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Introduction : 

1/12/2009 1 Introduction Pediatric & Obstetric Faculty Practice Organization (FPO) Status Report Stanford School of Medicine Leadership Retreat January 30 - February 1, 2003

Strategic Initiatives : 

1/12/2009 2 Strategic Initiatives The Strategic Plans for Adult and Peds/Ob Clinical Services have in common: Mission Statement Vision Strategic Goals Strategic Activities Regarding Support for: Medical School Professoriate Changes Medical Education Curriculum Changes Integration of Research and Innovation into Clinical Centers of Excellence

Pediatric/Obstetric Clinical Practice Strategic Initiatives : 

1/12/2009 3 Pediatric/Obstetric Clinical Practice Strategic Initiatives 2002 ACCOMPLISHMENTS Increase inpatient services in neonatology in South Bay hospitals. Expanding non-neonatal inpatient programs at SCVM and pediatric cardiac programs at Fresno and Oakland Children’s Hospitals. Continued and expanded over 50 clinical outreach programs. Implementation of CHI clinical initiatives, esp. in cardiac and transplant centers. Continuing education programs for primary care physicians (Livermore).

Pediatric/Obstetric Clinical Practice Strategic Initiatives : 

1/12/2009 4 Pediatric/Obstetric Clinical Practice Strategic Initiatives 2003 OBJECTIVES Expand inpatient pediatric bed capacity at LPCH and affiliate South Bay hospitals (El Camino Hosp). Improve access to LPCH subspecialty clinics and through clinical outreach. Planning for the move of most LPCH outpatient clinics out of the hospital. Implementation of CHI clinical initiatives, esp. in oncology, CF/pulmonary and neurosciences. Continuing education programs for primary care physicians (Hawaii).

LPCH Market : 

1/12/2009 5 UCSF Oakland Children’s .58 million pediatric lives in the primary service area 1.2 million pediatric lives in the secondary service area LPCH Central California Children’s 50 Miles Primary Service Area Secondary Service Area Other Total Pediatrics Only 70% 21% 9% LPCH Market

Pediatric/Obstetric FPO Outreach Sites: 1o & 2o Markets : 

1/12/2009 6 Primary Market San Mateo Cardiology Redwood City Satellite NICU Perinatal/Neonatal Educational Outreach Palo Alto Gastroenterology Mountain View Perinatology/Neonatology Service and Educational Outreach Santa Clara Gastroenterology San Jose Adolescent Medicine Endocrinology Gastroenterology General Surgery Urology Secondary Market Stockton Cardiology Gastroenterology Oakland Liver Transplantation CV Surgery San Francisco Cardiology Modesto Cardiology Pleasanton Pediatric Hospitalist Fremont Satellite NICU Cardiology Perinatal/Neonatal Educational Outreach Santa Cruz Satellite NICU Endocrinology Genetics Gastroenterology Infectious Diseases Perinatal Diagnostic Perinatal/Neonatal Educational Outreach Pulmonology Rheumatology Urology Watsonville NICU Medical Director Salinas Adolescent Medicine NICU Medical Director Monterey Cardiology & Gastroenterology Pediatric/Obstetric FPO Outreach Sites: 1o & 2o Markets

Pediatric/Obstetric FPO: 3o Markets : 

1/12/2009 7 Anchorage, AK Tacoma Portland Eureka Ukiah Redding Chico Sacramento Fresno Honolulu, HI Pediatric/Obstetric FPO: 3o Markets San Luis Obispo Sonora CALIFORNIA Chico Gastroenterology Eureka Genetics Gastroenterology Fresno Liver Transplant Clinic CV Surgery Redding Gastroenterology Sacramento Liver Transplant Clinic San Luis Obispo Cardiology Sonora Neurology Ukiah Genetics Gastroenterology Washington Seattle/Tacoma Liver Transplant Clinic Oregon Portland Liver Transplant Clinic Montana Billings Cardiology Alaska Anchorage Liver Transplant Clinic Hawaii Honolulu Liver Transplant Clinic

Market Share of LPCH Centers of Excellence : 

1/12/2009 8 Market Share of LPCH Centers of Excellence Est. Market Share Complex Congenital Heart Surgery (No. CA) 75% Liver Transplants (No. CA, OR, HI) 60% Neonatology (Santa Clara & San Mateo Co) 50% Bone Marrow Transplants (No. CA) 40% Brain Tumor Neurosurgery (No. CA) 30% Cystic Fibrosis Center Patients (No. CA) 30%

What do we hope to accomplish with the pediatric/obstetric FPO? : 

1/12/2009 9 What do we hope to accomplish with the pediatric/obstetric FPO? Support our academic mission by incorporating education and clinical research as integral components of our practice operations. Directly involve faculty in the day-to-day operations of their practice. Improve efficiency Improve quality and customer service Maximize revenue from patient care encounters. Improve billing, coding, and authorization process Better contracts for pediatric/obstetric services Understanding and oversee the funds flow to the practice from LPCH and the Departments. Align incentives so the cost savings and revenue enhancement accrue back to the practice.

Pediatric/Ob FPO Goals & Mission Statement : 

1/12/2009 10 Pediatric/Ob FPO Goals & Mission Statement The Pediatric/Obstetric Faculty Practice Organization will advance the missions of Stanford School of Medicine and Lucile Packard Children’s Hospital where they intersect in the delivery of professional medical services. Goals: To improve the efficiency and effectiveness of the physician practice and to improve quality of patient care through the establishment of a faculty practice organization in which: The faculty are responsible and accountable for the operations of the practice; and, Incentives are aligned between LPCH and the pediatric/obstetric clinical practice for the purpose of improved performance. Mission:

Faculty with Pediatric/Ob Practice : 

1/12/2009 11 Faculty with Pediatric/Ob Practice 16 Departments, all of which care for both adults and children, except for Pediatrics and Internal Medicine. (15 Departments will participate) Approximately 350 clinicians who care for pediatric or obstetric patients. 333 show >50% of charges linked to peds/OB 131 show >95% of charges linked to peds/OB 49 UTL, 133 MCL, 114 Staff Physicians, 50 Other

Operating Principles for Pediatric/Obstetric FPO : 

1/12/2009 12 Operating Principles for Pediatric/Obstetric FPO Alignment of goals between FPO, LPCH and Stanford School of Medicine through dual reporting structure to Dean and LPCH CEO; No new corporate entity; Faculty-driven governance structure; Faculty responsibility and accountability for financial, quality and service outcomes; Retention of control of Departmental finances within each Department, and retention of control of LPCH finances and clinics within LPCH.

Pediatric/Ob FPO Operating Principles : 

1/12/2009 13 Pediatric/Ob FPO Operating Principles Direct linkages to LPCH administration through participation of FPO leaders on LPCH Executive Committee and LPCH CFO on the FPO Management Committee; No incremental FTEs in FPO administrative structure; Commitment to the development of performance standards; and Full time administrative personnel to interface between hospital and clinical practice.

Pediatric and Obstetric FPOManagement Structure : 

1/12/2009 14 Pediatric and Obstetric FPOManagement Structure

Peds/Ob FPO Governance Structure : 

1/12/2009 15 *Sub-committees of existing hospital-wide committees Peds/Ob FPO Governance Structure

Pediatric/Ob FPO Management Committee : 

1/12/2009 16 FPO Management Committee Membership Faculty Sr. Associate Dean of Clinical Affairs for Pediatrics and Obstetrics Executive Director, FPO LPCH Chief of Staff LPCH Chief of Surgery Medical Director, FPO Ambulatory Services Chair, FPO Quality Improvement Committee Chair, FPO Finance Committee Chair, FPO Managed Care Contracting Committee Chair, FPO Pro-fee Billing Committee Administrative Staff FPO Director, Operations FPO Director, Finance Senior Associate Dean, Finances/Administration for SoM LPCH Chief Financial Officer DFA representing Peds/OB DFA Work Group Pediatric/Ob FPO Management Committee

Peds/OB Service ChiefsQuarterly Attendance @ Management Committee : 

1/12/2009 17 Peds/OB Service ChiefsQuarterly Attendance @ Management Committee Surgery Albanese, Craig Ophthalmology Alcorn, Deborah Renal Alexander, Steven Inf Dis Arvin, Ann Radiology Barth, Richard Cardiology Bernstein, Daniel Rad Onc Donaldson, Sara OB Druzin, Maurice Liver Transp Esquivel, Carlos Infant Dev Fleisher, Barry Intensive Care Frankel, Lorry Pathology Geaghan, Sharon Neurology Hahn, Jin Cardiac Surgery Reddy, Mohan Genetics Hoyme, Eugene Neurosurgery Huhn, Stephen Pain/Anesth Gregory Hammer(Interim) Hand Surgery Ladd, Amy Dermatology Lane, Alfred Hematology/Oncology Link, Michael Adolescent Medicine Litt, Iris General Pediatrics Mendoza, Fernando ENT Messner, Anna Pulmonary Moss, Richard Child Psychiatry Reiss, Alan Ortho Rinsky, Lawrence Kidney Transplant Salvatierra, Oscar Rheumatology Sandborg, Christy Plastics & CFA Schendel, Stephen Urology Shortliffe, Linda Neonatology Stevenson, David Allergy Umetsu, Dale Endo & Diabetes Wilson, Darrell

Management Committee Responsibilities : 

1/12/2009 18 Management Committee Responsibilities Review and further develop the vision Perform strategic planning for the pediatric and obstetric practice and the LPCH clinics Establish performance and productivity standards for the pediatric and obstetric clinical practice Design and approve the FPO financial model and monitor overall performance Establish and monitor incentive plan as approved by SoM and LPCH Approve/direct pediatric and obstetric FPO management team and oversee operating performance Establish key FPO policies

FY03 Goals : 

1/12/2009 19 FY03 Goals Establish the governance structure and hire the FPO administrative team; Create an integrated statement of revenue and expense for the Pediatric/Obstetric practice, reflecting all practice related income and expense regardless of hospital or departmental genesis; Establish performance goals and an incentive model for implementation in FY04; and, Assume accountability for the operations of the clinical practice, including the LPCH ambulatory clinics. By the end of FY03, the FPO expects to accomplish the following:

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