggle between fixed reimbursements and rising costs. “Cardiology businesses, just like any other healthcare business, have had to adjust to the new realities.”

Walpole said he felt like some of the changes in the local market over the past couple of years are tied to a great extent to the new economic landscape.

“I think groups have looked for ways to reduce their overhead, and one way you do that is to form a bigger company where back office costs can be shared and other costs can be reduced so that your risk is less,” he said.

“The other thing that’s changed,” added Crossley, “is the economics of an academic medical center.” He said that in the past, training centers were largely funded by grants that helped pay for other services. “Now there’s very little downstream payment, and academic medical centers are very dependent upon clinical income.”

“The thing that makes medicine unique is that no matter what you do with efficiency, you’ve got to give high-quality care. That is a requirement in this business,” Walpole continued.

To that end, Crossley said he believes there is also a core clinical value to the formation of Saint Thomas Heart.

“We certainly hope it makes us clinically efficient. It gets the right doctor in the right place for the right patient at the right time,” he said of their combined expertise.

Walpole added that in comparing current outcomes for Saint Thomas with other national leaders, the program fares very well. The expectation, he added, is that when Baptist Hospital figures are pulled into the mix on the next round of reporting, there will be more good news.

In addition to growing volumes, there has been an added emphasis on clinical research. Currently, 59 percent of the active clinical studies that are part of Saint Thomas Research Institute are related to cardiology.

Crossley, an electrophysiologist, said he has partnered with Dr. James Baker at Saint Thomas on numerous studies. “Together we have built a consortium that has done more clinical EP research than just about anybody in the country,” he noted. “I think it’s a good example of how we can work together.”

Just last month, Charlie Powell, CMPE, was named CEO of the cardiac practices of Saint Thomas Heart to mesh administrative and operational functions to maximize back office efficiency, as well as to lead strategic planning efforts going forward.

“The community is best served to know that regardless of what marketing has gone on in the last year, you have to look at the facts,” Walpole said. “Saint Thomas was the heart hospital for years and years — and it still is — and we have every intention of remaining.”

Crossley concluded, “We’re growing together and building something even better than where we started — and we started in a really good place.”



Vanderbilt Heart & Vascular Institute

Dr. Douglas E. Vaughan, chief of the division of cardiovascular medicine for Vanderbilt University Medical Center, points to the 1999 alliance with the Page-Campbell Cardiology Group as a turning point for Vanderbilt in terms of clinical focus and efforts to grow cardiovascular services at the teaching hospital.

Then based at Saint Thomas Hospital, it was the wholesale move of the Page-Campbell physicians to Vanderbilt on July 1, 2006, that was the impetus for the change seen in the market today. A few months later, Saint Thomas Cardiology Consultants split, with half their physicians going to Vanderbilt and the other half to Centennial.

“In aggregate, we moved 17 cardiologists from Saint Thomas,” Vaughan said of the 2006 upheaval. “It really ended up doubling the number of practicing cardiologists here at Vanderbilt.”

“Size does matter in cardiology,” he added with a laugh. “We have more interventional cardiologists here than any place in town, and it shows.”

He continued, “We’ve seen a tripling of our cardiovascular surgery over the last three years … that’s not happening elsewhere in the country. Nationally, on average, cardiac surgery is falling at a rate of about 5 percent a year.”

The growth is part of Vanderbilt’s concerted effort to bring together all aspects of cardiac care to achieve their stated goal of becoming one of the nation’s top 10 heart programs.

Vaughan said the hallmarks of such a program are fielding a large and diverse research initiative, training the next generation of leaders in cardiology, offering state-of-the-art cardiovascular care and having a clinical program that provides the full spectrum of care while optimizing quality and outcomes.

“I think we have all that now here at Vanderbilt,” he stated. “Each of those people who moved over here made individual decisions. They saw what was happening at Vanderbilt was unique and created a model for 21st century heart services.”

He added that what he believes makes the Vanderbilt program unique is a complete integration “philosophically, programmatically and financially.”

Vaughan said one of the areas that differentiates their program from Saint Thomas Heart is their academic offerings.

“No one else in town trains cardiologists, but we have 33 fellows in the program. They’re talented. They’re smart. They’re energetic, and they keep us on our toes,” he pointed out with a laugh.

Another area of specialty is in the research program that ranges from bench to bedside. While Saint Thomas Heart is heavily involved in clinical applications, Vanderbilt’s program stretches all the way back to the molecular level.

Vaughan noted that Vanderbilt was one of only five centers in the nation to be selected for the NIH-funded Cardiovascular Cell Therapy Research Network.

“This group will really define cardiac cell therapy in this country. We got picked because we had the right kind of expertise, the clinical volume, the technology and the right team.”

He added that Vanderbilt was also recently chosen as one of three centers in the nation to receive a $16 million clinical grant to study clotting in obese patients with diabetes. The other two selected were the nationally renowned Cleveland Clinic and the University of Pennsylvania.

From a clinical standpoint, Vaughan said that while his program only had a “fraction” of the volume of procedures done at Saint Thomas a decade ago, today Vanderbilt’s volume is “on par.”

Even with recent accolades and advances — Vanderbilt was named 21st on U.S. News & World Report’s list of the top 50 heart programs in the nation (a list they didn’t appear on at all in 2006) — Vaughan said he thought the program was still somewhat of a well-kept secret in town.

“The whole equation has shifted here in Nashville,” Vaughan said. “We are committed to being a top 10 cardiovascular program in the U.S. any way you shake it.”

Sharing that message and getting area consumers to rethink their choices for cardiovascular care is where the new mass media campaign comes into play. Using the tagline “where heart is headed,” Vanderbilt subtly recognizes its chief competitor’s storied history but shifts the focus to the future.

Despite the push to become number one, Vaughan was quick to say, “We have a lot of respect and admiration for what Saint Thomas has accomplished for decades.”

He added, “There’s room for two terrific cardiovascular programs in town.”

In the land of Southern cooking and sedentary lifestyles, that statement is all too true.



February 2008

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