PCPCardiology Service Line Agreement Peace Health Medical Group

PCP-Cardiology Service Line Agreement Peace. Health Medical Group Service Line Agreement PHMG Cardiology & Primary Care Physicians Family Care Network Critical/Urgent Referrals 1. For office based (outpatient) urgent consults, PHMG Cardiology provides a designated Cardiologist to support Physician and patient needs Monday through Friday from 08: 00 -17: 00. A call to the Office will connect you directly to a designated Cardiologist. 2. PHMG Cardiology will provide direct critical/urgent telephone access for inpatient consults and/or admissions for Family Care Network. PHMG Cardiology provides a Cardiologist at Peace. Health St. Joseph Medical Center for inpatient care and consults Monday through Friday from 07: 00 -18: 00. After hours and weekends is supported with a Cardiologist on call. This is the contact for any Physician that requires a Cardiologist over the weekend. 3. The PHMG Cardiology Physician Schedule is available via the Amion web-based program. Family Care Network Offices can be allowed access to the on-line Schedule through the Clinic Manager who can be reached at XXX-XXXXXXX. 4. Cardiologist services needed after hours can be obtained by contacting the after-hours phone service. 5. When a critical/urgent referral is requested, in addition to the phone call, an urgent referral will be sent along with relevant clinical information via Clarity. Critical/Urgent Testing 1. The FCN Clinician will contact the PHMG Cardiology Office to speak with the designated Cardiologist of the day (Code Blue Cardiologist at XXX-XXXX). If after initial critical/urgent test results warrant another procedure, the Cardiologist will contact the referring FCN Clinician with the designated information and approval to proceed with further care. 2. All critical/urgent test results will be called to the referring PCP the same day as the test is completed. With a formal report to follow within 48 hours. Most generally test results will be in the Hospitals EMR within 72 hours. 3. The Family Care Network Office will fax a PHMG Cardiology Procedure Form (i. e. Echo Order Form, Vascular Order Form, Nuclear cardiology Order Form, and Ancillary Order Form) with the appropriate clinical indications (i. e. ICD 10) for all tests/procedures ordered. The PHMG Cardiology fax number is XXX-XXXX. Routine Consultation 1. Family Care Network will submit a referral via Clarity, outlining what specific services are being requested (i. e. CHF, Device Clinic, HTN, Vascular) and providing appropriate clinical information. To make the patient’s appointment, the Family Care Network Office can either call directly to the PHMG Cardiology Office for the appointment, or include patient contact information for PHMG Cardiology to make the appointment with the patient. a. FCN referring clinician is responsible to indicate what the patient is to be seen for: i. Consult only, 2 visits. ii. Assume care of cardiac condition. iii. Assume management of care until the patient of condition is stable. iv. The PCP will specify on the Referral Form specifically what they would like the Cardiologist to address Source: Peace. Health Medical Group, Vancouver, WA; Cardiovascular Roundtable interviews and analysis. © 2017 Advisory Board • All Rights Reserved 1 advisory. com

PCP-Cardiology Service Line Agreement (Cont. ) Peace. Health Medical Group b. PHMG Cardiology only assumes care of patients with cardiac/vascular conditions. When there are findings on ancillary tests that are outside of cardiology/vascular specialties, recommendations will be included in the office report with the understanding that the FCN clinician will follow-up on the findings and assume the care. 2. PHMG Cardiologists will consult and order tests/procedures as appropriate. The Cardiologist is responsible to followup with the patient regarding all test results that were ordered by them. The Cardiologist will provide a consultation letter (this can be the actual visit note) with findings and recommendations, faxed to Family Care Network. Cardiologist Specialties/Sub-Specialties Cardiologist General Heart Failure A-Fib New Onset Undifferentiated Arrhythmias Dr. A X X Dr. B X X X Dr. C X X X X Dr. D Complex Arrhythmia MGMT Vascular Congenital Heart Disease X X X Follow-Up Care 1. When a patient is referred to PHMG Cardiology for: a. Consult Only b. i. Patient will be initially evaluated by a Cardiologist. Appropriate testing ordered if needed. ii. Patient may be asked to return for one follow-up to review test/procedure results or medication changes/affects. iii. Upon completion of second visit the cardiologist will place an order in Care. Connect for follow-up with FCN physician and the patients will have the appointments made by the PHMG Cardiology schedulers. iv. If medication(s) have been prescribed or changed, the FCN physician will be responsible for refills. v. If the Cardiologist recommends additional appointments with themselves or another Specialist they will contact the FCN physician for discussion and approval. Assume Care of Cardiac Condition/Disease i. Cardiologist will have the discretion for testing and follow-up care and will continue to copy the FCN physician on office notes, labs, and other tests. ii. Cardiologist will “cc” copy the PCP on all office notes, procedure results, and other test results. Source: Peace. Health Medical Group, Vancouver, WA; Cardiovascular Roundtable interviews and analysis. © 2017 Advisory Board • All Rights Reserved 2 advisory. com

PCP-Cardiology Service Line Agreement (Cont. ) Peace. Health Medical Group iii. c. d. Cardiologist will order cc to FCN PCP on the order form of all Peace. Health lab and imaging tests ordered, in order for results to be received electronically directly from the lab. Assume Management of Cardiac Care Until Patient is Stable i. Initial follow-up visits may be with an ARNP or the Cardiologist. ii. Cardiologist will assume primary cardiology care until stable, after which time the patient will be comanaged with the FCN clinician. iii. Exception to this agreed upon condition will be when the patient states they want their cardiac care to continue with the Cardiologist. The Cardiologist will note this in their office note. In this circumstance, the Cardiologist will endorse the capability/agreement of the FCN clinician to follow the patient, but offer to continue care if the patient desires. Unless the cardiologist is providing total care of the patient’s cardiac condition, it will be the responsibility of the Family Care Network physician to manage the patient’s lipids. Re-Referrals 1. When PHMG Cardiology assumes responsibility for patient’s medications they will be required to have a yearly visit without exception. However, it is strongly recommended that medication refills bet he responsibility of the FCN clinician and patients or requesting pharmacies will be referred there first. 2. If patient care has been transferred back to Family Care Network and the patient calls PHMG Cardiology with cardiac symptoms they will be scheduled for an office visit and a referral will be requested from the FCN clinician. The referral request will provide information on what service the patient is requesting (i. e. diagnosis, etc. ) Inpatient Care 1. If PHMG Cardiology is asked to consult with an inpatient or an ED admit patient that is an established patient of Family Care Network, the PHMG Cardiologist will contact the Family Care Network Inpatient Service. If the PHMG Cardiologist has assumed care for the patient and is responsible for the discharge, PHMG Cardiologist will cc a copy of the dictated discharge summary to the FCN physician. The dictated Discharge Summary will indicate who the primary Cardiologist is. In addition, the Discharge Summary will indicate recommendations and the follow care plan. If the patient requires a follow-up with the Cardiologist as an outpatient, the Cardiologist will arrange a follow-up appointment with the FCN physician, with a transfer of the patient’s care back to the FCN physician when their cardiovascular condition is stable. Education Program 1. PHMG Cardiology will offer education support for cardiovascular topics for Family Care Network and their office staff as needed or requested. 2. Request and education topics can be submitted at any time to the Executive Director of Cardiovascular Services via a phone call. It will be the responsibility of the Executive Director to contact the FCN Office to arrange the education session and time. 3. PHMG Cardiology agrees to contact the FCN Quality Medical Director for discussion if they note areas where can be improved by the FCN clinicians. Source: Peace. Health Medical Group, Vancouver, WA; Cardiovascular Roundtable interviews and analysis. © 2017 Advisory Board • All Rights Reserved 3 advisory. com

PCP-Cardiology Service Line Agreement (Cont. ) Peace. Health Medical Group Insurance Referral Request 1. PHMG Cardiology to FCN clinician referral request. a) PHMG Cardiology to include the clinical context (i. e. F/U to ED visit, patient request). b) Referral shall be processed via Clarity (within 2 business days. ) in a timely fashion to assure no unnecessary delays in patient care. Anticoagulation Clinic 1. PHMG Cardiology supports the Community Anticoagulation Clinic provided by the PH-SJMC Pharmacy Department. Results of the anticoagulation results are noted in the Hospital’s EMR and the PHMG Care Connect EMR. PHMG Cardiology also supports Family care Networks Anticoagulation Clinic, and will refer patients to this clinic unless their care is being totally managed by the cardiologist. 2. Family Care Network will do its best to sup[port anticoagulation results from their EMR’s to the Hospital wide EMR system for patient results, consistency and safety. Ata minimum, any patient fro whom FCN Anticoagulation Clinic is aware is anticipating a cardioversion will have the INRs entered regularly into the hospital EMR system. 3. If a patient is referred to the PHMG Cardiology for a consult and there is a question regarding their INR range from FCN’s Anticoagulation Clinic, PHMG Cardiology will call the FCN ACS clinic for the most recent result. If the patient presents in the PHMG Cardiologist Office and is in need of a Protime/INR, the test will be performed at the time of the office visit. Counsel to the patient will be provided with the results and the patient will be referred back to the FCN ACS clinic for continued monitoring. Ancillary Services 1. Ancillary testing (i. e. Echocardiography, Vascular US, Nuclear Stress Testing, Holter/Event Recorders) referred to the PHMG Cardiology Office will have results available: a. All services will have a preliminary report sent within 24 hours (generally a fax) after the completion of the test. b. Dictated report to be sent out in 48 hours. c. EMR results to be posted within 72 hours. Heart Failure Clinic 1. All heart failure patients referred to the PHMG Cardiology heart Failure Clinic will be seen by a Cardiologist then referred back to the FCN physician with recommendations for care, unless management by a Cardiologist has been requested by the FCN physician. All heart failure patients will have *unless already obtained or established): • Measurement of their ejection fraction, by definition to establish the diagnosis. • Evaluation for CAD, either by nuclear scan, Coronary CT or heart catheterization. • Beta-blocker therapy, specifically Coreg and/or Toprol XL, to target dose. • ACE inhibitor therapy if tolerated (i. e. if renal function is acceptable). • Further consultation with PHMG Cardiology Heart Failure Clinic shall be obtained at the FCN physician’s request or if he/she is unable to accomplish the designated noted therapies. Source: Peace. Health Medical Group, Vancouver, WA; Cardiovascular Roundtable interviews and analysis. © 2017 Advisory Board • All Rights Reserved 4 advisory. com

PCP-Cardiology Service Line Agreement (Cont. ) Peace. Health Medical Group 2. Patients with advanced heart failure may have further consultations or become patients of the PHMG Cardiology Heart Failure Clinic if they: • Have persistent heart failure symptoms • Hospitalization without obvious correctable reasoning for worsening symptoms. • Ejection fraction remains <35% despite goal drug therapy after 3 months. • Class III and IV heart failure, to evaluate if any additional therapies or interventions are warranted or appropriate. • Collaboration and communication between the FCN physician, the FCN Heart Failure nurse manager, and the PHMG Cardiology Heart Failure Clinic will be established to assure this patient population is being managed appropriately. • This population of patients may be followed by the Advanced Heart Failure Cardiologist and his/her care team (i. e. ARNP, RN). PHMG Cardiology Family Care Network Date Source: Peace. Health Medical Group, Vancouver, WA; Cardiovascular Roundtable interviews and analysis. © 2017 Advisory Board • All Rights Reserved 5 advisory. com