the Grace Report Provides Important Private Intelligence, Gathered Exclusively
for OBs & GYNs, Their Practice CEOs, and Key Administrators.

Headlines- September 18, 2006
THE GRACE REPORT

Headlines- September 18, 2006

Commentary and Opinion by Robert L. Michel:
Proven Business Strategies Can Boost Ob-Gyn Compensation

OB-GYNS SEEKING A SUPERIOR INCOME that’s grounded in their clinical skills should understand how the use of relevant business strategies directly leads to increased revenue and physician compensation. That is a common theme in each story presented in this issue of the GRACE REPORT.

The value of an effective business strategy is that it allows an ob-gyn, a hospital, or a medical practice to differentiate itself—in positive ways— from other competitors. These differences are recognized by customers (including patients and insurers), who are often willing to pay more for these services.

Essentially that’s the goal at Fairview Southdale Hospital in Edina,
Minnesota. Ob-gyns at Fairview Southdale have developed a surgery
training program in which they videotape simulated C-sections to identify breakdowns in communication and teamwork. The goal is to cut errors and improve outcomes. Over time, the hospital will become known as a superior provider in the Minneapolis market and it may get a reduction in malpractice rates and an increase in fees from payers. (See pages 3-7.)

The businiss recommendations of Marco Pelosi, II, M.D., have not only helped him and his partner substantially increase the income in their practice in Bayonne, New Jersey, but these business strategies are significant for another reason. Of the many ob-gyns Pelosi has trained in cosmetogynecology, at least 15 physicians credit the use of business strategies they learned from him as the reason their money-losing practices became comfortably profitable. (See pages 10-12.)

Fred Fitch of Millennium Medical Management, in Columbus, Ohio, is a knowledgeable consultant who shows ob-gyns willing to act on his advice how to save substantial amounts of money when implementing an electronic medical record (EMR) system. Fitch’s advice runs contrary to that of most information system vendors, but is brilliant in its simplicity and effectiveness. (See pages pages 13-16.)

The range of business thinking presented in this GRACE REPORT has the demonstrated potential to advance the clinical and financial fortunes of ob-gyns. Now all that’s required is for you and your partners to put them to work in your practice.

-------------------------------------------------------------------------------------------------------

Labor and Delivery Team Attacks Errors, Problems

Simulation training uncovers trouble points, fosters improved communication in surgery

CEO Summary: Ob-gyns, along with the labor and delivery staff at
Fairview Southdale Hospital in Edina, Minnesota, are pioneering a new way to reduce medical errors and improve patient outcomes. Using a mannequin designed for medical training, ob-gyns and staff at Fairview
Southdale have performed simulated stat C-Sections using the hospital’s surgical facilities. Videotapes of the procedures are used in post-operation reviews, which have identified significant opportunities to improve communication and clinical protocols.

-------------------------------------------------------------------------------------------------------

Simulated Surgery Training Finds Errors in Obstetrics

Video simulation training is early step in labor and delivery quality improvement program

CEO Summary: Ob-gyns familiar with quality improvement (QI) processes will recognize that the in situ video simulation training program at Fairview Southdale Hospital applies QI techniques to labor and delivery to identify sources of error. In the 16 surgical simulations completed to date, participating ob-gyns, nurses, and staff have been surprised at how frequently gaps in communication contributed to avoidable errors. Impressed with the results, hospital administrators
would like to expand the program to include all ob-gyns with privileges.
They also want to use clinical simulations in the OR, ED, and intensive care unit.

-------------------------------------------------------------------------------------------------------

Risk Management Update:

Big GPO Pushes Guidelines To Help Hospitals Cut OB Risks

-------------------------------------------------------------------------------------------------------

Four Strategies for Ob-Gyns Offering Cosmetic Services

Earn hospital privileges, team up with ENTs, subcontract OB patients to an MFM specialist

CEO Summary: Many ob-gyns want to shrink or close their obstetrics practice to shift their energy into other clinical services, including cosmetic surgery. Because of the financial difficulty in sustaining an obstetrics practice, these obgyns seek to redirect their clinical energies into services that are either paid in cash or come with higher reimbursement. Two ob-gyns who took this path are Marco Pelosi II, M.D., and Marco Pelosi III, M.D., who offer four business strategies
to help other ob-gyns transitioning from ob into other areas. Intriguingly,
the Pelosis accomplished this transition while keeping their obstetrics patients.

-------------------------------------------------------------------------------------------------------

Scan Paper Charts First, Then Implement an EMR

Expert offers advice that runs contrary to typical recommendations of IT vendors

CEO Summary: When the eight ob-gyns of Kingsdale Gynecologic Associates of Columbus, Ohio, implemented an all-electronic office, their first move was not to install an electronic medical record (EMR) system. Instead, their first step was to scan all paper charts and start using scanned images on their computers. By eliminating paper charts, they increased their return on investment. IT vendors don’t recommend this approach, in part because imaging is a secondary priority to vendors. But the Kingsdale ob-gyns found that scanning their
paper was a way to gain efficiencies rapidly.

-------------------------------------------------------------------------------------------------------

Healthcare Strategies: Walk-In Clinics in Retail Stores Is Exploding Healthcare Trend

CVS Pharmacy chain buys MinuteClinic in July for an estimated price of $170 million

-------------------------------------------------------------------------------------------------------

INTELLIGENCE: Late and Latent

• NURSES BUILD BUSINESS ONAFTER-HOURS OB CALLS
• MALPRACTICE DISSUADES STUDENTS FROM OB-GYN

Look for the next briefing on Monday, October 9, 2006.

Upcoming Events>>
the Grace Report
Current Issue Summary