Innovative Model of Ambulatory Care Within an Academic Hospital Center
e-Health ePoster Library. Barrett J. Jun 6, 2017; 167120; EP08.05
Jaqueline Barrett
Jaqueline Barrett
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Abstract
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Purpose/Objectives: St. Joseph’s Healthcare Hamilton is the busiest birthing centre in the region, delivering 3,600 babies per year, which accounts for 51% of all the babies born in Hamilton. The Obstetrics and Gynecology Clinic provides care for obstetrics (pre and post-natal), as well as gynecology patients. While the 2013 goal was a volume cap at 12,000 patients, the clinic received 13,747 ambulatory patient visits in 2014-15 and 14,013 ambulatory patient visits in 2015-16. Continued increasing patient volume in 2016 and cost containment pressures prompted an optimization review of services and an innovative model to emerge. Increasing access to care and efficiencies as well as acting upon pressures to reduce per patient care costs led to restructuring the ambulatory care model for Obstetrics and Gynecology.

Methodology/Approach: This will be a phased implementation, both from a care delivery perspective as well as a physical location within the hospital buildings. The expected outcome will be to establish a new 11-physician group practice model situated on site with physical space including several in-kind hospital support services, but funded and managed independently by the physician group. The redesign includes recommendations for staffing, physical space and an operating business model. The methodology included a review of background information, an environmental scan to identify hospital-based clinics with a physician-funded and managed model, analysis of reports and clinic data, a review of all EMRs currently certified in Ontario as considerations to increase efficiencies for the new model.

Finding/Results: For medical groups with 3 or more physicians, hiring a professional practice administrator may bring additional value and efficiency. The new structure ensures minimum overhead costs to the practitioners (≤10%) including staffing and supplies and shows various options for revenue sharing between the practitioners depending on previous year revenues of patient volumes or equal revenue sharing distribution. Job descriptions were developed for the various positions at the Ambulatory OB-GYN clinic and use as appropriate in recruiting staff for this new clinic. Taking into account physician roles in teaching and research as well, the respective Women’s & Infant Program at St Joseph HealthCare Hamilton and the Ambulatory OB-GYN Clinic Physician group have endorsed a plan for physicians practicing within the hospital setting to integrate their independent offices and processes at an operational level, while ensuring the independence and autonomy of each medical staff at a strategic level.

Conclusion/Implication/Recommendations: Recommendations included measurement metrics to know and track how the practice is performing clinically, financially, and in delivering services. Financial and operational considerations included tracking indicators of operational efficiency such as deliveries, diagnostic tests, surgeries by type, and outpatient visits. Tracking relative value units and revenue per doctor is also useful as indicator of practice performance. Managing change proactively was key to maintaining excellence in working relationship between physicians. Finally, looking at budgeted versus actual expenses and evaluating the service mix each month will ensure continued sustainability of the practice.

140 Character Summary: St Joseph Healthcare Hamilton Hospital developed an innovative operating business model to restructure its ambulatory care model for OB/Gyn Ambulatory care.
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