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Introduction

Pediatric & Obstetric Faculty Practice Organization (FPO) Status Report

Stanford School of Medicine Leadership RetreatJanuary 30 - February 1, 2003

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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

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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).

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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).

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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

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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

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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

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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%

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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.

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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:

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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

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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.

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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.

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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

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*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

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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

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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

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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

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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: