Vascular Practice Development Q&A with Gary M. Ansel, MD

How can vascular interventionists expand their practice in today’s market?

Today’s market will be expanded by the increase in outcome data being generated. The 2 major trials that I predict will increase the market are the CREST data that show similar outcomes to caroti­­­d endarterectomy overall while simultaneously demonstrating a tremendous decrease in stroke related to carotid stenting during the last 3 years of the trial. The second major trial success is the Zilver PTX (Cook Medical, Bloomington, Indiana) trial that is demonstrating low restenosis rates utilizing drug-coated stents out to 2 years. I think these trials demonstrate that good science and dedication are helping us develop successful, less invasive treatments for vascular disease that are increasing patient options and allowing the referring physician to have confidence that their referrals will benefit their patients.

Are you involved in a multispecialty vascular practice? If so, how do you manage potential conflict and friction?

Though my own practice is single-specialty cardiology, we have practiced a multispecialty approach for over 15 years. We have collaborated on our carotid procedures and AAA endografts with high success rates and volume. Thus, there is a lack of friction and all the specialties are busy.

What are some of the CPT coding issues you encounter in your practice?

We have utilized consultants to help with this for years. The only issue that we currently have is incorporating the new 2011 changes.

What clinical competence and accreditation do you require of your physicians?

Riverside Methodist Hospital addressed this successfully years ago. We created an endovascular section whose goal is to maintain a high level of expertise in all specialties for endovascular procedures. There is a uniform credentialing process in place as well as pathways for proctoring and training for those interested in expanding their treatment options. There is also a multispecialty conference for morbidity and mortality.

How are quality initiatives implemented and monitored in your practice?

The endovascular section identifies and implements these as a group. This has led to pre-printed orders for treatments such as AAA endografts. We conduct a large number of clinical trials that are typically monitored and serve as a secondary check in performance.

What are your recruiting methods for physicians and staff? What sort of training do they undergo once employed?

This varies among the specialties, though all individuals must meet the uniform credentialing process. Typically, new individuals participate and are further proctored in procedures with currently credentialed physicians until they meet the numbers required.

What do you do to educate your patients about their conditions and the procedures they may undergo?

Most patients undergo explanation from one of the physicians or nurse practitioners about specific procedures. There is a global effort to screen for concomitant vascular disease in all vascular and cardiac patients.

What guidelines and methods do you use to communicate with the media and to educate the local/regional physicians and the community at large?

The hospital media relations department interacts with the community, while the multispecialty endovascular section drives other efforts jointly. When possible, the physician community is educated about available research trials. Parts of these efforts have generated a multispecialty CD and practice-specific newsletters.

How have you created a “brand” for your practice vis-à-vis referring physicians and the community at large? How important is this?

My previous practice has recently become employed by the Ohio Health Care System. However, we continue to market our previous practice brand of MidOhio Cardiovascular Consultants. The brand is recognized both locally and nationally and appears to still be important.

What do you envision your practice will look like in the next 5 to 10 years?

As a large community-based tertiary system we are focused on the increasing prevalence of cardiovascular disease. We are currently evaluating the development of multiple portals of entry into this system. I foresee a day when all patients identified with one aspect of vascular disease will be screened and treated in a comprehensive fashion. The focus will be on identifying coexistent disease, aggressive risk factor modification and outcomes research.

__________________________________________

Gary M. Ansel, MD, is the Director for the Critical Limb Care Center at Riverside Methodist Hospital in Columbus, Ohio, and Assistant Clinical Professor of Medicine in the department of internal medicine at the University of Toledo Medical Center (formerly Medical College of Ohio). 

Dr. Ansel received his medical degree from the Ohio State University where he also completed a postgraduate research fellowship in cardiology. Dr. Ansel received post-fellowship training in peripheral-vascular intervention at the Ochsner Clinic in New Orleans. 

Dr. Ansel was previously a member of the Peripheral Vascular Committee for the American College of Cardiology, and is a member of numerous professional societies. He has contributed to several journals such as the New England Journal of Medicine, Circulation, Journal of Endovascular Therapy and the American Journal of Cardiology. Dr. Ansel has also contributed numerous book chapters.

Dr. Ansel is past president and a founding board member of the Vascular InterVentional Advances Conference (VIVA), which is a non-profit organization dedicated to the education and research of vascular disease.