Introduction

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

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

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).

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).

5. LPCH Market 54% 31% 15% UCSF Oakland Children’s • .58 million pediatric lives in the primary service area • 1.2 million pediatric lives in the secondary service area LPCH Total Pediatrics Only Primary Service Area 70% Secondary Service Area 21% Other 9% Central California Children’s 50 Miles

6. Pediatric/Obstetric FPO Outreach Sites: 1o & 2o Markets Stockton Oakland San Francisco Modesto Pleasanton Fremont San Mateo Redwood City Mountain View Santa Clara San Jose Santa Cruz Watsonville Salinas Monterey 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 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

7. Pediatric/Obstetric FPO: 3o Markets Washington Seattle/Tacoma Liver Transplant Clinic Oregon Portland Liver Transplant Clinic Montana Billings Cardiology Alaska Anchorage Liver Transplant Clinic Hawaii Honolulu Liver Transplant Clinic 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 Tacoma Anchorage, AK Portland Redding Eureka Chico Ukiah Sacramento Sonora Honolulu, HI Fresno San Luis Obispo

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%

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.

10. Pediatric/Ob FPO Goals & Mission Statement • 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. 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. Mission:

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

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.

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.

14. Pediatric and Obstetric FPOManagement Structure Stanford Univ. Provost LPCH Board of Directors Dean, SSoM CEO, LPCH Dept Chairs FPO Management Committee Chair Executive Director DFAs Ambulatory Medical Director Director, Operations Director, Finance Clinic Staff Peds/OB Pro Fee Billing Practice-related Inpatient Staff

15. Peds/Ob FPO Governance Structure LPCH Executive Committee (Christopher Dawes) Stanford School of Medicine (Philip Pizzo, MD) FPO Management Committee (Ken Cox, MD) Finance Committee Quality Improvement* Practice Operations Managed Care Contracting* Pro-Fee Billing/ Compliance* *Sub-committees of existing hospital-wide committees

16. Pediatric/Ob FPO Management Committee 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

17. 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 Peds/OB Service ChiefsQuarterly Attendance @ Management Committee

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

19. FY03 Goals By the end of FY03, the FPO expects to accomplish the following: • 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.