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BACKGROUND: St. David’s North Austin Medical Center
St. David’s North Austin Medical Center (NAMC) was recently named one of The Top 100 Hospitals in the nation by Truven Health Analytics. The 332-bed multi-specialty, acute care facility is dedicated to the highest level of women’s health services, including maternity and newborn care with Level I, II and III nurseries at the adjacent $83-million St. David’s Women’s Center of Texas, as well as a 24-hour emergency department, heart and vascular center, neurology and neurosurgery, a kidney transplant program, inpatient and outpatient surgery and acute inpatient and outpatient rehabilitation.
CHALLENGE: Providing Affordable, Quality Women’s Healthcare in a Safe Environment
St. David’s North Austin Medical Center was faced with the task of elevating the quality and safety of women’s healthcare in a financially viable and sustainable way while addressing obstacles in women’s healthcare such as increased costs, a shortage of OB/GYNs and a rise in uninsured and unassigned patients.
SOLUTION: Implementing an In-house Hospitalist Program
NAMC addressed the challenge by partnering with Ob Hospitalist Group (OBHG) to implement an in-house hospitalist program. OBHG’s highly-skilled, Board Certified OB/GYNs are on-site 24 hours a day, 365 days a year. They handle deliveries, emergency situations, and high-risk patients. The hospitalists help both the patient and private OB/GYNs by providing an extra level of care and support.
An OBHG program provides St. David’s North Austin Medical Center with the professional coverage needed to improve emergency outcomes, limit nurse liabilities, and reduce overall hospital malpractice exposure. OBHG hospitalists also provide physician services to patients admitted to NAMC who do not have an established relationship with an OB/GYN physician. Some OBHG hospital partners have been able to reduce their insurance reserves or premium requirements.
The presence of an OBHG program has elevated the quality and safety of women’s care at St. David’s North Austin Medical in the following areas:
- PostPartum Hemorrhage Protocols; an OBHG hospitalist is called to all postpartum hemorrhages
- Supervision of EBB intrauterine balloons
- OB Rapid Response Team participation
- Decreased unattended deliveries
- Accepts assignments for Maternal Fetal Medicine
The OBHG program at St. David’s North Austin Medical Center supports the obstetric providers by providing 24 hour a day, 365 days a year call coverage, providing a favorable work/life balance; triage support for improved productivity, surgical assistance to improve outcomes, providing unassigned coverage maximizing practice profitability and doing so while building trust as a non-competitor to the community provider. St. David’s North Austin Medical Center has witnessed a greater success in recruiting physician’s to their facility since the introduction of the Ob Hospitalist Group program as demonstrated by the success of women's healthcare provider recruitment accomplished by the hospital.
Support from the Ob Hospitalist Group enhanced recruitment and development of St. David’s North Austin Medical Center’s Maternal Fetal Medicine (MFM) group. The MFM program was successfully initiated in 2010; 2012 witnessed the recruitment of the fourth (4th) MFM physician. Recruitment and growth can be attributed to the existence of an Ob Hospitalist Group program; permitting the hospital to offer MFM a work/life option of a consultancy practice with the hospitalist team assuming primary care responsibilities for these often high-risk pregnancies.
The contributions and partnership between the MFM, Neonatology and Ob Hospitalist Group has led to a significant increase in demand for women’s and infant services. The NICU at St. David’s North Austin Medical Center has increased by 49% (from 19 beds in 2008 to 39 beds in 2012 and projected to increase to 59 beds by the close of 2013).
St. David’s North Austin Medical Center established an antepartum unit in 2010. The hospital boasts an upcoming expansion of the antepartum to one of the first Antepartum Intensive Care Units in the state.
Austin Area OB/GYN (AAOBGYN) practice sought to move their practice deliveries from Seton Medical Center after the arrival of an Ob Hospitalist Group program. The ability to eliminate main Emergency Room coverage as a requirement for all OB/GYN physicians (as it has been assumed by OBHG) was one of many favorable deciding factors (including providing an MFM program) prompting AAOBGYN to leave Seton Medical Center after thirty years of affiliation.
The OBHG model is predicated on the creation of an obstetrical emergency department (OBED). The OBED affords St. David’s North Austin Medical Center an opportunity to offset the cost of an obstetrical hospitalist program. The presence of a physician 24 hours a day, 365 days a year, fulfills one of the final requirements for an area previously utilized as an obstetrical triage (outpatient) to be transformed and billed as an obstetrical emergency room. St. David’s North Austin Medical Center realized substantial revenue gain by charging and collecting OBED facility charges.
The revenue betterment was not limited to St. David’s North Austin Medical Center. According to Wes Fountain, CFO for St. David’s North Austin Medical Center, lessons learned and the financial gain from implementing an obstetrical hospitalist program at St. David’s North Austin Medical Center were implemented across all HCA hospitals.
- Additional Financial Gains contributed to the presence of OBHG:
- Increased revenue with the generation of OBED facility charges
- Medical Malpractice reductions; no claims since the implementation of the program.
- Recruitment of new physicians to the hospital
- Maternal Fetal Medicine with maternal transfers (150/month)
- AAOBGYN and their 1800 deliveries/year
- Earned media through marketing of the obstetrical hospitalist program
Additional efficiency gains:
- Increase nursing skill set and training through patient safety drills lead by OBHG.
- A twofold increase in deliveries from 300 to 600 a month
- An 89% increase in NICU beds to 36 beds with plans to add more
- An increase from zero to 180 transfers per year – more than any other hospital in Austin, TX
- The addition of three perinatologists on staff (from zero)
- Hospitalists have had over 18,000 patient interactions and have delivered approximately 870 babies since implementation of the OBHG program
“The program at our hospital has been a huge success and has contributed to the highly successful opening of St. David’s Women’s Center of Texas and the development of a rapidly growing Maternal Fetal Medicine program dedicated to our hospital.”
Kenneth W. Mitchell, MD, Chief Medical Officer, St. David’s North Austin Medical Center
We invite you to discover more about OBHG and the advantages that our customized programs deliver to our partner hospitals, physicians and patients. An OBHG representative would be happy to answer any questions you have as well.