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04/12/23 1
Introduction
Pediatric & Obstetric Faculty Practice Organization (FPO) Status Report
Stanford School of Medicine Leadership RetreatJanuary 30 - February 1, 2003
04/12/23 2
Strategic Initiatives
The Strategic Plans for Adult and Peds/Ob Clinical Services have in common:
Mission Statement Vision Strategic Goals Strategic Activities Regarding Support for:
Medical School Professoriate Changes Medical Education Curriculum Changes Integration of Research and Innovation into Clinical Centers of
Excellence
04/12/23 3
Pediatric/Obstetric Clinical Practice Strategic Initiatives
2002 ACCOMPLISHMENTS
• Increase inpatient services in neonatology in South Bay hospitals.• Expanding non-neonatal inpatient programs at SCVM and pediatric cardiac programs at Fresno and Oakland Children’s Hospitals.• Continued and expanded over 50 clinical outreach programs.• Implementation of CHI clinical initiatives, esp. in cardiac and transplant centers.• Continuing education programs for primary care physicians (Livermore).
04/12/23 4
Pediatric/Obstetric Clinical Practice Strategic Initiatives
2003 OBJECTIVES
• Expand inpatient pediatric bed capacity at LPCH and affiliate South Bay hospitals (El Camino Hosp).• Improve access to LPCH subspecialty clinics and through clinical outreach.• Planning for the move of most LPCH outpatient clinics out of the hospital.• Implementation of CHI clinical initiatives, esp. in oncology, CF/pulmonary and neurosciences.• Continuing education programs for primary care physicians (Hawaii).
04/12/23 5
UCSFOakland Children’s
.58 million pediatric lives in the primary service area
1.2 million pediatric lives in the secondary service area
LPCH
Central California Children’s
50 Miles
Primary Service Area
Secondary Service Area
Other
Total Pediatrics Only
70%
21%
9%
54%
31%
15%
LPCH Market
04/12/23 6
San Mateo Redwood City
Mountain View
San Jose Santa Clara
Primary MarketSan Mateo
CardiologyRedwood City
Satellite NICUPerinatal/Neonatal Educational Outreach
Palo AltoGastroenterology
Mountain ViewPerinatology/Neonatology Service and Educational Outreach
Santa ClaraGastroenterology
San JoseAdolescent MedicineEndocrinologyGastroenterologyGeneral SurgeryUrology
Secondary MarketStockton
CardiologyGastroenterology
OaklandLiver TransplantationCV Surgery
San FranciscoCardiology
ModestoCardiology
PleasantonPediatric Hospitalist
FremontSatellite NICUCardiologyPerinatal/Neonatal Educational Outreach
Santa CruzSatellite NICUEndocrinologyGeneticsGastroenterologyInfectious DiseasesPerinatal Diagnostic Perinatal/Neonatal Educational OutreachPulmonologyRheumatologyUrology
WatsonvilleNICU Medical Director
SalinasAdolescent Medicine NICU Medical Director
Monterey Cardiology & Gastroenterology
Watsonville
Fremont San Francisco
Stockton
Oakland
Monterey Salinas
Santa Cruz
Pleasanton Modesto
Pediatric/Obstetric FPO Outreach Sites: 1o & 2o Markets
04/12/23 7
Anchorage, AK
Tacoma
Portland
Eureka
Ukiah
Redding Chico
Sacramento
Fresno
Honolulu, HI
Pediatric/Obstetric FPO: 3o Markets
San Luis Obispo
Sonora
CALIFORNIAChico
GastroenterologyEureka
GeneticsGastroenterology
FresnoLiver Transplant ClinicCV Surgery
ReddingGastroenterology
Sacramento Liver Transplant Clinic
San Luis ObispoCardiology
SonoraNeurology
UkiahGeneticsGastroenterology
WashingtonSeattle/Tacoma
Liver Transplant Clinic
OregonPortland
Liver Transplant Clinic
MontanaBillings
Cardiology
AlaskaAnchorage
Liver Transplant Clinic
HawaiiHonolulu
Liver Transplant Clinic
04/12/23 8
Market Share of LPCH Centers of Excellence
Est. Market Share
Complex Congenital Heart Surgery (No. CA) 75%
Liver Transplants (No. CA, OR, HI) 60%
Neonatology (Santa Clara & San Mateo Co) 50%
Bone Marrow Transplants (No. CA) 40%
Brain Tumor Neurosurgery (No. CA) 30%
Cystic Fibrosis Center Patients (No. CA) 30%
04/12/23 9
What do we hope to accomplish with the pediatric/obstetric FPO?
Support our academic mission by incorporating education and clinical research as integral components of our practice operations.
Directly involve faculty in the day-to-day operations of their practice.
Improve efficiency Improve quality and customer service
Maximize revenue from patient care encounters. Improve billing, coding, and authorization process Better contracts for pediatric/obstetric services
Understanding and oversee the funds flow to the practice from LPCH and the Departments.
Align incentives so the cost savings and revenue enhancement accrue back to the practice.
04/12/23 10
Pediatric/Ob FPO Goals & Mission Statement
The Pediatric/Obstetric Faculty Practice Organization will advance the missions of Stanford School of Medicine and
Lucile Packard Children’s Hospital where they intersect in the delivery of professional medical services.
Goals:
To improve the efficiency and effectiveness of the physician practice and to improve quality of patient care through the establishment of a faculty practice organization in which:
1. The faculty are responsible and accountable for the operations of the practice; and,
2. Incentives are aligned between LPCH and the pediatric/obstetric clinical practice for the purpose of improved performance.
Mission:
04/12/23 11
Faculty with Pediatric/Ob Practice
16 Departments, all of which care for both adults and children, except for Pediatrics and Internal Medicine. (15 Departments will participate)
Approximately 350 clinicians who care for pediatric or obstetric patients.
333 show >50% of charges linked to peds/OB 131 show >95% of charges linked to peds/OB
49 UTL, 133 MCL, 114 Staff Physicians, 50 Other
04/12/23 12
Operating Principles for Pediatric/Obstetric FPO
Alignment of goals between FPO, LPCH and Stanford School of Medicine through dual reporting structure to Dean and LPCH CEO;
No new corporate entity;
Faculty-driven governance structure;
Faculty responsibility and accountability for financial, quality and service outcomes;
Retention of control of Departmental finances within each Department, and retention of control of LPCH finances and clinics within LPCH.
04/12/23 13
Pediatric/Ob FPO Operating Principles
Direct linkages to LPCH administration through participation of FPO leaders on LPCH Executive Committee and LPCH CFO on the FPO Management Committee;
No incremental FTEs in FPO administrative structure;
Commitment to the development of performance standards; and
Full time administrative personnel to interface between hospital and clinical practice.
04/12/23 14
Pediatric and Obstetric FPOManagement Structure
CEO, LPCH Dean, SSoM
FPO Management Committee Chair
Executive Director
Ambulatory Medical Director Director, FinanceDirector, Operations
Clinic Staff
Practice-related Inpatient Staff
DFAs
Peds/OB Pro Fee Billing
Dept Chairs
LPCH Board of Directors Stanford Univ. Provost
04/12/23 15
*Sub-committees of existing hospital-wide committees
Peds/Ob FPO Governance Structure
Quality Improvement* Practice Operations
Managed Care Contracting*
Pro-Fee Billing/ Compliance*
Stanford School of Medicine
(Philip Pizzo, MD)
LPCH Executive Committee(Christopher Dawes)
FPO Management Committee
(Ken Cox, MD)
Finance Committee
04/12/23 16
FPO Management Committee MembershipFaculty
Sr. Associate Dean of Clinical Affairs for Pediatrics and Obstetrics Executive Director, FPO LPCH Chief of Staff LPCH Chief of Surgery Medical Director, FPO Ambulatory Services Chair, FPO Quality Improvement Committee Chair, FPO Finance Committee Chair, FPO Managed Care Contracting Committee Chair, FPO Pro-fee Billing Committee
Administrative Staff FPO Director, Operations FPO Director, Finance Senior Associate Dean, Finances/Administration for SoM LPCH Chief Financial Officer DFA representing Peds/OB DFA Work Group
Pediatric/Ob FPO Management Committee
04/12/23 17
Peds/OB Service ChiefsQuarterly Attendance @ Management
Committee
Surgery Albanese, Craig Ophthalmology Alcorn, Deborah Renal Alexander, Steven Inf Dis Arvin, Ann RadiologyBarth, Richard Cardiology Bernstein, Daniel Rad Onc Donaldson, Sara OB Druzin, Maurice Liver Transp Esquivel, Carlos Infant Dev Fleisher, Barry Intensive Care Frankel, Lorry PathologyGeaghan, Sharon Neurology Hahn, Jin Cardiac Surgery Reddy, Mohan Genetics Hoyme, Eugene Neurosurgery Huhn, Stephen Pain/Anesth Gregory
Hammer(Interim)
Hand Surgery Ladd, Amy Dermatology Lane, Alfred Hematology/Oncology Link, Michael Adolescent Medicine Litt, Iris General Pediatrics Mendoza, Fernando ENT Messner, Anna Pulmonary Moss, Richard Child Psychiatry Reiss, Alan Ortho Rinsky, Lawrence Kidney Transplant Salvatierra, Oscar Rheumatology Sandborg, Christy Plastics & CFA Schendel, Stephen Urology Shortliffe, Linda Neonatology Stevenson, David Allergy Umetsu, Dale Endo & Diabetes Wilson, Darrell
04/12/23 18
Management Committee Responsibilities
Review and further develop the vision Perform strategic planning for the pediatric and obstetric
practice and the LPCH clinics Establish performance and productivity standards for the
pediatric and obstetric clinical practice Design and approve the FPO financial model and monitor
overall performance Establish and monitor incentive plan as approved by SoM and
LPCH Approve/direct pediatric and obstetric FPO management team
and oversee operating performance Establish key FPO policies
04/12/23 19
FY03 Goals
Establish the governance structure and hire the FPO administrative team;
Create an integrated statement of revenue and expense for the Pediatric/Obstetric practice, reflecting all practice related income and expense regardless of hospital or departmental genesis;
Establish performance goals and an incentive model for implementation in FY04; and,
Assume accountability for the operations of the clinical practice, including the LPCH ambulatory clinics.
By the end of FY03, the FPO expects to accomplish the following: