Two Louisiana Interventional Cardiologists Find a Good Fit with CardioSolution: 7 Days On, 7 Days Off

Cath Lab Digest talks with Yunus Moosa, MD, and Chris Mallavarapu, MD.
Cath Lab Digest talks with Yunus Moosa, MD, and Chris Mallavarapu, MD.

Two board-certified interventional cardiologists have found the unique model offered by CardioSolution to be a good fit. Dr. Yunus Moosa is an interventionalist practicing in Zachary, Louisiana (close to Baton Rouge) and Dr. Chris Mallavarapu is an interventionalist practicing out of Lafayette, Louisiana. Both are seasoned interventional cardiologists with experience doing no-surgical-backup percutaneous coronary intervention.

CardioSolution has a model that doesn’t fit the traditional mold for delivering cardiology services. Can you describe it?  

Dr. Moosa: CardioSolution is not a physician-owned private practice nor is it a locum practice. It is a turnkey solution for comprehensive cardiovascular services specific to regional and rural hospitals. We also assist smaller, surrounding critical access hospitals in being a resource for them. CardioSolution comes into a small rural or regional hospital to assist that hospital in building their heart and vascular program from the ground up. It offers us the opportunity to assist and build a program in a smaller town without being permanently located in that facility. We don’t have to uproot our family.

Dr. Mallavarapu: The concept of building an interventional program from the ground up is not easy, and CardioSolution offers experienced interventionalists, doctors who have done large numbers of cases, who can come in and get the program up and running very quickly. Whenever you start a cardiology program, everyone is always worried about experience. What CardioSolution offers is not just a solution, but an experienced solution.

How is CardioSolution different from the traditional options of either hiring a cardiologist to directly work for the hospital or inviting an existing cardiology physician practice to come to town?  

Dr. Mallavarapu: Before calling in a company like CardioSolution, I am sure the hospital explored other other options, such as trying to get  preexisting groups to come to the area or perhaps recruiting for themselves. Sometimes groups may not have the capability to recruit additional experienced interventionalists, or may not want to do so. One reason I think that the CardioSolution model is successful is the reluctance of groups to change their practice patterns.

Dr. Moosa: The other reason is that CardioSolution drives loyalty to the hospital. It’s not a physician-owned practice, and neither is it a CardioSolution-owned practice. Essentially, as Chris alluded to earlier, it is a ground-up opportunity, and to start a new program, it takes experienced interventional cardiologists to be there 24/7, with 365-day coverage. This includes treatment of patients presenting with acute coronary syndromes, ST-elevation myocardial infarction (STEMI), etc. We partner with the hospital, attempt to do everything for the hospital, and drive most of the business to the hospital. CardioSolution allows us to remain independent and focused on providing care. Essentially, we provide overall program direction in all aspects. Based on American College of Cardiology (ACC) standards, we try to standardize our approach in any given hospital.

Why do rural and regional hospitals have such a difficult time bringing experienced cardiologists to their towns?

Dr. Moosa: Typically, I think smaller towns and hospitals do have a hard time recruiting experienced interventionalists to relocate. It is very difficult for a small hospital or a rural community hospital to try to recruit the level of experience that CardioSolution brings to the table. Many of us have had a lot of experience in building new programs, and it’s not easy trying to get that experience base with new graduates. That’s one aspect.

Dr. Mallavarapu: It is tough for either an experienced interventionalist or even brand-new fellows to relocate to small towns in America. The problem is that maybe you can’t convince a cardiologist to go live in a small town of 10,000, 365/days year, but maybe you can convince a cardiologist to do so for one week a month or two weeks a month. Especially when you have the two weeks off. CardioSolution is successful in bringing the cardiologists to the rural areas because it offers us the right financial reward and balance of lifestyle. CardioSolution pays the cardiologist enough so they don’t have to work four weeks a month.

What CardioSolution sites have you worked at and for how long?

Dr. Moosa: We started our program in Lewiston, Idaho at St. Joseph Medical Center in February of 2012, and to date, I have worked there and in Aberdeen, South Dakota, at Avera St. Luke’s Hospital. In 2012, Avera was in the top 10% for coronary interventions nationally, a 5-star recipient for coronary interventions and heart attacks, and a  recipient of HealthGrades’ Coronary Intervention Excellence award. In 2011, Avera was number one in the state of South Dakota for PCI outcomes.

Those are the two I have worked at; there are other hospitals currently in the pipeline.  

Dr. Mallavarapu: I have worked in Lewiston, Idaho. I’m still in private practice as well. 

Are you on call during the week you are at the hospital site?

Dr. Moosa: We are clearly on 24/7 interventional call for the time we are there. There might be a non-invasive cardiologist that is capable of doing invasive diagnostic work, but we are there to assist them. We assist in doing ICU/CCU, consults in the hospital, etc. We also assist the hospital in running their clinics if we are not tied up in the cath lab. 

How does CardioSolution’s 7 days on-site and 7 days off model work personally for each of you?

Dr. Moosa: It provides me with a more balanced lifestyle. I am not trying to be an office manager on a day-to-day basis while running a private practice. Essentially, I am more focused on practicing evidence-based care. Our locations have a very welcoming atmosphere. In the hospital and in the cath labs, we are regarded as individuals there to assist the community and the hospital, so it is very positive. The hospital and its affiliate physicians are also there to help support us in whatever is necessary for the program and community to develop. It leaves me feeling good at the end of the day. It also allows me to get more procedures done; I think I am more focused. I am not involved in the day-to-day of trying to run an office-based practice. We are in a hospital setting that is very welcoming, seeking to assist the hospital and community. My focus is on practicing and trying to be a good doctor — not an office manager or a business person. 

Dr. Mallavarapu: Cardiologists can come to these places and make a significant impact in terms of actually saving lives. It is transferring our skill set to a small community and making a visible difference. Many times, if cardiologists are located in a very large community, their skill set may not be as appreciated or may not be as rewarded. It is personally rewarding to feel appreciated and recognized for providing quality heart care.

Dr. Moosa: I agree. I think it is mutually gratifying for us and the hospital(s) we serve. The impact is huge in terms of coming into a small community and building a program, but more importantly, it is in a town that has never had the ability to provide this type of service. Patients were either LifeFlighted out or transferred by ambulance. These patients can now stay locally in the community and it means a lot to that community, especially the families of the elderly patients who don’t have to drive a couple hundred miles or fly.

Dr. Mallavarapu: Especially in the winter. I recall being in Lewiston, Idaho, where the weather was such that the helicopters couldn’t fly out, and all of a sudden, we had an acute anterior wall MI. A thrombolytic was available, but in this day and age in America, there should be access to a cath lab and an experienced interventionalist. The patient is much better served by the right cardiologist being available locally. 

The facilities you are going into do not have surgery on site.

Dr. Mallavarapu: No, they do not. The controversy should be put to rest by now. I would say that as long as experienced interventional cardiologists are doing the procedures, there should not be any issue with care. In Europe, they routinely do not have surgical standby. Today, even if surgical standby is present, unless there is an open OR and an open team ready to go, it takes a significant amount of time just to go from the cath lab to the operating room. In that same time period, if there ever was any kind of terrible disaster, the patient can be helicoptered out. Obviously, if we feel that a patient may need surgical intervention or is extremely high risk, we choose not to tackle a case like that in a rural setting and instead refer it out to a larger tertiary facility. We always do what is in the best interest of the patient. In the setting of an acute STEMI, it doesn’t matter if you have surgical standby or not. In Europe, it’s very common not to have it. The other thing is that we now have the Impella left ventricular assist device (Abiomed) and similar bailout devices, on top of balloon pumps. 

A while ago, I attended a talk where a doctor was criticizing Europe for providing angioplasty without surgical backup. In America, he said, we do the mother test, i.e., where would you do the procedure if it was your mother? Well, I can tell you that if my mother was having a STEMI, I’d want her intervened in very quickly and would prefer PCI over thrombolytic therapy. 

Dr. Moosa: That’s why it is important to get the right skill set of an experienced interventionalist in these programs. Patient selection is important: knowing what kind of patients need to be referred out versus the kind of patients who need to be intervened on. It takes a certain level of judgment, and that’s why it is so important to have experienced cardiologists on our team as we start out these small programs. Inevitably, you are looked at under a microscope and clearly, our goal is to render the best possible outcomes wherever we are.  We are very transparent and post our data on the ACC-National Cardiovascular Registry (NCDR). 

Cardiologists with small or solo practices are concerned with changes that are ongoing in healthcare presently. How does CardioSolution provide a level of security for you as a physician?  

Dr. Moosa: There is a very entrepreneurial spirit behind the company. It’s not a big corporate culture where you are stuck in committee meetings and so on. We work well together, discuss issues regularly, and make decisions that are in everyone’s best interest. There is a great degree of responsiveness from the administrative team. Clearly, there is good interaction between all of us.

Dr. Mallavarapu: CardioSolution has been a very good company to work for. I would say that to be in on the ground floor is a good thing. The way health care trends are going, hospitals have to look to develop cardiovascular service lines. CardioSolution will be an important part of this as we move forward. 

Any final thoughts?

Dr. Moosa: CardioSolution provides a very unique solution to meet the cardiovascular needs of smaller hospitals and communities that just don’t have access to experienced interventionalists. Usually they have a very difficult time not just in recruiting, but in retaining interventional cardiologists.Our culture is very inclusive. All of our physicians have a strong voice in the decision-making process. Most importantly, our foundation is quality patient care — if patients are well taken care of, everything else falls into place.    

Dr. Moosa can be contacted at ymoosa@cardiosolution.com. Dr. Mallavarapu can be contacted at cmall@cardiosolution.com.

Learn more about CardioSolution at www.cardiosolution.com.

Recommended reading

1. Cath Lab Digest talks with Dr. Lou Vadlamani, chief medical officer of CardioSolution, and Perrin Peacock, chief executive officer of CardioSolution, Columbus, Ohio. Building rural interventional programs with CardioSolution. Available online at http://www.cathlabdigest.com/Building-Rural-Interventional-Programs-CardioSolution. Accessed February 12, 2013. 

2. Cath Lab Digest talks with Tim Sayler, President/CEO of St. Joseph Regional Medical Center in Lewiston, Idaho. Partnering with CardioSolution to build an interventional program at St. Joseph Regional Medical Center. Cath Lab Digest 2012 Dec;20(12). Available online at http://www.cathlabdigest.com/articles/Partnering-CardioSolution-Build-Interventional-Program-St-Joseph-Regional-Medical-Center. Accessed February 12, 2013.