Founded in 2006, Ob Hospitalist Group is a national physician group based in Mauldin, S.C., that develops, staffs and manages OB/GYN hospitalist programs in 28 states. Its network includes more than 550 clinicians in more than 100 partner hospitals. Overall, these clinicians see 300,000 patients and deliver about 30,000 babies annually, with nearly 123,000 of these cases being high-risk encounters.
Leonard Castiglione, CEO of OBHG, and Nicolas Kulbida, MD, medical director of operations at OBHG and chair of the department of obstetrics and gynecology at Schenectady, N.Y.-based Ellis Medicine, recently shared their tips for hospitals and observations from their work.
Observations
1. The OB hospitalist industry has evolved in recent years. The OB hospitalist industry has about 30 percent market penetration nationwide, meaning about 1,000 of the up to 3,000 hospitals offering labor and delivery may have an OB hospitalist program, according to Mr. Castiglione. He says 30 percent market penetration is only about 6 percent outsourced. "As hospitals increase their focus on safety and risk mitigation, they're realizing that their local model lacks the depth of experience to mitigate that risk, so they are increasingly looking toward outsource providers," he explains. With this demand for depth of knowledge and expertise, OBHG contends that single-specialty providers will lead the growth of the outsourced providers.
2. The American Congress of Obstetricians and Gynecologists now has a majority female membership, according to Dr. Kulbida, who serves as a chair with ACOG. This is a significant change from the past, when it was a majority male membership. He says this shift in demographics combined with the incoming millennial generation has shifted the demands for work-life balance and expectations regarding night and weekend calls. Dr. Kulbida also notes he sees a majority of ACOG member physicians gravitate toward urogynecology, maternal fetal medicine and other subspecialties of OB/GYN. These trends are putting pressure on the supply of OB/GYNs and will require a solution that extends the life of their practice and improves the efficiency of patient care.
3. Medical malpractice risk exposure in hospital OB departments is greater than expected, according to Mr. Castiglione. "It's not just about having Ob hospitalists in-house 24/7, it's about proactively preventing serious harm events," he says. So "these incidents have a greater impact even beyond medical malpractice as they can impact public relations and cash flow requirements to hold for potential losses."
He recommends hospitals get assessments of potential risk exposure to determine how well the organization understands their OB risk and the appropriate mitigation opportunities in the market. Mr. Castiglione adds, "The industry has historically bought into the false pretense that a physician on call 30 minutes away mitigates risk. But hospitals are learning that in an emergency situation in the Ob unit a matter of minutes can mean the difference between a positive outcome and a catastrophic malpractice case that is going to cost you on public opinion and financially." He also notes OBHG has a reporting system and provides data feedback to hospitals to give national benchmarks of how hospitals are performing. This tells hospitals if other organizations perform risk assessments for OBs, if physician training is standardized and how other organizations do quality-based incentives. "You should evaluate how you support your Ob program. Do you recruit and retain the top obstetricians in the market?" he says. "Our perspective is this is going to be the standard of care."
Tips
4. Stay attuned to physician burnout. OB/GYNs face burnout partly due to taking calls outside of their normal working hours. Some hospitals are in the early stages of identifying OB/GYN burnout — they try to have questionnaires and try to have some support — but a majority aren't addressing it on a regular basis, according to Dr. Kulbida. He says his institution has done physician burnout surveys and physician health management assessments that identify physicians who are on the verge of burnout or who have already burned out. Those physicians are referred for additional support services. Dr. Kulbida says there is room for improvement in identifying physician burnout and providing support to physicians. "We set up the structure to identify physicians at risk of burnout and provide them with support. And from a risk management perspective, that's when many of our physicians involved in high-risk cases, they become a second victim, and it's important to support them so they don't burn out."
5. Decrease the administrative burden on physicians. To help curb physician burnout, Dr. Kulbida recommends hospitals cut down on any physician duties that are unrelated to direct patient care. He also recommends hospitals limit the amount of documentation physicians have to do.
6. Hospitals should determine whether physicians are happy with what they're doing, according to Dr. Kulbida. "If they're happiest in the operating room, make sure they're in the operating room as much as possible," he says. "If they're happiest in the clinical setting, make sure that's where they spend most of their time. If they're happiest in labor delivery, that's who I want in labor delivery. So it really comes down to knowing your staff and providing them with the options where they can be happiest and most productive."
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