Frequently Asked Questions
What are National Cardiovascular Partners’ responsibilities?
How does NCP offer a majority ownership to physicians when hospitals and others do not?
Does the physician investment include the land and facility?
What is a founder? Is an outpatient cath lab or hospital-based CV joint venture the appropriate facility for our physician group?
Can peripheral interventions be done in an outpatient cath lab?
Is it possible to invite other physicians along with my group to form a partnership with NCP?
If my group builds a cath lab with NCP, what is the process for selecting the design, the equipment, and other details of planning and implementing the project?
How much control would our practice have over the clinical operation of the cath lab if we joint venture with NCP?
How will owning an outpatient lab with NCP affect my relationship with the hospital? Open to 3-way Joint Ventures
How does NCP help with regulatory issues such as CON and state regulations that affect building a lab?
What value does NCP add to my practice?
What if our practice already has its own outpatient cath lab? Does NCP form joint ventures with existing labs?
Q: What are National Cardiovascular Partners’ responsibilities?
A: National Cardiovascular Partners (NCP) offers a turnkey solution to our physician partners. Typically involved in projects from inception, our responsibilities to physician partners include:
- Physician partner recruitment
- Recruitment, interviewing and hiring of all staff
- Site selection
- Managed care contract negotiations and contracting
- Building design
- Financial arrangements and legal structure
- Day-to-day management of the facility
- Oversight of the facility construction
- Monthly reporting to the facility’s Governing Board
- Equipment, supplies purchasing
- Development of all policies, procedures and related forms
- Medical and management information systems (MIS)
Q: How does NCP offer a majority ownership to physicians when hospitals and others do not?
A: NCP believes that physicians, as the major party, should own the majority of the equity – pure and simple.
Q: Does the physician investment include the land and facility?
A: Partnerships are structured so that the land and building can be held in a separate partnership from the facility operating partnership. This allows physicians to decide whether they want to participate in both partnerships or in only the facility operating in the real estate entity. This decision is at the sole discretion of the physician partners.
Q: What is a founder?
A: A founder is a person who meets the financial standards of an accredited investor. Founders usually make up the original governing board that moves the project along in an orderly fashion. They are typically involved in both the initial decisions and direction of a project.
Q: Is an outpatient cath lab or hospital-based CV joint venture the appropriate facility for our physician group?
A: The “Physician Practice Payor Mix Profile / Patient Case Mix Profile / Investor Qualification Questionnaire” forms submitted by the interested physicians will determine whether an outpatient cath lab or hospital-based CV joint venture is the appropriate facility. This decision is based on the types of cases the physician group performs and the payor mix of their practices. The proper type of facility is obvious upon completion of the analysis of the “Physician Practice Payor Mix / Patient Case Mix” profiles. Each facility type results in control being put back into the physician’s hands.
Q: Can peripheral interventions be done in an outpatient cath lab?
A: Yes, as of January 1, 2005, Medicare will pay physicians to perform peripheral angioplasty in an outpatient facility.
Q: Is it possible to invite other physicians along with my group to form a partnership with NCP?
A: Yes, if it makes sense strategically or in terms of establishing a critical mass. You may invite other cardiologists or physicians who perform procedures in a cath lab to form a partnership and build an outpatient facility.
Q: If my group builds a cath lab with NCP, what is the process for selecting the design, the equipment, and other details of planning and implementing the project?
A: NCP will meet with key cardiologists and administrative personnel to identify preferences and agree on expectations with regard to design, equipment, staffing, scheduling and clinical protocols. Then we develop an overall facility design with our cardiology partner and architect, negotiate with vendors, and establish a timeline. Additionally, we oversee the entire project development and communicate regularly with the practice to provide updates and receive input.
Q: How much control would our practice have over the clinical operation of the cath lab if we joint venture with NCP?
A: NCP empowers the physician practice and does not interfere with the lab’s clinical operation. We work with the cardiologists to execute their wishes regarding staffing, scheduling, types of catheters, and clinical protocols. Significantly, the medical director of the lab is a member of the physician group chosen by the physician partners.
Q: How will owning an outpatient lab with NCP affect my relationship with the hospital? (Open to 3-way Joint Ventures)
A: We have previously joint ventured with hospitals on a 3-way JV and welcome the opportunity to have hospitals join our partnership based on our physicians’ vision.
Q: How does NCP help with regulatory issues such as CON and state regulations that affect building a lab?
A: NCP can navigate complex regulatory barriers in building a new facility. Expertise in overcoming regulatory hurdles to create an outpatient cath lab is required in most states, even when a CON is not required. Unfortunately, many cardiology groups have not built cath labs because they have been dissuaded by formidable regulatory complexity and empty promises from hospitals in which they operate. Proactively, NCP offers comprehensive experience dealing with CON, Stark, Stark II, individual state anti-kickback legislation and state quality rules.
Regarding the types of service that NCP can provide, examples include:
- Petitioning a state regulatory agency to accept new ACC guidelines as to where a cath lab can be located (e.g., redefine what constitutes a “hospital building”)
- Managing the need for CON with sophisticated financial management (i.e., managing costs below the threshold for filing a CON)
- Negotiating with the CON office to obtain waivers or favorable interpretations
- Introducing new legislation to remove old regulatory barriers that are not consistent with the most recent ACC/SCA&I Expert Consensus Document on Cardiac Catheterization Laboratory Standards and the precedent set by inpatient specialty heart hospitals
- Submitting Medicare Carrier Application and application for appropriate licensure certification
- Orchestrating timing of inspections for Certification by Medicare and State Department of Health
- Obtaining accreditation from JCAHO (Accreditation Association for Ambulatory Health Care)
Q: What value does NCP add to my practice?
A: Ways in which a partnership with NCP can benefit a cardiology practice include:
- As a long-term partner in an outpatient cath lab, NCP will provide capital enabling the group to acquire new expensive technology for outpatient services as they become clinically relevant
- Partnering with NCP to develop and manage ancillary services will substantially improve cardiologist efficiency in the cath lab and, by extension, the practice’s overall profitability
- Unlike a hospital partner, we have no competing constituencies; our sole focus is on our shared outpatient cardiovascular services and cardiology partners
- Unlike many other groups, we have professional management resources
- We have extensive experience in securing contracts with third party payors
- We are experts in development and regulatory experience
- We can respond quickly to changes in cardiology practice
- As a national company, we have access to numerous groups nationwide for sharing experience and information
- For smaller groups, we can serve as an independent third party to facilitate formation of a partnership involving multiple groups
Q: What if our practice already has its own outpatient cath lab? Does NCP form joint ventures with existing labs?
A: Yes, we can form a joint venture with an existing lab by purchasing equity. Payment to the practice for purchasing a portion of their facility is attractive to many groups wanting to reduce their risk of experiencing declining revenues due to new technologies emerging.