Becker's Hospital Review

17 Executive Briefing Sponsored by: E mergency rooms in communities where surgeon availability is limited can be forced into a game of patient hot potato when an individual presents with a condition the hospital is unable to treat. When the hospital has to send a patient to another facility as quickly as possible, quality patient care is put at risk, community trust in the hospital erodes and revenue opportunities are lost. An orthopedic surgeon generates an average of $3,286,764 in annual revenue for hospitals, according to Merritt Hawkins' 2019 Physician Inpatient/Outpatient Revenue Survey. Physician shortages and hospitals' overreliance on community-based orthopedic surgeons to come in and treat ER patients can result in reduced surgical revenue. These circumstances are driving many organizations to take advantage of physician specialty services to close gaps in staffing and ensure patients have access to the care they deserve. Similar to surgery, hospitals' obstetrics and gynecology programs are critical yet inherently fragile. Many patients first interact with a hospital through labor and delivery, meaning the OB/GYN program and experience is an important opportunity for the hospital to nurture longtime loyalty with patients. At the same time, stagnating birth rates, tightening margins and difficulty in recruiting providers make OB/GYN programs difficult for hospitals to operate. TeamHealth provides both hospital-based surgical services and OB/GYN hospitalists to health systems around the nation. Neil Vining, MD, the company's national medical director for surgical services, and Khadeja Haye, MD, the company's national medical director, obstetrics and gynecology, recently spoke with Becker's about opportunities in hospital-based physician specialty services. Note: Responses have been edited for length and clarity. Question: What value can hospitals and patients expect to realize from implementing a hospital-based specialty surgical or OB program? Dr. Neil Vining: I think the value for hospitals comes in two fairly distinct forms. One is value from a strictly financial perspective and the other is value in the sense that you're providing a better product to the consumer. Sometimes this value can be financially remunerative, but other times it is more mission driven. On the financial side, if an ER is losing surgical cases because the hospital doesn't have enough staff to deliver general and orthopedic surgical services promptly enough, every one of those cases they lose is a pretty significant financial hit to the hospital. On the mission side, the difficulty many hospitals are having in a lot of markets is simply the provision of basic on-call surgical services. When they are able to provide those services reliably, hospitals provide value to the community by allowing patients and families to get the care they need locally. The ultimate patient dissatisfier is showing up to the ER with a problem and the hospital tells you, "We don't have a doctor who treats that here, so we're going to take you back in the ambulance and send you to a different hospital." If you can stop that from happening, you've made a huge impact not just on that patient's satisfaction, but on the entire community's satisfaction. Community-based surgeons have work to do in their clinics, so they simply can't be as responsive as we can. Our time is not divided. When a time slot becomes available in the operating room, we can take advantage of it and get the patient in as soon as possible. The sooner a patient sees a surgeon, the sooner they're discharged from the hospital, which is a major patient satisfier. Dr. Khadeja Haye: As with surgery, a hospital-based OB/GYN program yields a number of benefits for the hospital, patients, private physicians and nursing staff. Having a physician in-house 24/7 to attend to obstetric emergencies is hugely important from a patient safety and quality care perspective. For example, if you have a patient that shows up with a post-partum hemorrhage, having a physician immediately available can often mean saving a life. From a nursing perspective, I find that in traditional settings, where doctors are on call, nurses do not feel as supported when they have a question or concern. The doctor may be tired, it might be 3:00 a.m., so nurses might be hesitant to call and wake them up. But if a physician is on site, nurses won't feel that they're extending themselves outside the scope of their practice by being the only eyes and ears that can assess the patient. For patients, hospital-based OBs have the time when rounding to counsel patients. They have the time to evaluate all the patients who come in through triage, both of which are huge contributors not only to quality care but to a positive patient experience. Q: What is the scope of TeamHealth's specialty programs? KH: We often provide obstetric and gynecologic care for unassigned patients. Those are patients who show up to the hospital and don't have a provider on staff there. They may have a provider somewhere else or, in many cases, they may not have an OB/GYN at all. When those cases present, either through labor and delivery or the ER, if they require a consultation or admission to the ER, we cover those patients. We also provide assistant services to the private physicians, for both scheduled and nonscheduled cesarean sections. If there's an anticipated difficult delivery, if the private physicians want another physician's hands available, we're there for them. We also provide other services, such as educational support to all providers on staff at the hospital. How to build community trust with hospital-based specialty programs: 5 Qs with 2 physician leaders

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