When the CEO of a global corporation overseeing more than 85,000 employees in over 160 countries tells you that his job is easier than yours is, some might rethink their careers. Not Gary Rogal, M.D., Chief of Cardiology for Barnabas Health, the largest not-for-profit integrated health care system in New Jersey and one of the largest in the nation. He's wanted to practice medicine, particularly cardiology, since he can remember.
Under his leadership, Barnabas Health – comprising seven acute-care hospitals that serve more than two million patients each year – has continued to revolutionize cardiac care by offering the latest technologies, patient-centered services and a dedicated team of specialists committed to quality and health care excellence.
Those two goals – quality and efficiency – are the key to the system's success and the primary focus as it pertains to his responsibility as Cardiology Chief, according to Dr. Rogal.
"We need to make sure the system's cardiac services function the most efficiently with the highest quality possible," he says, adding that doing so is complicated as quality is a moving target. "New quality standards are set all the time, so part of my responsibility as Chief of Cardiology for the system is to ensure that the Cardiac Program at each Barnabas Health hospital – plus hundreds of physicians, nurses and employees – follow the latest practice guidelines down to their very minute details, all while maintaining the highest level of efficiency."
As a practicing cardiologist himself, Dr. Rogal understands firsthand the importance of a health system that provides cardiology services as uniformly and with as little variation as possible – he says it enhances quality and minimizes the potential for adverse outcomes.
"The evidence-based and uniform approach to care is important in getting the best results," agrees Frederic F. Sardari, M.D., Vice Chairman of the Department of Cardiothoracic Surgery at Saint Barnabas Medical Center in Livingston.
"Previously, hospitals separated cardiology – or medical treatment of the heart – and cardiac surgery," says Dr. Sardari, adding that today, more and more hospitals are shifting toward providing the kind of collaborative approach offered by Barnabas Health that's being spearheaded by Dr. Rogal. "By integrating the scope of care we offer under cardiac services, we're incorporating both medical and surgical teams to provide a comprehensive approach to patients' cardiac care."
As part of Dr. Rogal's overall approach to offer integrated cardiac care system-wide, Saint Barnabas Medical Center recently added a new procedure – minimally invasive endoscopic atrial fibrillation (AF) ablation – to its array of treatment options.
The Convergent ablation procedure combines minimally invasive cardiac surgery and traditional AF Ablation performed in the cath lab to treat patients with atrial fibrillation, a type of irregular heart rate that is also known as AF or AFib.
According to Dr. Sardari, the prevalence of AFib and the challenge in treating it is a vast and expanding problem in this country, as it is costly and accounts for a major source of morbidity. The traditional procedure uses ablation techniques to isolate the triggers of AF, either via open surgery or through cardiac catheterization.
"The new hybrid procedure delivers the best of both worlds," says Dr. Sardari, who, along with cardiologist David Dobesh, M.D., performs the hybrid procedure. "The multidisciplinary technique is about 80 percent effective in treating AFib, far better than the success rate of traditional surgery or catheterization alone."
As an attending cardiac surgeon at Barnabas Health's Newark Beth Israel Medical Center and Saint Barnabas Medical Center for the past 15 years, Dr. Sardari is an integral member of the hospitals' Transcatheter Aortic Valve Replacement (TAVR) teams – with one of the highest patient volumes. Barnabas Health hospitals have utilized TAVR to successfully implant aortic valves in more than 400 patients.
"TAVR is a minimally invasive valve replacement that uses a catheter to replace the valve rather than opening the chest. The minimally invasive procedure allows for fewer complications, less pain, shorter hospital stays and a quicker recovery than traditional surgery, and it's a particularly good option for older or sicker patients who may not be good candidates for open surgery," says Dr. Sardari.
The integration of Barnabas Health's cardiac services program into system hospitals has been so successful, Dr. Sardari and his colleagues at Saint Barnabas Medical Center have taken components of the program to underserved populations through a partnership with LIG Global Foundation.
In March, Dr. Sardari, accompanied by a multispecialty team comprising medical specialists and nurses, traveled to Cajamarca, Peru to perform heart valve surgery alongside Peruvian doctors as part of a training and educational campaign. Through the partnership, the team will travel back to Peru later this year to continue helping the medical team there establish a cardiac surgery program.
While the traveling physicians are focused on educating medical professionals in Peru about lifesaving cardiac services, education takes a different form here at home as an important component of Barnabas Health's overall approach to cardiac care.
"Barnabas Health is focusing on offering care across the lifespan. We are taking a more involved role in promoting healthy lifestyles to prevent various diseases, including heart conditions. We want to promote prevention, but we're also available to offer the highest quality diagnostic and treatment services if people do get sick. Then, once they've been treated, we want to help make sure they don't have repeat episodes," says Dr. Rogal.
Barnabas Health is paving the way for such a comprehensive continuum of care by offering integrated, coordinated services, including introducing a program focused on the coordinated care of congestive heart failure patients in Barnabas Health Medical Group practices and system hospitals' heart clinics. In this environment, patients receive education from and care by skilled nurse practitioners who specialize in caring for people with heart failure. Later, and throughout the course of treatment, these patients continue to interact with those same specialists to help them manage their chronic disease.
"We're not operating in silos – we are offering integrative programs, fostering coordination throughout those programs, and working closely together to deliver quality care," says Dr. Rogal, adding that patients must take advantage of this integrated system in order for it to be effective.
"While patient education is very important and something we stress here at Barnabas Health, it also requires patients to recognize the power they possess to keep themselves healthy," he says. "We have the programs and services people can use to improve their health, but risk factor management accounts for about 50 percent of the tools in the box to keep people healthy."