1. 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

2. ‘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

3. ‘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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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…”

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

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