The Cardiac Care Center was established in a collaborative effort by physicians in several medical practices in the Philadelphia area to provide diagnostic cardiac catheterization services in an outpatient setting similar to a physician office. This experimental model of a freestanding cardiac care facility is viewed by the physician-owners as a means of advancing caregiving in their field to a new level of quality and efficiency.

"The Cardiac Care Center is designed as an extension of the physician's office," notes Christine Coyne, director of the center. "We have everything they need at their fingertips, and they simply rent this as their procedure facility for 4 hours at a time," she explains. "Our staff helps the physicians with teaching and caring for the patients during their visit, and the physicians handle the billing, referrals, and follow-up blood work from their own office. So there is an inherent mutual convenience and efficiency in this model."

The technology in the procedure room enhances the convenience of the arrangement. "We provide high-quality equipment [see Clinical Protocol] that minimizes the time spent on a case, both during and after the procedure. The physician can perform the catheterization, complete a report in the same control room, and have it ready for billing before going on to the next patient," Coyne reports.

The physician-owners saw an opportunity in the cardiology field for a diagnostic services provider that would compete with primary care hospitals for the diagnostic patient segment. By meeting the needs of this segment more efficiently, they knew that the facility could be competitive. Essentially, the goal was to become the area's most respected diagnostic cardiac catheterization provider.

The Cardiac Care Center focused on differentiating its services from those of hospitals and clinics by targeting the ambulatory patient segment in need of diagnostic versus interventional procedures. This enabled it not only to fulfill a high-demand service area (coronary diagnostic procedures accounted for 65% of angiographic procedures in the United States in 2002) but also to provide the service in a way that would attract physicians because of its value and efficiency and attract referrals from a base of satisfied clients.

The business development strategy involved targeting leading physicians and group practices and presenting the benefits of the freestanding facility versus those of hospitals and clinics---especially with regard to greater productivity---in order to attract referrals and physicians who wanted to perform their procedures there. The developers of the model realized that by providing a superior, supportive, patient-oriented service, they would win the approval of not only the patients but their physicians as well.

"Higher patient satisfaction generates a virtuous circle of satisfaction that is ultimately economically beneficial for participating cardiologists," notes F. Stewart DeBruicker, adjunct professor of marketing at the Wharton School of the University of Pennsylvania (Philadelphia), who has studied the center's financial model. "Satisfied patients are likely to report their successes to their primary care physicians, who in turn are more likely to refer more patients to those cardiologists affiliated with the Cardiac Care Center."

According to DeBruicker, annualized figures from AMR (Arlington Medical Resources Inc, Malvern, Pa; www.amr-data.com) indicate that approximately 2.3 million cardiac diagnostic procedures were performed in the United States in 2003. According to database information from IMV (Greenbelt, Md), approximately 1,900 hospitals have one or more catheterization laboratories, which suggests that an average hospital would perform approximately 1,200 diagnostic procedures per year. If the Philadelphia metropolitan market accounts for about 2.8% of the United States population and hospitals, then approximately 30 local hospitals would account for about 64,000 diagnostic cardiac procedures each year.

In its start-up year, the Cardiac Care Center performed more than 1,000 procedures. "One can assume a prolonged launch phase as cardiologists were recruited, trained, and ultimately persuaded to give up traditional venues for the center," DeBruicker theorizes. "With the Cardiac Care Center's focus on satisfying the patients, referring physicians, participating cardiologists, and employees, and with its focus on scope, scale, and integrated technologies, the center is theoretically capable of about 10 to 12 diagnostic procedures per daywith one of the two procedure rooms currently operationalor about 2,000-plus procedures per year, with the assumption that procedures occur 5 days per week, 50 weeks per year."

"As the Cardiac Care Center's patient volume grows, the second procedure room will become operational for diagnostic or other purposes," says Joseph Stern, regional director for Southern Medical Corporation, the facility's management firm.

And the payoff for physicians is invaluable: more time in their busy schedules and loyalty from their satisfied patients.

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