Request for Membership: DeBakey Heart & Vascular Center

Please complete the fields below to be considered for membership in the Houston Methodist DeBakey Heart & Vascular Center (HMDHVC)

• Membership applications will be considered on a rolling basis
• Criteria must be met within 12 months of initial application. Following the inaugural year criteria requirements will be presented to the leadership committee for review quarterly.
• Applicants must meet all requirements
• Please note, members must reapply every three years
• For more information and/or questions, please email debakeymembership@houstonmethodist.org
• FAQs

Benefits of Membership include:

• Listed as a Member, Houston Methodist DeBakey Heart & Vascular Center in the Houston Methodist Physician Referral database.
• Featured as a Member, Houston Methodist DeBakey Heart & Vascular Center on the physician's web profile on the Houston Methodist website.
• Listed as a Member on the Houston Methodist DeBakey Heart & Vascular web page.
• Listed as a Member in the Houston Methodist DeBakey Heart & Vascular biennial report.
• Invited to participate in Houston Methodist DeBakey Heart & Vascular Center focused marketing activities.
• Members have access to new technology and competency enhancements.
• Eligibility to hold a leadership position at a Houston Methodist facility or an affiliated academic institution including but not limited to Hospital department deputy leadership, membership in MDHVC Executive committee or Council, Hospital based CV program leadership role, leadership or membership of a CV program committee, subcommittee or workgroup.

First name * Middle initial Last name * Address * Suite City * State * AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal code * Phone * Email address *

Membership Commitment

I promise to:

Accept and continue my appointment to the medical staff, with privileges to practice cardiovascular (CV) medicine at one or more Houston Methodist facility * Yes No Demonstrate support of the mission, vision, goals and objectives of the HMDHVC * Yes No

Commitment to DeBakey Heart and Vascular Center Services

Participate in at least 50% of Cardiology or Cardiovascular Surgery Service Line meetings at the Houston Methodist hospital where the majority of my practice occurs * Yes No Participate in hospital-based quality standards performance measurement as well as performance improvement processes * Yes No Participate in quality assurance reviews, national guideline adherence reviews, and the NCDR/STS registry (where applicable) * Yes No Adhere to the Houston Methodist Accountable Care Organization’s CV protocols, established for patients enrolled in this program, by providing clinical information on patients to networks on a timely basis * Yes No Adhere to protocols established as part of any other clinically integrated network sponsored by Houston Methodist * Yes No Participate in community and/or patient outreach activities sponsored by Houston Methodist, as requested * Yes No

Commitment to Education and Research

Collaborate with DeBakey Heart & Vascular Center research programs to extend available clinical trial information to eligible patients in my practice * Yes No

Commitment to Excellence

Attend and/or participate in a local, regional or national CV medical conference bi-annually * Yes No Adhere to national treatment guidelines and best practices * Yes No