Topic # 4: OB-ER

The Ob's in our community are currently paid hourly by our hospital to cover our Labor and Delivery service 24 hours per day. This has mainly been done as a safety net to cover the family MD births, which have steadily increased in our community due to a shortage of OB providers. Our hospital is entertaining employing a contract group to provide this service. Their proposal for coverage would entail seeing all patients not seen by their own

MD in triage and charging for that service, much like an emergency room. The charges generated in that fashion would go a long way towards covering the cost of this hospitalist service to the hospital. It is a paradigm shift but is an intriguing thought for smaller hospitals who are looking for this kind of service. Do you know of other programs funded in this manner? We do about 2000+ births for year.

-Sherry Holtzman   

Bellingham, WA

Editors note:

I think this is an extremely important subject and would hope everyone with an opinion will respond with comments. Please forward this to other interested parties to help increase breadth and depth of discussion with additional participation with more Ob/Gyn Hospitalists.

-Rob

8/27

At Evergreen Healthcare we currently offer seeing private patients in triage and ED if we are not occupied with higher priorities.  We do charge for E&M of the patient and for reading NST’s.  The charge is to the patient.  All patients over 20-24 weeks that come into the ED are also sent to triage for an evaluation.

Our triage policy, imperfect as it may be. Open to comments/suggestions for change.

Guidelines for Physician Oversight of Patients in OB Triage.

5/1/2008

Routine labor patients

·     After nurse assessment, phone call to physician of record followed by evaluation and management as needed

·     Bedside evaluation at discretion of physician

·     All patients to have real time physician evaluation of fetal monitor strip prior to discharge if patient going home

·     If physician unable to see fetal monitor strip from remote site, hospitalist can be called to view the strip

·     Charge for NST can be rendered if there are appropriate reasons for an NST

·     Bedside physician assessment at request of nurse Complicated OB/Labor patient

·     After nurse assessment, phone call to physician of record followed by evaluation and management as needed

·     Bedside physician evaluation required

·     Hospitalist can be called for consult at discretion of physician of record

Non Labor OB patient

·     After nurse assessment and phone to physician of record, all patients should have a bedside physician evaluation prior to discharge home.

·     OB Hospitalist can be called for consult/evaluation if patient’s physician requests this

-Terry Pheifer MD

Medical Director OB GYN Hospitalist Program

Evergreen Healthcare

Kirkland, WA