Go Big or Go Home – Making Your IVF Center Achieve

Optimum ExcellenceKevin Doody MD

kevind@embryo.net

Goal

• Understand how to define your market space• Discuss revenue generation strategies• Develop a Quality Management / Business Process Approach• Marketing• Patient care

• Administrative• Clinical• Laboratory

• Accurate billing• Manage expenses• Information technology in REI

Go Big or Go Home????

• Bigger not always better• Sometimes less is more and more is less

Blue Ocean Strategy, Kim and Mauborgne, Harvard Business School Press 2005

Market Space

• Red Ocean• Blue Ocean

Red Ocean

• Industry boundaries are defined and accepted• Competitive rules of the game are known• Clinics try to outperform rivals to grab a greater share of existing demand• As the market space gets crowded, prospects for profits and growth are reduced• Products become commodities and cutthroat competition turns the ocean bloody

Red Ocean

• Good understanding exists with regard how to compete skillfully in red waters• Analysis of underlying economic structure of an existing industry• Choosing a strategic position of low cost or differentiation or focus• Benchmarking the competition• Active management

• Quality Management / Quality Assurance• Efficiency• Compliance with regulations

Blue Ocean

• Untapped market space• Demand creation• Opportunity for highly profitable growth• Most blue oceans are created from within red oceans by expanding existing

industry boundaries• Competition is irrelevant because the rules of the game are waiting to be set

Revenue Generation in “Red Ocean”REI Practice- A Quality

Management / Business Process Approach

Assumptions

• Delivery of REI services is a business• Active management of business improves outcomes for customers

(patients), employees, and stakeholders• Quality management is essential for active management

Define Business Goals

• Recruit and retain patients• Marketing• Ease of treatment process

• Delivery of good patient care• Administrative• Clinical• Laboratory

• Accurate billing• Manage expenses

Define Scope of Patient Care

• Implementation is based often based on “local issues”• Diagnostic testing

• Sonography• HSG• Andrology• Endocrine

• Treatment• IVF / IUI• Gynecology• Surgery

• Physician provider• Facility provider (certified ASC)

• Laboratory services• IVF• Other

Definitions

• Quality Programs / Systems• TQM• Six Sigma• ISO 9000

Definitions

• Process Mapping – Illustrated description of how things get done, which enables participants to visualize an entire process and identify areas of strength and weaknesses.

Definitions

• Control chart – Graphic representation of variance in a process over time

Definitions

• Statistical Process Control – The application of statistical methods to analyze data, study and monitor process capability and performance

Definitions

• Root Cause Analysis – Study of the original reason for non-conformance with a process

Six Sigma

• Sigma is a statistical term that is a measure of variance• Processes are designed / developed to minimize variance such that

one can be “six sigma” from perfection and the product is within specified tolerance from defect• Six Sigma equates to no more than 3.4 defects per million

opportunities (this number is relevant only to manufacturing)

Six Sigma- Definitions

• Defect – failure to deliver what the customer wants. Defects are considered to be sources of customer irritation They are also considered to be costly both to customers and to manufacturers or service providers.• For IVF, failure to conceive should not be considered a defect.

Incidents and deviations from protocols or expected outcomes are defects.

Six Sigma- Definitions

• Opportunity – the total number of chances to have a defect. Each opportunity must be independent of other opportunities, must be measurable and observable. The final requirement of an opportunity is that it directly relates to the customer perception of quality.

Six Sigma- Methodology

• DMAIC• Define

• Business processes • Opportunities• Defects

• Measure • Opportunities• Defects

• Analyze• Improve• Control

Six Sigma- Methodology

• DMADV• Design

• New product or process (e.g. egg freezing or IVM)• Measure and identify

• Characteristics critical to quality• Product capabilities• Production process capability• Risks

• Analyze• Design• Verify

• Pilot runs

Tools

• Document control system• Error logs• Complaint logs• Indicators• Audit mechanisms• Objective measures of quality• Graphical tools / statistical calculations• Meetings / training• Use of IT

Information Technology for REI Practices

Objective

• Detail the network requirements for IT systems in REI practice• Detail the general requirements and desired specifications for practice

management and EMR systems in REI practices• Demonstrate the value of ART specific EMR for both patient care and Quality

Management• Describe the various interfaces / compatibilities available to enhance IT systems

in REI practices

Disclosure

• Owner, CEO and Digital Medical Data Systems (aka – Digital MD Systems)• Chief Software Architect of DOC (EMR for REI practices)

Background

• Microsoft Physician of the Year – 2004• Runner up other years

• Microsoft Clinic of the Year – 2006• Microsoft Ambulatory Record of the Year – 2006• Runner up other years

• Member HIMMS

Electronic Medical Records

• Point of care documentation (not a database)• General considerations

• Security / access rights (permissions)• Audit trail• HL-7 communication with practice management software for scheduling, billing• Encounter documentation• Image archival (DICOM)• Bidirectional laboratory interfaces (HL-7)• Manage / reconcile medications, allergies, diagnoses (problem list)• Prescriptions

• Printed• Faxed• Email (requires encryption)• Provider choice

Electronic Medical Records

• General considerations• Management of paper documents (scanning)

• Prior records• Information sheets• Consent forms

• Best practices advice / protocol management• Algorithm driven

• Document management

Electronic Medical Records

•EASE OF USE

Electronic Medical Records

• ART specific issues• Integrated Treatment of Male and Female Partner• Radiology, laboratory, surgery and complex medical• CDC Compliance• FDA Compliance• ART Lab Recordkeeping• LIS Andrology / Endocrinology• IVF and Andrology Laboratory Quality Management• Flow sheet management

Conclusion

• Information Technology is an important aspect of any medical practice• REI practices have both broad and very specific needs• A well designed REI EMR should facilitate recordkeeping, patient

management, workflow and QM

Blue Ocean Strategies for SREI

• Offer a “product” that your competitors aren’t offering• Non-premium ART cycles

• Minimal stimulation• Premium IVF

• PGS / embryo accumulation• Multi-cycle plans• Refund• Donor egg bank• Embryo morphokinetics

• Pharmaceutical, laboratory or device trials

• Note that what starts out as a blue ocean strategy quickly becomes red ocean

Summary

• REI is a business• Many markets are saturated with providers• Maximizing revenue requires active management• Define business goals• Evaluate services offered• Define business processes• QA• Use IT to maximal advantage• Look for opportunities to create demand