The American Heart Hospital Journal
Heart Hospital Spotlight Series
patients/guests, including more than 1300 inpatients
possess the highest technical and professional skills
plus a passion for service excellence. Even with a
national shortage of nurses, more than 400 regis-
tered nurses applied for employment at The Heart
Center and 38% of applicants were offered a posi-
tion. More than 70% of registered nurses offered
employment at The Heart Center accepted, despite
considerable competition in the Indianapolis area.
from more than 260 zip codes, which reflects the
extended regional reach of the hospital’s medical
staff. Over the same period, patient/guest activity net
revenue increased by an average of 40% per month,
as illustrated in Figure 1. The Heart Center also has
considerable future potential, as demonstrated by
the fact that the hospital reached 100% occupancy
on the 191st day of its first year of operation.
The Early Results
Whereas one of the major criticisms leveled at
heart hospitals is the presumption that they skim
only the least complex and most profitable patients,
the actual experience of The Heart Center presents a
much different reality. During the first 7 months of
2003, the case mix index of all patients/guests of The
Heart Center of Indiana was 2.65, and the severity of
illness among inpatients clearly belied the notion of
a heart hospital admitting only the least complex
cases. In fact, according to the most recent available
case mix index data from the Centers for Medicare
and Medicaid Services, The Heart Center’s case mix
index through the first 7 months of 2003 places it
among the 10 hospitals in the nation with the high-
est case mix index. There were days when one-third
of the inpatients of The Heart Center were on venti-
lators and other days when more than one-quarter of
inpatients required one-to-one nursing care. As dis-
cussed below, managing patient/guest acuity is a
major challenge for The Heart Center and potential-
ly any relatively small tertiary-care hospital. Yet,
despite the high acuity levels experienced by The
Heart Center, the hospital’s medical and nursing staff
has produced superior outcomes. Through the first
half of 2003, the mortality rate of The Heart Center
is well below the expected level (Table I), guest satis-
faction scores are outstanding (Table II), and The
Heart Center is demonstrating its efficiency through
a remarkably short length of stay in light of the level
of inpatient acuity (Figure 2).
Starting from a blank sheet of paper, hospital operat-
ing processes including all staffing, equipment, sup-
plies, and information systems were developed and
installed in less than 1 year. The information system
itself included an electronic medical record, a com-
pletely digital imaging system, and 23 separate major
system applications with more than 100 interfaces.
The Heart Center of Indiana opened and admit-
ted its first patients/guests on December 2, 2002.
The hospital underwent a 45-day period of
installing and refining operating processes. During
this time, the hospital obtained its state license and
Medicare provider number. During 2003, The
Heart Center’s first full year of operation, a total of
3600 admissions were budgeted, including 2000
percutaneous coronary interventions, 800 cardio-
thoracic surgical procedures, and 400 peripheral
vascular procedures.
The management team decided to ramp-up hos-
pital operations in an expeditious yet careful man-
ner. The involved parties recognized that a strong
foundation was essential to the long-term success of
the hospital, and care was taken to ensure that The
Heart Center’s growth was staged and controlled.
The early capacity limitations of the hospital were
the result of limited provider contracts with insurers,
and limited registered nurse staffing in the
Progressive Critical Care Unit of the hospital. To
ensure clinical quality and capital conservation, hos-
pital leadership elected to seek a delicate balance
between the ability of the hospital to provide high-
quality, economically sound care and the desire to
rapidly increase patient/guest volumes.
Very early, it became clear that due to the active
involvement of physicians and the careful selection of
staff, The Heart Center was establishing a solid founda-
tion for excellence. The medical staff roster quickly grew
to 300. Confidence in The Heart Center and physicians’
desire to shift their practices resulted in considerable
pressure to accelerate the ramp-up of the hospital.
During the first 7 months of operation, The
Heart Center provided care for more than 2500
What We Have Learned
To be sure, considerable challenges confront The
Heart Center of Indiana during its continued ramp-up
of operations, and the future will bring many more
challenges. Some of the lessons learned to date may
help others developing a heart hospital.
Committed, Involved Physicians are the Key. From
the conception of the project, The Heart Center of
Indiana has realized the significant benefits of a
committed, actively involved group of physicians. From
their major role in the design of the facility to their
Fall 2003
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Changing the Way Hearts are Treated