Issue link: https://beckershealthcare.uberflip.com/i/1141789
18 Executive Briefing NV: Both on the orthopedic side and the general surgery side, our scope of practice is acute care surgery. We very specifically don't do elective and semi-elective surgeries for two reasons: one, so we maximize our responsiveness to the hospital for more urgent procedures; two, to ensure that we maintain good relationships with community surgical groups and don't get into a competitive environment. Something else we do that's particularly valuable to the hospital is that our surgical service lines run an outpatient clinic. That outpatient clinic is a landing pad for all those cases that present at the ER that need somebody to follow up. ERs hate it when somebody comes in with an ankle fracture and they're calling around town trying to find somebody who can see this patient and they don't have insurance and the ER has to find somewhere for them to go. Once our program is in place, they never have to make that call again. Q: What is the financial impact of transitioning to a hospital- based model? NV: There's a cost — the hospital has to be willing to say, "Okay, we're going to put this line item on our budget and we're going to pay for it." The bigger financial picture, though, includes all the other ways in which our services impact revenues and costs. The return on investment analysis is much greater than what the doctors collect and what share the hospital takes. There are hospitals where we don't make good financial sense, and I think it's important to be clear about that. If a hospital has a very robust call panel and it's got lots of doctors in the community who are willing to take call, provide good services, and do it for no stipend or a low stipend, they probably don't need our service. But for hospitals losing patients, the overall financial impact makes sense. If you look at the whole financial picture, the stipend a hospital pays us no longer looks like redline — it looks like a black line. And, part of what we're saying to the hospital is "Look, a lot of these people are uninsured, they are self-pay or they are under-insured. We're probably not going to collect a ton of money from them, but we're going to see them and take care of them, regardless." And that matters. That has value in and of itself. KH: As a result of the way we practice and the patient population we care for, many patients are uninsured and a lot of what we do we're never reimbursed for. Our programs don't generate a lot of money based off professional fees. One of the benefits, however, is once you have an OB/GYN hospital program, it allows you to profitably convert the triage area into an obstetric emergency department, which then tends to provide some additional facility revenue for the hospital. This revenue can be significant and does help offset the cost of the program. Q: What is the impact of hospital-based programs on community-based physicians? NV: In most of our markets there's some local surgical presence. In these instances, we are often viewed with skepticism. However, we've found we enhance these surgeons' ability to do the cases that serve them best. Once upon a time, surgeons built their practice on the backs of ER calls. They sat around and waited for patients to come into the ER. That's not how practices are built anymore; they're built on community referrals. So, if you're a total joint surgeon, hand surgeon, foot surgeon or geriatrics surgeon who really looks at the numbers, the last thing you want to be doing is taking call and filling your operating room with uncompensated or under-compensated trauma cases. You're much better off taking that time and adding on another total hip or another ACL reconstruction. What we've seen is that the community surgeons actually improve their own productivity by being able to take the whole burden of calls off their plate. Q: What is the future for hospital-based specialty programs? How are these programs evolving to meet changes in reimbursement and rising consumerism in healthcare? KH: I think these programs will eventually become the standard of care. I think more and more hospitals are recognizing the need for an in-house OB/GYN presence and that traditional staffing models are not necessarily sustainable long-term. I think OB/GYN hospital programs will ultimately become the standard of care, especially for larger hospitals that deliver more than 1,000 babies per year. For hospitals, this service is an investment in the community and in taking better care of your patient population. It's also about getting ahead of the value-based reimbursement curve, especially for hospitals that are poor performers. Whether it's measures on C-section rates, epidemiology rates or even maternal hemorrhage rates, systems with these programs will be better positioned to withstand some of those changes to reimbursement. 'Our docs love this job' — The future of physician staffing models At the end of the conversation, both Drs. Vining and Haye made a point to emphasize another group of individuals who benefit from these staffing models — the TeamHealth specialists. "Our doctors love this job," Dr. Vining said, adding that the novel staffing models mitigate many of the circumstances that contribute to physician burnout, such as unrealistic and inflexible schedules. "We give surgeons an opportunity to actually get back to doing what they enjoy doing and to do it in a way that provides them with work-life balance you cannot find anywhere else in the surgical world … I have a number of surgeons in my programs who would have left medicine if they hadn't ended up working for us." Dr. Haye echoed this sentiment, stating that the TeamHealth model makes physicians' clinical load more manageable, which means they are more likely to stay in practice longer. "Not only are our doctors happy with the improved work-life balance, but this model is extending the life of their careers," she said. As the nation's physician shortage worsens and recruitment becomes even more competitive, physician practices like TeamHealth are poised to become a destination for physicians looking to achieve work-life balance without abandoning their calling. Learn more about the value TeamHealth is bringing to Hospital and ED partnerships at TeamHealth.com n At TeamHealth, our purpose is to perfect the practice of medicine, every day, in everything we do. TeamHealth offers emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, ambulatory care, post-acute care and medical call center solutions to approximately 3,100 acute and post-acute facilities and physician groups nationwide.