The pace of health care change is accelerating rapidly, and to stay abreast
of the newest ideas, methodologies and best practices requires innovative,
forward-thinking physicians. CaroMont Health was pleased to welcome such
an individual to the Greater Charlotte region on October 1, 2010, as James
P. Greelish, M.D., assumed the role of Director of Cardiothoracic Surgery
at the organization.
Dr. Greelish’s desire to become a physician was rooted in his firsthand
observation of the crippling power of disease and the potential of medicine
to improve the lives of others. His brother was confined to a wheelchair
from an early age by Duchenne muscular dystrophy, and Dr. Greelish served
as one of his brother’s caretakers throughout his life.
Dr. Greelish began his career in health care on the bottom rung of the
ladder by cleaning floors at Morristown Memorial Hospital in Morristown,
NJ. He later became a phlebotomist at the facility, a position that further
piqued his interest in medicine by allowing him to observe aspects of
the hospital ranging from patients in the intensive care unit to newborns
in obstetrics. Despite his interest in medicine, however, he began his
undergraduate years still unsure if a career as a physician was what he
wanted for his future.
Fueled by Family Tragedy
After earning his undergraduate degree from Emory University in Atlanta,
GA, Dr. Greelish took a research position at Wake Forest University School
of Medicine in Winston-Salem, NC, where a year spent focusing on atrial
natriuretic peptide — a hormone released by the heart — sealed
his decision to attend medical school.
“Shortly before I began medical school at Wake Forest, my brother
died after an increase in the severity of his illness,” says Dr.
Greelish. “I focused my energy on performing well in medical school
as part of the grieving process. During my education at Wake Forest, I
experienced another instance of personal exposure to medicine when my
father died unexpectedly due to a pulmonary embolism. Those deaths profoundly
shaped my journey towards becoming a physician.”
As with many medical students, Dr. Greelish’s search for a specialty
led him to seek a field that meshed with his personality and skill set.
He settled on cardiothoracic surgery because of its technicality and potential
for innovation, as well as its demand of excellence from its practitioners.
Dr. Greelish graduated from Wake Forest University School of Medicine in
the top 10% of his class, Alpha Omega Alpha, and was accepted into a seven-year
surgical training program at the Hospital of the University of Pennsylvania
that included a two-year research component. During his time at Penn,
Dr. Greelish worked as a postdoctoral research fellow at the university’s
Institute for Human Gene Therapy, where he focused on muscular dystrophy
with a colleague whose two brothers had also died from the disease.
“We did some very interesting research at Penn in which we essentially
created a truncated form of the dystrophin gene, cloned it into a viral
vector and were able to transfer it into the majority of muscle cells
of the mdx mouse with muscular dystrophy,” Dr. Greelish says. “That
work essentially showed that we could cure the pathophysiology of muscular
dystrophy in the mouse. Personally, the research was very rewarding for
me because it provided closure on the chapter of my life that brought
me into medicine.”
The research Dr. Greelish helped conduct on muscular dystrophy was published
as the lead article and cover photo in Nature Medicine and earned him
the Jonathan E. Rhoads Research Award at Penn — experiences that
spurred him on to a three-year fellowship in cardiothoracic surgery at
the Brigham and Women’s Hospital in Boston, MA, a major teaching
affiliate of Harvard Medical School. During his time in the Northeast,
Dr. Greelish worked with some of the leading cardiothoracic surgeons in
the country, including Lawrence Cohn, M.D.; David Adams, M.D.; David Sugarbaker,
M.D.; and John Byrne, M.D. It was an experience that taught him a lot
about what it takes to be a successful surgeon.
“I learned at Brigham that a surgeon must constantly evolve and not
become stale,” Dr. Greelish says. “Some surgeons learn a skill
set and become comfortable with it, and they forget how important it is
to be a lifetime learner and stay current with the best techniques available.
The program in Boston epitomized that concept of being on the cutting
His training complete, Dr. Greelish traded Boston for Nashville, where
he spent eight years as associate professor and director of research and
education for the cardiac surgery department at Vanderbilt University.
Shortly after his arrival in Tennessee, Dr. Greelish persuaded Dr. Byrne
to join him, and the two set about creating an environment of excellence
in cardiac surgery that they fondly called “Brigham South.”
At the core of the endeavor was the advancement of the hybrid operating
room concept — an idea that went much further than simply creating
a space for combined cardiology and cardiac surgery procedures.
“We sought to foster sincere collaboration across cardiology and
cardiac surgery,” Dr. Greelish says. “Too often in medicine,
that sort of environment is one that is foreign to physicians due to the
prevalence of competing interests. If an environment can be created where
interests are aligned, you can achieve a true collaborative process, and
the best in medicine surfaces. At Vanderbilt, the concept of collaboration
wasn’t just occurring between cardiology and cardiac surgery; a
cultural merger was also taking place between private practice physicians
who had recently joined the practice and established academic physicians.
Both practice types of hospital environments have their advantages —
academic physicians tend to be cutting edge and evidence based, but they’re
not always the best business person or the most skilled when it comes
to cost efficiency. When we welcomed private practice physicians into
our practice at Vanderbilt, they brought those skills with them to an
academic setting, and we were able to achieve the highest possible care.
Instead of working in isolated environments, our physicians were able
to work together so the best decisions came to the surface.”
Bringing the Spirit of Collaboration to CaroMont Health
When asked what attracted him to CaroMont Health and his practice, Carolina
Cardiovascular and Thoracic Surgery Associates, Dr. Greelish was quick
with his response — the chance to recreate the atmosphere of collaboration
in which he worked at Vanderbilt at a time when CaroMont Health is embarking
on some exciting national initiatives, such as a partnership with Columbia
University and the implementation of a new system of medical accountability.
“I’d like to foster a sense of collaboration among physicians
across all specialties, which dovetails well with the bigger goals of
the health system,” he says. “Valinda Rutledge, CaroMont Health’s
President and CEO, is a forward-thinking leader who wants CaroMont to
become one of the first accountable care organizations [ACOs] in the United
States. The idea behind an ACO is to get away from an antiquated model
of ‘fee for service,’ which drives up health care costs and
leads to unnecessary patient testing due to system inefficiencies and
self interests, and puts the focus back on patients through value-based
health care that’s rooted in quality, outcome data and efficiency.
The only way an organization can pull that off is to have an environment
of high collaboration across all services. I felt coming to Gastonia was
a unique opportunity to get in early with an organization that was thinking
in a forward way and that had values consistent with my own.”
CaroMont Health launched its ACO initiative during the spring of 2010 as
one of only 19 health systems across the country. As an ACO, CaroMont
Health providers work to ensure patients’ health and prevent intensive
care stays by accepting accountability for a specific population of patients.
At the heart of the ACO model is outcome-based reimbursement — providers
are paid based on quality of care and health of patients, rather than
on services rendered. ACO health systems share their best practices with
each other in focus areas ranging from patient-centered health homes to
“It was obvious to me that CaroMont Health possessed a great team
of physicians with the highest level of expertise,” Dr. Greelish
says. “The idea of creating an ACO requires a system to be big enough
to have the entire spectrum of patient care, including outpatient, inpatient
and postacute care services. It must also be big enough to have reliable
performance and quality measurements, but not so big that it’s restricted
by a cumbersome bureaucracy, which is a frustration I encountered in academic
medicine. I thought coming to CaroMont Health would give me the best of
both worlds by allowing me to join a cutting-edge, high-quality cardiac
surgery team and be part of the direction medicine is heading.”
CaroMont Health’s commitment to a new vision of health care delivery
wasn’t the only exciting development that captured Dr. Greelish’s
attention. In June 2010, CaroMont Health announced a partnership with
Columbia HeartSource, a cardiovascular group at NewYork-Presbyterian Hospital
and Columbia University Medical Center that will give physicians at CaroMont
Health exposure to some of the most advanced cardiac procedures being
performed, as well as access to a shared quality control database.
“The partnership between CaroMont Health and Columbia really impressed
me because it seemed like an interesting transition out of a purely academic
setting into a community-based hospital,” Dr. Greelish says. “That
relationship allows for a higher level of focus on quality outcomes and
evidence-based care that might not exist in isolated, private practices.
The relationship really allows our program to stay on the leading edge
of the field by giving our physicians the opportunity to learn more about
procedures that are currently being performed only in academic centers,
such as percutaneous valve surgery, certain valve-sparing operations and
transplantations. My colleagues and I are able to attend morbidity and
mortality teleconferences with our colleagues at Columbia. We’re
also invited to participate in surgeries at Columbia to continue our education
and bring back skills from an Ivy League institution to the community
Performing Advanced Procedures
A sense of collaboration among physicians isn’t the only thing Dr.
Greelish has brought to CaroMont Health; he’s also introduced several
surgical techniques and innovations to the system. All bypass procedures
at CaroMont Health are now performed off pump, a strategy that decreases
transfusion rates, produces better neurologic outcomes and speeds recovery
times. Dr. Greelish and colleagues also recently began performing minimally
invasive direct coronary artery bypass procedures, often as part of hybrid
operations in conjunction with stenting by cardiologists.
Dr. Greelish and his colleagues also perform:
■aortic root procedures,
■minimally invasive aortic valve surgery,
■minimally invasive mitral valve repair and replacement, and
“Through our partnership with Columbia, we’ll soon be able
to offer percutaneous valve surgery,” Dr. Greelish says. “Community-based
cardiac surgery programs aren’t always able to offer high-level
operations, such as aortic root procedures and minimally invasive surgery,
but we can perform those procedures for the residents of Gaston County
and Greater Charlotte.”
When Dr. Greelish thinks about the future of his field and the future
of cardiac surgery at CaroMont Health, it’s clear to him there is
much to be excited about.
“It’s significant that we’ll soon be able to offer percutaneous
valve surgery here because it’s a procedure that many in the field
are eagerly anticipating,” he says. “Percutaneous valve surgery
involves many of the issues that have come to the forefront as medicine
changes, not least of which is collaboration. Cardiac surgeons can’t
pull it off alone, and neither can cardiologists; they have to work together.
The procedure holds the potential to help many patients who are currently
considered inoperable and will do so with lower morbidity and mortality.”
As for his vision for cardiac surgery at CaroMont Health, Dr. Greelish
knows it all starts with a change in mindsets.
“Our No. 1 goal is the highest level of value-based cardiac care
to our customers and our patients by focusing on what works,” he
says. “The new era of medicine will revolve around transparency
in quality, outcomes, efficiency and cost. I’m proud to be a part
of an organization that’s helping usher in that new era. CaroMont
Health is redefining the standard in cardiac care for Greater Charlotte.”
For more information about cardiac surgery at CaroMont Health, visit www.caromonthealth.org
or call (704) 671-7670
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