Bringing Patient-Centered Care Home
By MELANIE KILGORE-HILL
Dr. Frank Perry Works to Make his Hometown Healthier
Nashville native Frank A. Perry, MD, is making his hometown a little healthier. The Father Ryan High graduate attended Fisk University before graduating with honors from Meharry Medical College School of Medicine in 1976.
The second generation physician would then spend the next 35 years as an internist in Nashville, Cookeville and McMinnville, before joining a new venture at Nashville General Hospital. In October, the community-based hospital announced creation of the Nashville Healthcare Center, a new primary care clinic that will offer patients a single healthcare home to help better manage an individual's complete health.
The PCMH Model
Based on a patient-centered medical home model, Nashville Healthcare Center offers holistic, team-based, coordinated primary and specialty care, as well as wellness and educational resources. Its three physicians, nurse practitioners and dedicated care coordinator ensure that patients have access to all of the resources that could help them lead healthier lives. This might include linking patients with community resources such as trauma counseling or substance abuse services to address issues that could negatively impact their health, helping their overall wellbeing. It's a model that appealed to Perry from the start.
"I had been doing hospital medicine for 12 years and wanted to cut back from the rigor of intense hospital practice," Perry said. "My practice involved outpatient and inpatient practice, but that service model has changed so that now you either work in the hospital or out of it. Very few do both and even fewer do both well."
A conversation with a fellow Meharry professor led Perry to the patient-centered home model then being explored by Nashville General. The idea appealed to Perry, who disliked the increasingly disjointed nature of patient care. "A lot of times patients don't understand that the person taking care of them in the hospital doesn't know what's been done or tried in terms of a specific illness, and you end up repeating tests that don't need to be repeated," he said. "Years ago, you knew the ER docs seeing patients, and they would call and tell you what they thought or admit your patient and you'd come care for them in the hospital. Now you might get that information two weeks after discharge ... or not at all unless a patient tells you. With patient-centered medical homes, the idea is that you're in control and in touch with the patient if he's hospitalized."
A New, Old Approach
In contrast, each Nashville Healthcare Center patient has a personal care team that "huddles" before each appointment to review that patient's medical history and prepare for his or her visits. This allows the team to be ready and waiting when the patient arrives. A dedicated care coordinator helps the patient navigate any post-appointment support that might be needed, such as additional medical visits, tests or questions about prescriptions.
Perry said the clinic will offer same day appointments and 24/7, on-call support to help patients avoid unnecessary emergency room visits. "ER care is very expensive, and we want to decrease utilization so that wait times and costs of ER visits can be better controlled," Perry said. "We want ERs to see emergency patients as opposed to routine follow-up or primary care."
In his years as a hospitalist, Perry would regularly see older patients who had never established a primary care provider before experiencing a serious health setback like a stroke. "They would get well enough to go home; but with no PCP, they couldn't get in to see one as a new patient for another eight weeks," he said. "That's not good care. The idea is to try to get availability for follow-up and discussions about what needs to happen with these patients, and to have an integrated model of healthcare instead of silos."
A Clinic for the City
Nashville Healthcare Center is open to those covered by the Metro Employee Healthcare Incentive Program and the general public. Through the Metro Employee Healthcare Incentive Program, employees and family insured through the City of Nashville could receive care from Nashville Healthcare Center and Nashville General Hospital with little to no out-of-pocket expense. Nashville Healthcare Center also accepts most commercial insurance and TennCare.
"What makes us unique is that it's a metro-run facility so part of our initiative now is to get word out to Metro employees to come in and do things to take better care of themselves," Perry said. He hopes the holistic model will appeal to patients and that the partnership will bring about a healthier Nashville.
"The best way to lower the cost of a disease is to prevent the disease," Perry said. "If we can facilitate those kinds of discussions and population changes, I think we will have done a good job for the city."
In addition to Perry, Nashville Healthcare Center is led by family medicine physicians Hunter Davis, MD, and Simon Spilkin, MD. Carol Ann Moseley, MSN, RN, is the center's lead care coordinator.