The Realities of Managing On-Site Labor & Delivery Coverage
From the Show: OB Hospitalist Group
Summary:
Air Date: 3/8/21
Duration: 10 Minutes
Dr. Mark Olszyk, Chief Medical Officer and Vice President of Carroll Hospital, discusses the benefits of having a national provider manage L&D coverage and the realities of a hospital trying to manage it alone.
Transcription:
When choosing how to staff and manage your onsite, labor and delivery coverage program, you want to ensure your patients receive thorough, dependable, and exceptional care during emergent hospital visits.
Prakash Chandran: Having a well-integrated care team that reduces your risk profile can help provide a better experience for all your patients.
We're going to talk about it today with Dr. Mark Olszyk, the Chief Medical Officer and vice-president at Carroll Hospital. This is the Obstetrics Podcast from OB Hospitalist Group. My name is Prakash Chandran. So first of all, Dr. Olszyk, it's great to have you here today. I'd love to start by asking you just to give an overview of your role at Carroll.
Dr. Mark Olszyk: Sure. Thanks for having me. As you mentioned, I'm the Chief Medical Officer. What that means is I oversee all the contracts and the quality of our 350 providers, physicians, and advanced practice providers at the hospital. It encompasses eight budget lines and all the service contracts. So altogether, I've about 200 employees working under my org chart and a combined budget of about $37 million. And I say that so you know I'm not just a physician, but I'm also aware of the revenue cycle, strategic planning, return on investment, operating margin, that sort of thing.
Prakash Chandran: And just diving a little bit deeper, can you give us an overview of what your hospital's labor and delivery department looks like?
Dr. Mark Olszyk: Sure. So we're the sole hospital in Carroll County and we see more or less a thousand deliveries a year. There's two practices in the immediate vicinity. We're largely a suburban exurban community about an hour North of Baltimore. And fortunately, most of our patients, probably over 95%, have insurance and prenatal care. The trends we've been monitoring over the last few years are probably common to most places and that moms are getting, on average, a little bit older and their BMIs are getting a little bit higher, but basically your standard community hospital.
Prakash Chandran: And what are Carroll's labor and delivery or women's service line objectives? Can you talk a little bit about those?
Dr. Mark Olszyk: Definitely. We have a strategic plan to really keep most of the births that we can accommodate from the county in our hospital, because we realized that moms direct most of the care for their family. You know, they pretty much determine where everyone goes for their doctor visits or for their specialist visits. And if we can win them over at the time of delivery, then we can pretty much keep them, you know, in our hospital system. So that's really important for us,
And so we embarked on a program of couplet care, where the mom and the newborn baby stay in the same room, no matter what the conditions are surrounding the birth and the aftercare. We would like to have more births. Obviously, we can't do too much about that, but we can try to increase our retention. And of course, our goals are the same as I think everybody else, to decrease C-sections, decrease episiotomies, increase breastfeeding, and of course, decrease any complications for the moms and babies.
As I mentioned, as moms get a little bit older and BMIs get a little bit higher, there tends to be a little bit more complexity involved in the birthing process and the care surrounding the mom and the baby.
Prakash Chandran: Yeah, that completely makes sense to me. And what you were saying earlier about winning the mother over just resonates with me so much, because when we had our first couple of years ago, we had such a great experience at the hospital with all of the nurses and the providers. And it's such a critical time that afterwards my wife was like, "If this is a glimpse into the type of care we're going to be receiving, we're not going to go to any other hospital. We're definitely going to stay here for the rest of our lives." So I definitely see why that's a priority.
Dr. Mark Olszyk: Wow. That's great it resonated with you. You got the message.
Prakash Chandran: Absolutely. So let's talk a little bit about your OB coverage model prior to 2018.
Dr. Mark Olszyk: If I had to pick one word, it would be Byzantine. So we have a hospital and we also have an associated multispecialty care group. And so, in that vehicle, we employed some OB-GYNs and some midwives and they rotated call covering themselves their own group and triaging for the community practices and any unaffiliated unassigned patients.
Because of that, at one point, we had three, if not four, parallel call schedules. So a physician could be on for themselves, for their group, for the outside group, for the unassigned. And sometimes it got so bizarre that I had a situation where a physician was covering for everyone else except for herself. And that just led to a lot of confusion, yeah.
Prakash Chandran: So obviously, those are some of the things that didn't work. Is there anything that worked about the model before?
Dr. Mark Olszyk: Not really. No. It was very complicated. It was complex. It forced me to be the recruiter and the scheduler of last resort and that was certainly not a job that I wanted.
Prakash Chandran: And so based on all of this craziness in coordination, what were some of the potential patient safety risks involved when managing your own OB coverage?
Dr. Mark Olszyk: So we were always negotiating last minute deals. Sometimes somebody would call out for very good reasons, medical reason, they couldn't cover. So often I was put in a position where I needed to persuade someone, rarely needed to coerce one of our employees to take ED call that night. And that's just a miserable situation to be in as a boss or, you know, as an employee. So the safety risk, the ultimate risk, is that the hospital is completely uncovered and there's no obstetrician in-house to respond to any emergencies that might come in through the ED or through labor and delivery.
And then when you have to use your own physicians or midwives to cover call, instead of them being in the office seeing patients, they're standing by in the hospital and that can lead to burnout. It can lead to poor patient satisfaction, which is an increasingly important metric for all of us, especially when the docs have to cancel clinic because they, you know, were up all night or they're attending a delivery. Docs can get tired. They did the very best they can, but as I mentioned, the complexity is increasing, the demands are increasing and they simply can't be in two places at the same time. You just can't cover your clinic and be on call.
Prakash Chandran: Sure. You know, at the top of the episode, you talked a little bit about how you had that purview into the revenue. So maybe then talk about how managing your own OB coverage program affects a hospital's bottom line.
Dr. Mark Olszyk: So we did a couple of different proformas and looked at different models. And if we did it entirely ourselves compared to just contracting out to a company such as OBHG, we could save a little bit of money. At least our CFO looked at the bottom line and said, "Gee, if we just do it ourselves, we employ everybody, we can maybe do it a little bit more efficiently," you know, saving maybe 15%, which doesn't sound like a lot, but in the end it could be a hundred thousand dollars or more.
But that doesn't look at the risk. It doesn't look at the potential of how much more it would cost if we just had a few more call outs, I mentioned the docs were getting tired of getting burned out. If one of them happened to quit and you had to factor in the cost of emergency locums or PRN coverage or the really unacceptable risk of there not being a physician here and something untoward happening and then having to recruit and retain a physician that you had to replace, then the cost just escalates ever upward.
So if we have one more doc quit, we would have been very desperate. We've had to use locums. So, assuming a very stable proposition where you can have your own cadre of employed physicians versus a contract group, maybe it seems a little bit cheaper. But that doesn't account for all of the realities, all of the risks, all of the sweat and tears on the part of the administrative staff and the leadership, trying to ensure that the call schedule is filled up and the patients are taken care of.
Prakash Chandran: Yeah. And you're obviously touching on this, but walk me through in a little bit more detail leadership's thought process in switching to a comprehensive in-house coverage model.
Dr. Mark Olszyk: So we were in the business of outpatient OB-GYN, and we made a strategic decision to get out of that model because our community practices were able to accommodate the patients and, honestly, to probably do a little bit better than we were doing it. So then we were only in the business of providing laborists, providing a 24/7 in-hospital coverage, but again, we had to do our own employing of those physicians and midwives.
Then the outside community practices said, "You know what? There's a national group out there. You should probably look into them and do an assessment. And so we did the proformas. And I thought that was a very elegant solution. It's much easier to deal with, you know, one representative, one contract.
If you have some metrics or some safety or quality goals, it's a lot easier to negotiate that, to explain it to a representative from one group who can cascade that down rather than have five or six separate conversations with the individual employed physicians and midwives. So, it just became a much more elegant solution and one that really enhanced our safety and quality.
Prakash Chandran: So getting into some of the specifics, maybe talk a little bit about why it's more advantageous to work with the national OB coverage provider some of the benefits that you see.
Dr. Mark Olszyk: Yeah. Well, it's just much, much easier. I'm no longer the scheduler. I'm no longer the recruiter. You know, if there's ever an opening, they do all of the recruiting, the initial credentialing. They monitor them. They take care of all the HR. And then we have the luxury of setting the performance metrics and they cascade it down. And they gave us very nice high production value monthly reports.
Another nice thing is that they're not in competition with the community practices. The OBHG providers are solely in the hospital 24/7. They're not in the outpatient setting, so they're not in competition. So it was a lot easier for everyone to coordinate their care and their activities and to get along. Everyone has their own distinct job and everyone benefits.
We used to have a little bit of professional friction from time to time. Now, there's no strife. The nurses are happier, the docs are happier. There's fewer quality issues, fewer peer reviews. I would say it's very harmonious.
Prakash Chandran: So you talked about some of the benefits, but I'm curious to learn more about how you've seen the partnership between your community, OB-GYNs and OB hospitalists evolve over time.
Dr. Mark Olszyk: It's just gotten better and better. I think It's been going on for over two years. And the trust has continued to deepen, the relationships have broadened. I think the patients are much happier. They're certainly well taken care of. The nurses are very happy as well. So it's really enhanced the department cohesion. There's fewer issues to address. And it's really been a beautiful relationship.
Prakash Chandran: So just as we close here today, is there anything that you'd like to discuss or mention just around the partnership with OBHG?
Dr. Mark Olszyk: They have a deep bench. They have a reputation, they have accountability and they can draw on best practices from elsewhere. So it's really been a wonderful relationship and I've enjoyed getting to know all of the physicians as well as their leadership over the last two years.
Prakash Chandran: All right, Dr. Olszyk. Well, this has been hugely informative. Thank you so much for your time. That's Dr. Mark Olszyk, the Chief Medical Officer and Vice President at Carroll Hospital. To learn more about the differences between local and national run OB coverage programs, please visit www.obhg.com.
If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of the OB Hospitalist Group podcast series. name is Prakash Chandran, and we'll talk next time.
When choosing how to staff and manage your onsite, labor and delivery coverage program, you want to ensure your patients receive thorough, dependable, and exceptional care during emergent hospital visits.
Prakash Chandran: Having a well-integrated care team that reduces your risk profile can help provide a better experience for all your patients.
We're going to talk about it today with Dr. Mark Olszyk, the Chief Medical Officer and vice-president at Carroll Hospital. This is the Obstetrics Podcast from OB Hospitalist Group. My name is Prakash Chandran. So first of all, Dr. Olszyk, it's great to have you here today. I'd love to start by asking you just to give an overview of your role at Carroll.
Dr. Mark Olszyk: Sure. Thanks for having me. As you mentioned, I'm the Chief Medical Officer. What that means is I oversee all the contracts and the quality of our 350 providers, physicians, and advanced practice providers at the hospital. It encompasses eight budget lines and all the service contracts. So altogether, I've about 200 employees working under my org chart and a combined budget of about $37 million. And I say that so you know I'm not just a physician, but I'm also aware of the revenue cycle, strategic planning, return on investment, operating margin, that sort of thing.
Prakash Chandran: And just diving a little bit deeper, can you give us an overview of what your hospital's labor and delivery department looks like?
Dr. Mark Olszyk: Sure. So we're the sole hospital in Carroll County and we see more or less a thousand deliveries a year. There's two practices in the immediate vicinity. We're largely a suburban exurban community about an hour North of Baltimore. And fortunately, most of our patients, probably over 95%, have insurance and prenatal care. The trends we've been monitoring over the last few years are probably common to most places and that moms are getting, on average, a little bit older and their BMIs are getting a little bit higher, but basically your standard community hospital.
Prakash Chandran: And what are Carroll's labor and delivery or women's service line objectives? Can you talk a little bit about those?
Dr. Mark Olszyk: Definitely. We have a strategic plan to really keep most of the births that we can accommodate from the county in our hospital, because we realized that moms direct most of the care for their family. You know, they pretty much determine where everyone goes for their doctor visits or for their specialist visits. And if we can win them over at the time of delivery, then we can pretty much keep them, you know, in our hospital system. So that's really important for us,
And so we embarked on a program of couplet care, where the mom and the newborn baby stay in the same room, no matter what the conditions are surrounding the birth and the aftercare. We would like to have more births. Obviously, we can't do too much about that, but we can try to increase our retention. And of course, our goals are the same as I think everybody else, to decrease C-sections, decrease episiotomies, increase breastfeeding, and of course, decrease any complications for the moms and babies.
As I mentioned, as moms get a little bit older and BMIs get a little bit higher, there tends to be a little bit more complexity involved in the birthing process and the care surrounding the mom and the baby.
Prakash Chandran: Yeah, that completely makes sense to me. And what you were saying earlier about winning the mother over just resonates with me so much, because when we had our first couple of years ago, we had such a great experience at the hospital with all of the nurses and the providers. And it's such a critical time that afterwards my wife was like, "If this is a glimpse into the type of care we're going to be receiving, we're not going to go to any other hospital. We're definitely going to stay here for the rest of our lives." So I definitely see why that's a priority.
Dr. Mark Olszyk: Wow. That's great it resonated with you. You got the message.
Prakash Chandran: Absolutely. So let's talk a little bit about your OB coverage model prior to 2018.
Dr. Mark Olszyk: If I had to pick one word, it would be Byzantine. So we have a hospital and we also have an associated multispecialty care group. And so, in that vehicle, we employed some OB-GYNs and some midwives and they rotated call covering themselves their own group and triaging for the community practices and any unaffiliated unassigned patients.
Because of that, at one point, we had three, if not four, parallel call schedules. So a physician could be on for themselves, for their group, for the outside group, for the unassigned. And sometimes it got so bizarre that I had a situation where a physician was covering for everyone else except for herself. And that just led to a lot of confusion, yeah.
Prakash Chandran: So obviously, those are some of the things that didn't work. Is there anything that worked about the model before?
Dr. Mark Olszyk: Not really. No. It was very complicated. It was complex. It forced me to be the recruiter and the scheduler of last resort and that was certainly not a job that I wanted.
Prakash Chandran: And so based on all of this craziness in coordination, what were some of the potential patient safety risks involved when managing your own OB coverage?
Dr. Mark Olszyk: So we were always negotiating last minute deals. Sometimes somebody would call out for very good reasons, medical reason, they couldn't cover. So often I was put in a position where I needed to persuade someone, rarely needed to coerce one of our employees to take ED call that night. And that's just a miserable situation to be in as a boss or, you know, as an employee. So the safety risk, the ultimate risk, is that the hospital is completely uncovered and there's no obstetrician in-house to respond to any emergencies that might come in through the ED or through labor and delivery.
And then when you have to use your own physicians or midwives to cover call, instead of them being in the office seeing patients, they're standing by in the hospital and that can lead to burnout. It can lead to poor patient satisfaction, which is an increasingly important metric for all of us, especially when the docs have to cancel clinic because they, you know, were up all night or they're attending a delivery. Docs can get tired. They did the very best they can, but as I mentioned, the complexity is increasing, the demands are increasing and they simply can't be in two places at the same time. You just can't cover your clinic and be on call.
Prakash Chandran: Sure. You know, at the top of the episode, you talked a little bit about how you had that purview into the revenue. So maybe then talk about how managing your own OB coverage program affects a hospital's bottom line.
Dr. Mark Olszyk: So we did a couple of different proformas and looked at different models. And if we did it entirely ourselves compared to just contracting out to a company such as OBHG, we could save a little bit of money. At least our CFO looked at the bottom line and said, "Gee, if we just do it ourselves, we employ everybody, we can maybe do it a little bit more efficiently," you know, saving maybe 15%, which doesn't sound like a lot, but in the end it could be a hundred thousand dollars or more.
But that doesn't look at the risk. It doesn't look at the potential of how much more it would cost if we just had a few more call outs, I mentioned the docs were getting tired of getting burned out. If one of them happened to quit and you had to factor in the cost of emergency locums or PRN coverage or the really unacceptable risk of there not being a physician here and something untoward happening and then having to recruit and retain a physician that you had to replace, then the cost just escalates ever upward.
So if we have one more doc quit, we would have been very desperate. We've had to use locums. So, assuming a very stable proposition where you can have your own cadre of employed physicians versus a contract group, maybe it seems a little bit cheaper. But that doesn't account for all of the realities, all of the risks, all of the sweat and tears on the part of the administrative staff and the leadership, trying to ensure that the call schedule is filled up and the patients are taken care of.
Prakash Chandran: Yeah. And you're obviously touching on this, but walk me through in a little bit more detail leadership's thought process in switching to a comprehensive in-house coverage model.
Dr. Mark Olszyk: So we were in the business of outpatient OB-GYN, and we made a strategic decision to get out of that model because our community practices were able to accommodate the patients and, honestly, to probably do a little bit better than we were doing it. So then we were only in the business of providing laborists, providing a 24/7 in-hospital coverage, but again, we had to do our own employing of those physicians and midwives.
Then the outside community practices said, "You know what? There's a national group out there. You should probably look into them and do an assessment. And so we did the proformas. And I thought that was a very elegant solution. It's much easier to deal with, you know, one representative, one contract.
If you have some metrics or some safety or quality goals, it's a lot easier to negotiate that, to explain it to a representative from one group who can cascade that down rather than have five or six separate conversations with the individual employed physicians and midwives. So, it just became a much more elegant solution and one that really enhanced our safety and quality.
Prakash Chandran: So getting into some of the specifics, maybe talk a little bit about why it's more advantageous to work with the national OB coverage provider some of the benefits that you see.
Dr. Mark Olszyk: Yeah. Well, it's just much, much easier. I'm no longer the scheduler. I'm no longer the recruiter. You know, if there's ever an opening, they do all of the recruiting, the initial credentialing. They monitor them. They take care of all the HR. And then we have the luxury of setting the performance metrics and they cascade it down. And they gave us very nice high production value monthly reports.
Another nice thing is that they're not in competition with the community practices. The OBHG providers are solely in the hospital 24/7. They're not in the outpatient setting, so they're not in competition. So it was a lot easier for everyone to coordinate their care and their activities and to get along. Everyone has their own distinct job and everyone benefits.
We used to have a little bit of professional friction from time to time. Now, there's no strife. The nurses are happier, the docs are happier. There's fewer quality issues, fewer peer reviews. I would say it's very harmonious.
Prakash Chandran: So you talked about some of the benefits, but I'm curious to learn more about how you've seen the partnership between your community, OB-GYNs and OB hospitalists evolve over time.
Dr. Mark Olszyk: It's just gotten better and better. I think It's been going on for over two years. And the trust has continued to deepen, the relationships have broadened. I think the patients are much happier. They're certainly well taken care of. The nurses are very happy as well. So it's really enhanced the department cohesion. There's fewer issues to address. And it's really been a beautiful relationship.
Prakash Chandran: So just as we close here today, is there anything that you'd like to discuss or mention just around the partnership with OBHG?
Dr. Mark Olszyk: They have a deep bench. They have a reputation, they have accountability and they can draw on best practices from elsewhere. So it's really been a wonderful relationship and I've enjoyed getting to know all of the physicians as well as their leadership over the last two years.
Prakash Chandran: All right, Dr. Olszyk. Well, this has been hugely informative. Thank you so much for your time. That's Dr. Mark Olszyk, the Chief Medical Officer and Vice President at Carroll Hospital. To learn more about the differences between local and national run OB coverage programs, please visit www.obhg.com.
If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of the OB Hospitalist Group podcast series. name is Prakash Chandran, and we'll talk next time.