Erie hospital manages affiliations with 2 health systems

April 27--More patients with complex heart problems are being referred from Saint Vincent Hospital to the Cleveland Clinic since the two hospitals entered a clinical affiliation in December 2012.

Cleveland Clinic officials said that trend continues even though Saint Vincent in July joined Highmark's Allegheny Health Network, which provides similar heart services at Allegheny General Hospital.

"The number of referrals we see for patients who require a higher level of care has increased since the start of our affiliation," said Joseph Cacchione, M.D., chairman of operations and strategy at the Cleveland Clinic Heart and Vascular Institute. "We are pleased with the results and haven't seen any influence of their relationship with Allegheny General, though we are watching that carefully."

Saint Vincent announced its partnerships with the Cleveland Clinic and Allegheny Health Network less than a week apart in October 2012. The affiliations are different, however.

The deal with the Cleveland Clinic is a clinical affiliation for which Saint Vincent pays the Cleveland health system to use its brand to promote Saint Vincent's cardiac services, and have its clinical data analyzed by Cleveland Clinic physicians and administrators.

The agreement also streamlines referral patterns from Saint Vincent to the Cleveland Clinic.

"It's like the Good Housekeeping seal of approval," said Sam Ward, M.D., a Saint Vincent cardiologist. "They come in, look at our methods, our quality and our stats, and validate what we have done."

Saint Vincent's deal with Highmark was a merger, in which the Erie hospital received $20 million for giving the Pittsburgh-based health insurer control of its board.

Saint Vincent cardiologists and cardiovascular surgeons meet with their counterparts at Allegheny General and other hospitals in the Allegheny Health Network to make clinical decisions, establish pathways of care and standardization of care, Ward said.

"It's a very collaborative thing," Ward said. "We even helped with a protocol that Allegheny General was struggling with."

Though Saint Vincent has partnerships with two out-of-town health systems, the goal is to keep heart patients in Erie whenever possible, Ward said.

Referrals happen when patients require heart transplants -- which aren't performed in Erie -- or some other type of surgery or treatment that local heart doctors don't see on a regular basis.

"For those cases, we have access to two great, world-class centers: Cleveland Clinic and Allegheny General," Ward said. "The decision on where my patients go is based on the patient's insurance, the patient's preference and which place I think is better in their particular circumstance."

Allegheny Health Network officials said they don't see a reason why Saint Vincent's affiliation with the Cleveland Clinic can't continue. The deal doesn't expire until December 2017.

"I haven't heard of any friction or concerns about the affiliation, either from the Cleveland Clinic, patients or their families," said Tony Farah, M.D., chief medical officer of the Allegheny Health Network.

Cacchione, a former Saint Vincent cardiologist and administrator, said that while the Cleveland Clinic hasn't seen a decline in referrals since Saint Vincent joined the Allegheny Health Network, it has seen fewer referrals from another Erie hospital.

"We have seen a dramatic decrease in referrals from Hamot since it joined UPMC," Cacchione said. "It's even beyond the decrease you would expect from patients with UPMC Health Plan insurance," which doesn't have Cleveland Clinic in its network.

Any decrease is due to more heart patients staying at Hamot and not because more of them are being sent to other UPMC hospitals, said Gary Maras, chief executive of the Hamot Heart Institute.

"UPMC does not require its physicians to make referrals within the system," Maras said. "In (Hamot's) agreement, it is stated that physicians would not be required to refer within the system."

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ ETNbruce.

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