Practice profiles By James F. Benenati, MD, FSIR, and Ripal Gandhi, MD, FSIR


Miami Cardiac & Vascular Institute


“Practice profiles” is a new column exploring the wide array of models in which interventional radiologists practice. Each entry will describe the benefits and challenges inherent to that model, what makes it unique and more. To submit a description of your practice's model or for questions, contact irq@sirweb.org.


Our collaboration with vascular surgery has been intellectually stimulating and is great for the patient, the hospital and the community.” —James F. Benenati, MD, FSIR


Background In 1987, Barry T. Katzen, MD, FSIR, founded our practice as the Miami Vascular Institute, with physicians including Michael D. Dake, MD, FSIR; Gary J. Becker, MD, FSIR; Gerald Zemel, MD, FSIR, RPVI; and James F. Benenati, MD, FSIR. In 2003, the Institute merged with a vascular surgery practice, which strengthened our core and allowed us to practice high-quality vascular medicine in a collaborative environment.


Structure Today, Miami Cardiac & Vascular Institute is a larger multispecialty practice (including IR, DR and vascular surgery), with over 85 members. The practice’s clinical division includes nine IRs, six vascular surgeons, two neurointerventionalists, five fellows (soon to be residents) and five advanced practice practitioners (ARNP and PAs). The IR group provides in-house service at three hospitals and provides IR services at two additional hospitals.


“To ensure we have a voice and a leadership role in the Cancer Institute, we have to be at the table when important decisions are being made. To this end, we’ve actively participated in its establishment, clinical research, its tumor site committees and disease management teams, as well as development of service lines and cancer treatment pathways.” —Ripal Gandhi, MD, FSIR


18 IRQ | WINTER 2019


The group was a private practice until it was acquired by MEDNAX, Inc. (a national health solutions company based in Sunrise, Florida), in August 2017. However, our practice still functions independently, governing itself. To date our relationship with MEDNAX has been very positive for the IR group because we have received support for our office, marketing and growth needs. We are in a better position to focus on finding innovative ways to provide effective, high- quality, efficient care in a rapidly changing and challenging health care environment. We can better scale areas of strength in our practice such as cardiac imaging. Consolidation allows for improved ability to negotiate more favorable reimbursement rates from payers. Like other private groups, we value autonomy and feared losing control when joining MEDNAX. When the relationship is structured correctly, however, we’ve found that it is possible to join a larger group without losing independence.


Scope


Although we cover all aspects of IR, our IO program has exploded in the last few years—especially with the opening of the new Miami Cancer Institute. The institute is one of the four members of the Memorial Sloan Kettering Cancer Alliance, a unique partnership dedicated to providing the latest and most effective cancer treatment care with a focus on a collaborative approach, expansion of clinical trials and personalized cancer care.


In addition, our scope includes complex venous interventions, minimally invasive therapies for pulmonary embolism, and embolization procedures like the treatment of uterine fibroids, pelvic congestion, varicoceles, visceral aneurysms, endoleaks and benign prostatic hyperplasia. We perform MSK interventions and all biopsies and drainages for the health system, as well as biliary, GI and GU interventions. The vascular practice includes all aspects of PAD, including peripheral occlusive disease for patients with claudication or CLI, aneurysms and carotid interventions.


The IR division reads vascular imaging including (CTA and MRAs) as well as noninvasive vascular laboratory testing, with yearly volumes of close to 10,000 studies that include carotid duplex, venous duplex, mesenteric and renal duplex, and arterial physiologic testing pulse volume recordings, doppler and segmental pressures.


We are completely integrated with vascular surgery, sharing procedures, patients and consultations. The collaboration between IR and vascular surgery allows for management of very complex vascular diseases, often with the development of innovative treatment options. Many procedures are performed in conjunction with vascular surgery and cardiac surgery in a hybrid vascular lab.


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