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#1 - Does a hospitalist obstetrician need to work a certain # of hours per week? or type off shift (day vs night)? Does the hospital offer any benefit as for a regular employee?
Also, I'd like to know if the hospitalist covers the self-referred
patients and performs their surgeries (non-emergent C/section)?
Also, if a hospitalist desires to work at more than one hospital, is it allowed?

Posted: July 8, 2008

Response:
We typically assign 4-6 OB Hospitalists to a hospital to cover
all shifts. Most doctors prefer working 24-hour shifts, but some work 6-12 hours, weekend-only, evening only, etc. We typically manage all of the unassigned ob/gyn patients requiring hospitalization. So, if a patient arrives to the hospital needing a
C-section, we would manage it. We don't typically do much elective surgery but this varies depending on the needs of the host hospital. Our physicians are independent contractors. We provide the benefits of malpractice insurance and a great salary...the doctors then cover their own other "benefits".
Our doctors are assigned to one hospital but we like for them to become "back-ups" at our other area hospitals. Thus, many of our doctors choose to work at more than one facility.
Chris Swain, MD
OB Hospitalist Group
www.ObHospitalistGroup.com
cswain@OBHG.org

Posted: August 5, 2008

 

#2 - I admit patients to a non-profit, community hospital that does approximately 4800 deliveries per year. We have a very successful Internal Medicine Hospitalist program with 17 hospitalists, and a very successful intensivist program with 7 critical care intensivists. Our obstetricians are reluctant (and somewhat adversarial) about the establishment of an OB hospitalist program. Do you have any advice on how to overcome this barrier with our 72 OB/Gyn private practice MDs who service patients in a small 15 mile radius? Also, does a hospitalist program obviate the need for a designated "call group"?

Posted: July 6, 2008

Response:
Ob/Gyn physicians have learned (the hard way) to live in fear
of anything new that comes along. Thus, they suspect that this program will somehow cause them to suffer less income, more work, etc. In fact, this program (OB Hospitalist Group) will cost them nothing while allowing them to be more productive and to have more quality time away from the hospital.
Often, we have to explain to the physicians that we are not there to compete or interfere. But, rather, we are there to assist them. At OB Hospitalist Group, we have these kinds of discussions daily. We can usually convert these fears into overwhelming support by the physicians. To answer your other question: Yes, having OB Hospitalists negates the necessity for unassigned or "walk-in" call coverage. Please contact us if we can assist you!

Sincerely,

Chris Swain, MD
www.ObHospitalistGroup.com
cswain@OBHG.org

Posted: August 5, 2008

 

#3 - Has anybody tried billing for a consult for labor managed by laborist for the privates,even if the private comes in and does delivery? An OB can consult another OB regardless of the reason and thus obtain coverage for things like pitocin and epidural even when the private is not there....a win win

Posted: April 30, 2008

 

 

#4 - I’m an editor with HealthLeaders Magazine, and I’m currently working on an article about hospital-based specialists, such as laborists, focusing on issues related to ED call coverage. I would like to speak with someone in a hospital (perhaps a CFO or someone dealing with finance) about the financial impact of these programs. Do you have any suggestions?

Thank you for your help.
Sincerely,
Elyas Bakhtiari
Managing Editor
HCPro, Inc.
HealthLeaders Media
(781) 639-1872 x3273
ebakhtiari@hcpro.com

Posted: April 22, 2008

Response:
I would suggest that you contact:

William J. Mann, Jr. MD FACOG FACS MBA
Chairman and Gyn Oncologist, Dept. OBGYN
Jersey Shore University Medical Center
1945 Route 33, Neptune, NJ 07754
732 776 3790        fax 732 776 4525

Best wishes, Debra Gussman, MD

Posted: April 22, 2008

Response:
Osceola Regional Medical Center in Kissimmee, Florida has a
long-standing successful program. This is a very unique program and they would welcome your call. The primary contact at this hospital are:
Ruth Reichard (Women's Health Director, ruth.reichard@hcahealthcare.com
407-518-3377
The hospital CEO is Tim Cook, 407-518-3601.

Hope this helps!
Chris Swain,MD
OB Hospitalist Group
www.ObHospitalistGroup.com
cswain@obhg.org

Posted: April 30, 2008

 

#5 - Are there any others, besides Delphi Healthcare Partners, Inc. that provide this service as a package? If so, who are they? I can't seem to find any others. Most hospitals create and manage their own program.
Thank you!

Posted: April 22, 2008

Response:
"OB Hospitalist Group" develops programs nationwide. They
have a very high quality program that is the most cost-effective model available.
They can be reached at www.ObHospitalistGroup.com or 800-967-2289.

Posted: April 30, 2008

Response:
Legacy Healthcare has two groups of 4 OB Hospitalists at
Emanuel in Portland, OR and Salmon Creek Hospital in Vancouver, WA. There is also a group at Salem Hospital in Salem, OR.

Posted: July 6, 2008

 

#6 - Are there any others, besides Delphi Healthcare Partners, Inc. that provide this service as a package?  If so, who are they?  I can’t seem to find any others.  Most hospitals create and manage their own program.

Thank you!

Cindy O'Hara RN, CES
Inova
Loudoun Hospital
Manager, Perinatal Services
44045 Riverside Pkwy
Leesburg, VA  20176
(703) 858-6360
C
ynthia.O'Hara@inova.org

Posted: April 22, 2008

Response:
"OB Hospitalist Group" develops programs nationwide. They
have a very high quality program that is the most cost-effective model available.
They can be reached at www.ObHospitalistGroup.com or 800-967-2289.

Posted: April 30, 2008

 

#7 - I am a full scope CNM in New Jersey with 25 yrs experience.  Are you aware of any of these models employing CNMs?  I know at least one of our local hospitals is considering it, and another has had a model loosely based on it.

Posted: April 22, 2008

 

 

#8 - What are some Physician Compensation Models for Ob/Gyn Hospitalist programs? Are most salaried or do they function as Independent contractors? If salaried by hospital, what is the general going rate for programs around the country? Geography or experience related? Dept on what their specific function will be --i.e. Perinatology extenders (assuming OB only without ED coverage), or Ob/Gyn hospitalist coverage with both back-up of private MDs and coverage of triage and ED? It seems a bit like comparing apples and oranges, but still there should be some benchmarks here on the programs that have been/are being developed. Any thoughts for someone who is weighing offers? I need some info, as MGMA and surveys simply don't have the data. Furthermore, if an offer doesn't seem competitive, how do you direct your potential employers to info which they should consider so they can be competitive? Thanks!

Posted: Feb. 27, 2008

Response:
OB Hospitalist Group is a closely managed, full service, OB Hospitalist provider.  We typically pay our physicians $120 per hour and provide occurrence malpractice coverage. In further answer to your question, our doctors are independent contractors. Hospitals will often have a "Fair Market Value" assessment performed to confirm the pay rate.

Chris Swain, MD
www.ObHospitalistGroup.com
cswain@obhg.org

Posted: March 17, 2008

 

#9 - What is the minimum number of deliveries needed to support a laborist program?

Posted: Feb. 20, 2008

Response:
Studies have shown that a hospital needs to be doing 200-300 deliveries/month for a program to be considered. This is speaking, of course, from an economic standpoint. The economics, however, are not yet based on the reduction of liability. Some studies definitely suggest there is a reduction in malpractice claims, and everyone in the business promotes the programs as such, but we still lack the data to support our claims. Questcare Obstetrics is currently providing a proposal to a hospital doing only 100-150 deliveries/month but their goal is 200-250. They are willing to invest in the program and believe it is worth the investment for several reasons. #1 It will help them maintain their current OB/GYN staff, & hopefully encourage them to bring more deliveries to this hospital. #2 They believe instituting a Ob/Gyn hospitalist program will attract more, new Ob/Gyn staff to their facility. #3 They feel this program will help other services within the hospital grow - specifically NICU. #4 They believe the hospitalist program will in fact, reduce potential liability issues.
Wayne L. Farley, Jr.,DO,FACOG

Posted: Feb. 21, 2008

Response:
From a strictly financial standpoint, this program is very cost-effective (sometimes free) for hospitals with 3000 deliveries per year. If you factor in the liability reduction, studies suggest these programs to be feasible for hospitals with 2400 deliveries per year. We actually have a hospital with 2300 deliveries per year that will operate at a profit because they have a large group of deliveries directed to the laborist group.

Chris Swain, MD
OB Hospitalist Group
800-967-2289
cswain@obhg.org

Posted: Feb. 22, 2008

 

#10 - Can you connect me with hospitals that provide this service? We are exploring the concept.

Posted: Feb. 20, 2008

Response:
Questcare Obstetrics is a business based in Dallas, specializing in OB/GYN Hospitalist Programs. They specialize in designing true, complete Ob/Gyn programs based on the hospital's specific wants and needs. Visit them at www.questcare.com

Posted: Feb. 21, 2008

Response:
OB Hospitalist Group develops OB/GYN Hospitalist programs nationwide. We have the best and most cost effective program in the nation. We provide a free, on-site analysis for prospective hospitals. Our satisfied clients are our best advertisement. You are welcome (and encouraged) to contact any of our host hospitals. Our longest existing program is at Osceola Regional Medical Center. Ruth Reichard, RN, CNA is their Director of the Maternal-Child Center.
You may contact her at ruth.reichard@hcahealthcare.com
or by phone at 407-518-3377.
Chris Swain, M.D.
OB Hospitalist Group
cswain@obhg.org

Posted: Feb. 22, 2008

 

#11 - Is there any information on a certified nurse midwife in the
role of an OB Laborist?

Posted: Jan. 10, 2008

Response:
Our company, Ob Hospitalist Group, uses only board-certified Ob/Gyn physicians. This is because one of the core duties of laborists is the ability to rapidly manage emergencies; this often requires surgical intervention.
However, I am presently considering using certified nurse midwifes to supplement our laborists at one of our busier hospitals.
Chris Swain,MD
Ob Hospitalist Group

Posted: Jan. 11, 2008

Response:
I came across your great resource for OB laborists.

I want to share some information about certified nurse-midwives working as laborists.This article: Skilled Labor was published in The Hospitalist, the newsletter of the Society for Hospital Medicine.

Feel free to contact me if you would like more information.

Rebecca Jacob
Communications Manager
American College of Nurse-Midwives
Direct line: 240-485-1822
www.midwife.org

Posted: Feb. 20, 2008

 

#12 - I attended a conference in SF and was introduced to the “laborist” movement around the country. Our hospital does ~3000 births a yr.   I need data supporting a “laborist” in our FBC. Can you point me in the right direction? The thinking by our administration is that it is too costly.  We have a family practice residency program and a nurse-midwifery clinic that would benefit from having “laborist” in the FBC.

Posted: Jan. 8, 2008

Response:
Indeed, laborist programs can be costly if not managed properly. Most hospital administrators hear this fact and look no further.
In 2006, I founded Ob Hospitalist Group. We specialize in the development, staffing, and management of laborist programs nationwide. I have found that, in many hospitals with 3000 deliveries per year, we are capable of operating a 24/7 laborist program at little or no cost! We provide an on-site hospital evaluation and a cost/benefit analysis at no charge. This is a wonderful, life saving program. Ob Hospitalist Group would welcome the opportunity to assist you and your hospital. You can find more information at www.ObHospitalistGroup.com or email me at cswain@OBHG.org
Chris Swain, MD

Posted: Jan. 9, 2008

 

#13 - I am the QA manager of a large practice which has utilized laborists for more than 10 years.  We have a large volume of patients (approx 300 deliveries per month) which are frequently from community clinics.  We struggle greatly keeping track of the patients and their clinical information while they are in the hospital.  I am wondering if you have any software that you use to track patients.

Posted: Dec. 27, 2007

Response:
I'm not aware of any specific software that solves this problem. We encounter this difficulty at each of our hospitals and I have seen 3 methods that each work fairly well.
#1 The clinics deliver or fax a copy of the pertinent prenatal record after initial labs, then at 32 and 36 weeks to the hospital where they are filed in the Labor unit.
#2 Clinics give a copy of this info to patients and they must bring it with them.
#3 (my favorite) Clinics scan or fax this info into a digital filing system that is always available on the labor unit computer. These files don't get lost or accidentally misfiled or sent to the medical records dept.
Hope this helps!
Chris Swain, MD

Posted: Jan. 7, 2008

 

#14 - What is the benefit to a solo private practitioner?
Who pays these doctors?
What is the liability of the laborist and private practitioner?
What is the payment arrangement for each physician or reimbursement arrangement?
How do or will patients perceive this arrangement?

Posted: Nov.12, 2007

Response:
There are no set rules for what works best. There are many different ways that doctors are approaching this model. The benefit to the solo doctor is time off without worrying about your patients, uninterrupted office hours, uninterrupted surgery time, a reasonable life style without the expense (and brain death) of hiring an associate.

Who pays? It depends. Some high volume hospitals have hired a laborist to help their physicians. Smaller volume hospitals have divided the schedule among all the doctors on staff and either paid into a coverage pool with time or with money.

In terms of liability, it also depends on the arrangement. Most doctors are demanding that participating doctors comply with all published ACOG guidelines.

The pay schedule also depends on the arrangements. Many doctors bill their own deliveries and treat the laborist as their associate. A legal document is sometimes needed. Some allow the laborist to take the delivery fee. A lot depends if the laborist is part of a covering group or if they are paid an hourly or shift wage. The thinking is that if they are being paid to be there, or they are being "paid" with time off, they are being paid for their time and it doesn't matter if they do no deliveries or 10 deliveries. They are being paid already so the delivery fee isn't theirs. You should review your 3rd party payer contracts to make sure you are in compliance with the contracts you agreed to.

All the research shows that patients accept the hospitalist models more easily than doctors do!

Posted: Dec.3, 2007

Response:
There are a few "do-it-yourself" ob/gyn laborist groups that operate in various ways. In early 2006, I started ob Hospitalist Group, a nationwide ob/gyn laborist group, to provide safety and stability to this industry. I believe that I have addressed most, if not all, of your questions on our website: www.ObHospitalistGroup.com
Please feel free to contact me if I can be of any help.
And thanks oblaborist.org for this great forum!
Chris Swain,MD

Posted: Dec.4, 2007

Response:
Your article (The Laborist: A Flexible Concept) on the Laborist was excellent and certainly timely. You are right, in many cases -it already exists and our failure to acknowledge it and establish it as a separate and legitimate job needs to be corrected. Although some might point to times of poor patient care, it seems very clear that by establishing the laborist as routine, hospitals would improve care, cut costs, and improve nursing and resident satisfaction. I can recall far too many times that care of patients in labor being compromised because of my other duties. This is not good medicine - unfair and not good for patients and nursing/resident staff. Also, I would mention that, as being in house attending, being called to a private attending's patient delivery, and needing to deliver the patient; all with NO knowledge of the patient and her history. That can result in extremely bad outcomes and litigations. Certain attendings were notorious for being there only when the baby was coming out, and chastising the residents if they were called too early (as if the resident can control this). The one other issue you mention that needs to be worked out is compensation. The laborist can and should contribute to the the care of labor and delivery and deserves the compensation. There is no reason why this should be a problem or difficult to resolve.

Posted: Feb. 20, 2008

 

 

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