Welcome to the Suburbs

by Michelle Saxton
January 2013

Health care moving closer to the neighborhood

Routine medical care is important to Missy Miley, who has suffered three strokes in recent years and has scar tissue from brain surgery to treat an aneurism. But going to a doctors office was challenging for Miley, 54, who stopped driving after having a seizure.

I used to have to arrange or beg somebody for a ride and then pick me up, Miley says. You cant tell them how long its going to be because you never know how long youre going to be there.

But Miley, who had been seeing doctors at Wilmington Health on Medical Center Drive, recently heard the provider had just opened a new internal medicine office at Mayfaire Town Center closer to her home. There she was soon connected with Dr. Sandra Brannin.

I actually cried a little bit after that, I was so happy, Miley says during a November visit to the Mayfaire office, later adding, It really does make a big difference to know that
you have somebody who knows you and all you have to do is call.

Miley, whose medical appointments can range from monthly to weekly, now rides her bike to the office.

Everything is more accessible to me, Miley says. And it makes me feel I can take my medicines ... more seriously because I know there is a friendly ear.

Miley was frank but somewhat lighthearted during the interview, saying while her life had been turned upside down she was still better off than most stroke victims. Her recent visit was to check her blood pressure and other information.

Im really trying to learn about myself now, Miley says. I never was doing that before.

Closer to Patients

Wilmington Health has about 20 locations as far south as Oak Island and as far north as Jacksonville, CEO Jeff James says.

We are interested in moving primary care closer to where the patients are, says James, who adds that expanding into communities is a trend thats been going on for years in the industry, not just in Wilmington.

Rather than fewer large centers for primary care, we are moving toward more smaller centers, James says.

Brannin and Dr. George Sylvestri work at Wilmington Healths Mayfaire location, which opened on Parker Farm Drive last fall. It is a temporary office until construction on a new one across the street is completed this spring.

Dermatology Associates, which has a Wilmington office at Tradd Court and a satellite office in Whiteville, also plans a move to Mayfaire this year. The new Mayfaire office will become the practices main location, while the Tradd Court office will be a satellite location.

We will become more centrally located for the great majority of our patients, says dermatologist Dr. Kim Edwards. Instead of building practices and hoping patients find you, its putting locations where patients live, work and shop.

Besides the Wilmington and Wrightsville Beach areas, Dermatology Associates sees patients from Burgaw, Hampstead, Jacksonville, Rocky Point, Kenansville and as far as Emerald Isle, the practice states.

Patients want convenient access to primary care, says John Gizdic, New Hanover Regional Medical Centers executive vice president of strategic development.

They want to be able to access their physicians and especially primary care closer to home or closer to where they work, and not necessarily always have to come down to the medical district, if you will, around the hospital for everything, Gizdic says.

Besides several hospital campuses, NHRMC has 28 locations in six counties, including physician group practices, urgent cares and diagnostics facilities, spokeswoman Erin Balzotti says.

Like pediatricians and family practitioners, more specialists have been moving closer to their patients, OrthoWilmington CEO Steve DeBiasi says.

I think that trend is going to continue, DeBiasi says.

That is why Ortho-Wilmington was created as a merger between Wilmington Orthopaedic Group and Atlantic Orthopedics last year, DeBiasi says, adding the practice has locations in Wilmington, Porters Neck, Brunswick Forest and Jacksonville.

Access is particularly important for physical therapy patients, who may visit two or three times a week, DeBiasi says.

The critical thing is to be able to offer the patient a choice, DeBiasi says. Its not just where the patients live but where they work as well.

Wilmington Ear, Nose and Throat on Delaney Avenue in Wilmington opened a satellite office in Porters Neck about seven years ago.

The community has grown, says otolaryngologist Dr. George Brinson. Its become more spread out.

Physicians may see incentives in joining bigger groups, such as having more power to negotiate with insurance companies, Brinson also notes.

Reimbursement cuts are among factors for medical care consolidation, Gizdic says.

Our physicians in our community are running a business, Gizdic says. Their revenue or reimbursement has consistently been cut year after year, much like we faced here in the hospital, yet their expenses have continued to increase.

Access to sophisticated technology and a preference to focus solely on medicine and let others deal with the business side are other factors, James says.

Its very difficult to develop in small practices because its expensive,
James says.

Preventive Care

Better access to primary care can help keep people away from more expensive trips to emergency rooms, providers say.

While rates depend on individual insurance plans and designs, Sylvestri says primary care for patients with insurance can be $25 to $30, whereas emergency room care can be $100.

Strong partnerships between physicians, hospitals and other providers can help with preventive care, quality improvement and cost reductions, Gizdic says.

We have to improve quality while reducing the overall cost of health care, and that is a sea change in the industry That is definitely part of the strategy of placing primary care further out into the community, Gizdic says. Getting your primary care in the emergency room is not something thats sustainable going into the future.

Technology

Technology is part of the equation. New Hanover Regional Medical Center has NHRMC Connect, an Epic-based electronic health records system that stores and shares secure patient information.

That is certainly a very important piece of improving care and reducing costs, in a way that we dont have to duplicate tests and a way for providers to be able to
collaborate, Gizdic says.

Wilmington Health uses the Humedica MinedShare data mining software, which James says can help doctors conduct predictive modeling to better understand the health of specific high-risk groups, such as patients with diabetes or heart conditions.

A little bit of the cost on the front end will make a big difference in a lot of costs in technology and medications, particularly in subspecialty care, on the back end, Sylvestri says of preventive care. Better control of diabetes so they dont get the diabetic complications, better control of cholesterol so people do not get coronary disease, but also social things that can be done, whatever we can do to get people not to smoke.

What Matters

More than convenience matters. Accessibility is not always the main draw for patients.

Most patients are delighted to hear that we have additional locations and that they can get the care more conveniently, DeBiasi says of OrthoWilmington. At the same time there are patients willing to drive several hours to get to our office. Every patient is different.

Toria Campbell drives about 50 miles from Rose Hill to see Brannin at Wilmington Health. There are more choices here, says Campbell, 53, who has multiple health issues that include high blood pressure and a thyroid condition.

She listens, looks at the whole picture, Campbell says.

Campbell, a mother of two grown children and a fine arts student at Cape Fear Community College, acknowledges letting her health go in recent years.

Im trying to get back on track, says Campbell, who is retired from the television business. I was focusing too much on my kids and not enough on me I cant help them if Im not around.

Brannin, who is listening, says that is one of the main points she tries to make.

You cant take care of someone else if youre not taking care of yourself, Brannin says.

House Calls

Dr. Alan Kronhaus works to overcome barriers to medical care access by having physicians see patients in their own homes.

When its tough to connect with a physician you tend not to go, Kronhaus says. You postpone and postpone until theres a crisis.

Kronhaus co-founded Doctors Making Housecalls with his wife, Dr. Shohreh Taavoni, about 10 years ago in North Carolinas Research Triangle.

The practice now has about 32 physicians making approximately 45,000 home visits a year in the Triangle region, Kronhaus says, adding patients include mostly seniors with
complex conditions, as well as some wealthy and famous people seeking privacy or convenience.

It allows our clinicians to function in a much more proactive, prevention-oriented manner, Kronhaus says. We can lavish care on our patients, keep them on an even keel and reduce unnecessary ER visits and reduce unnecessary hospitalizations.

Doctors Making Housecalls is covered under insurance; however, patients must pay a $95 travel fee, which can be waived for senior community residents when doctors make a regular visit, he says.

Clinicians can learn much from a patients home environment, including medications, environmental hazards and diet, Kronhaus says.

[If] you have a diabetic patient whose glucose is difficult to control and the refrigerator is full of Boston cream pie or something you understand what the challenge is, Kronhaus says.

Doctors Making Housecalls does not currently serve New Hanover County, but Kronhaus says he is considering that for the future once he recruits enough clinicians.

Wed love to extend the service into the eastern part of North Carolina Wilmington, Wrightsville Beach, Kronhaus says.

 


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