Dale Geerdes and Pamela Funke Practice Acquisitions - Lesson Learned Practice Acquisitions - Lesson Learned Dale Geerdes and Pamela Funke Department of Obstetrics and Gynecology Univ. of Iowa

‘It was the best of Times!’ 2009 Practice Acquisitions - Lesson Learned Practice Acquisitions - Lesson Learned Charles Dickens ‘Tale of Two Cities’ ‘It was the best of Times ‘It was the worst of Times’ Dept OBGyn at the U. Of Iowa First ever practice acquisition of an Infertility practice roughly 60 miles away Department of Obstetrics and Gynecology ‘It was the best of Times!’ 2009 Univ. of Iowa

‘We were all going direct the other way’ Practice Acquisitions - Lesson Learned Practice Acquisitions - Lesson Learned But the quote continues and ultimately outlines our progression with this clinic acquisition over the last 9 years. ‘‘It was the best of Times, It was the worst of Times …..’ ‘We were all going direct to heaven’ ‘We were all going direct the other way’ Department of Obstetrics and Gynecology Univ. of Iowa

Acquisition concerns and timeline Practice Acquisitions - Lesson Learned Practice Acquisitions - Lesson Learned Acquisition concerns and timeline Philosophical Concerns Timeline for resolution Immediately upon acquisition Department of Obstetrics and Gynecology Programmatic Concerns Timeline for resolution Immediately upon acquisition Practical Concerns Timeline for resolution Evolved with growth Univ. of Iowa

Philosophical Issues Practice Acquisitions - Lesson Learned -Outreach (Hospital) vs. Offsite (Department) Outreach model implies shared revenue and expense Department model implies departmental control Departmental responsibility for revenues and all expenses Offsite Department management was the appropriate choice Gave the department mobility, adaptability, responsiveness Significant resistance from hospital to support offsite activity Supplies, protocols, inspections, compliances Equipment procurement and Sterilization processes Department of Obstetrics and Gynecology Univ. of Iowa

Philosophical Issues Practice Acquisitions - Lesson Learned -Place of service (Hospital Outpatient vs. Office) Patient Satsifier for lower costs No Procedure upcharge by the hospital Lower patient coinsurance rate Billing rules for Advanced Practice Providers Significant education Office based billing was the right choice then and now single Physician bill vs Facility and Physician bill Quicker response to competitive rates Department of Obstetrics and Gynecology Univ. of Iowa

Philosophical Issues Practice Acquisitions - Lesson Learned -What Services to offer Strictly subspecialty Slows growth potential Requires more specialized support\equipment Increases costs and lengthens ROI Competitive Approach Risks alienating the referral base Faster expansion capability with market share Minimal additional costs – Better ROI Choice was to restrict services to subspecialty only Specialty MDs then travel from campus Physician resentment to offsite travel Department of Obstetrics and Gynecology Univ. of Iowa

Philosophical Issues Practice Acquisitions - Lesson Learned -Staffing (Hospital Union vs UICMS Non-Union) Part of UIHC Union based employees Bumps and job bidding Less control over appropriate placement Non-UIHC staff – Univ. of Iowa Community Medical Services Non-union employees UICMS was for profit arm of UIHC Created to establish community clinical services Department chose to hybrid model Staff hired by UICMS but managed by the Dept Department of Obstetrics and Gynecology Univ. of Iowa

Programmatic Issues Practice Acquisitions - Lesson Learned -EMR modifications New Sched Departments New Divisions New Locations Department of Obstetrics and Gynecology -Automated Patient Services Everything was previously referenced from the main hospital Need to program new location outside of main hospital Automated patient letters with new address Automated phone texts identifying new locations -Different Fee Schedule for Office Location System needed to be reprogrammed for office based billing Univ. of Iowa

Practical Issues Practice Acquisitions - Lesson Learned Staff supervision - Department opted for remote management Four staff members One provider Pay Scale, benefits and HR structure different than campus Success = Growth Move and expansion Added staff and services Biggest problem was failure to adequately transition to onsite management in a timely manner. Learning curve was painful! Department of Obstetrics and Gynecology Univ. of Iowa

Practical Issues Practice Acquisitions - Lesson Learned Medical Directorship Transition from initial MD to UIHC trained MD Daily subspecialty MDs travel to the clinic Expectation - Implement clinic change within UIHC structure Private practice does not equal UIHC structure Onsite management challenges with the leadership Painful power struggle to regain control and reset expectations Department of Obstetrics and Gynecology Univ. of Iowa

Practical Issues Practice Acquisitions - Lesson Learned Staffing Levels Need to retain staff for appropriate peaks, but flex as needed UICMS failed – need to transition staff to UIHC Department of Obstetrics and Gynecology Equipment and materials transport Sterilization, Drugs, Linens, Lab Samples, Supplies Compliance mandates Training, protocol implementation, mandates stand alone clinic without Hospital JCAHO support Univ. of Iowa “This lab is your lab….it isn’t my lab…”

Practice Acquisitions - Lesson Learned Department of Obstetrics and Gynecology Univ. of Iowa

Practice Acquisitions - Lesson Learned Department of Obstetrics and Gynecology Univ. of Iowa