Fierce Q&A: MetroHealth gets patient-centric with outpatient care

As the industry shifts toward a patient-centered model, outpatient care is becoming more important to hospitals' missions and bottom lines. Hospitals across the country are increasingly investing in outpatient services, bringing cost-effective, patient-friendly and accessible care away from urban hospital campuses to local community settings.

One regional example of the trend is found in Ohio, where healthcare organizations have been seeing a growth in newly opened outpatient facilities and increased outpatient staff hiring this year. And less than two weeks ago, Cleveland's MetroHealth System broke ground on its newest suburban health center.

So FierceHealthcare caught up with MetroHealth's William R. Lewis (pictured), chairman of the market development campaign, leader of the network expansion initiative and chief of clinical cardiology at MetroHealth Medical Center, to talk about the system's expansion into outpatient care and how the new MetroHealth Middleburg Heights Health Center will work to provide quality care outside the main hospital walls.

FierceHealthcare: Why did MetroHealth decide to move primary and specialty care services out to the suburbs? What were the main factors in the outpatient planning process?

William Lewis: First of all, we believe this is the way healthcare is going to be delivered in the future. We need to deliver healthcare in the community because that's where patients are demanding healthcare be delivered. So while not everything can be delivered there--we're not going to do cardiac bypass surgery, for example--we want to provide those things that can be done in the community in the community. It's mostly because we are being patient-centric. Patients want care there, and that's what we're going to do.

Second, we believe this is an efficient way to provide healthcare. In a large hospital system, in a main campus-type hospital system, it's difficult to provide high-quality care efficiently. So the goal is to try to do that in the community.

The third thing that's really important about this is that MetroHealth has a narrow network healthcare plan (MetroHealth Select) that we have been offering to county employees, municipal employees and a variety of other entities. That plan involves the delivery of healthcare to its insured in Cuyahoga County, and we need to be convenient for individuals to whom were delivering the program. If we're going to offer companies a healthcare program like that, we're going to have to be present in the communities were their employees live. So we need to be in all parts of Cuyahoga County. So this building is really one of several that were looking to put in the county.

FH: How will the move benefit the health system and its patients?

Lewis: One of the things we've noticed is that MetroHealth is one of the best kept secrets in Cuyahoga County. We don't want it to be secret anymore; we would like people to know about all of the care we provide. Putting a building in a very visible location and having a specific design that will say to people "We are MetroHealth" will bring more patients into the MetroHealth system and let that secret out a little bit.

We believe patients will want to come to see our physicians there--they're faculty of Case Western Reserve University. They are outstanding physicians, and we've really kept them a secret from people in a variety of communities. So that's one advantage to both MetroHealth and patients.

Obviously, being in the community is an advantage to patients--it's very patient-centric. For example, if I'm seeing a dermatologist, I don't think I should have to go to a main campus to have my dermatological problems taken care of. I should be able to be seen by a physician in my community to provide that. If you're seeing a physical therapist three times a week, you really don't want to travel a long distance to do that. We would love to provide our care to our patients in their community. So we look at this as though we are the patient and we're figuring out. If we are the patient, what services would we want to have provided in our local community?

FH: What enables MetroHealth to deliver a range of healthcare services on an outpatient basis?

Lewis: There are three factors. One is the service needs to provided in ambulatory setting. For instance, we're not going to do major surgeries in the local communities. So the service has to be something that can practically be provided in the community.

The second thing is we have to have the physicians who are able to travel and be in those locations. We have high-quality physicians who are capable of providing care, and where they provide that care is really up to us. We decided as system that we're going to provide care in that location and those physicians are happy to oblige that.

The third thing is that you have to have the equipment needed to provide care. If I'm a cardiologist and a patient needs to have a stress test done, we need to be able to provide the stress testing equipment in that local area. We need to provide the range of imagine services, physical therapy and occupational therapy. We need to be able to provide all of those services to patients and there's equipment required to do that.

FH: What is MetroHealth's approach to running outpatient facilities? Does it use in-house management, partnerships with physicians, joint ventures?

Lewis: We're currently looking at options with respect to how we would staff those locations. Because we are a county institution, we are limited in terms of what we can do. But we're going to explore those opportunities to the fullest. There are a large number of physicians who want to partner with MetroHealth in the community to be able to provide care. Many of those physicians will want to be part of the MetroHealth system; many will want to partner with MetroHealth.

FH: Does the system have other plans to expand its outpatient presence?

Lewis: Absolutely. The first thing we need to do is expand our locations. We have done that with smaller facilities in the outreaches of Cuyahoga County where we have not really been in the past. We are now in the far western suburbs and the far eastern suburbs.

This building is replacing a very busy practice in Strongsville. So we are expanding, but we're doing it carefully by making these buildings an extension of programs that we already have in place in those locations. So we're not going to build this from scratch and say, "now we built this, let's fill it up." We're going to build the facility as a replacement for a practice that's already in place, and we began building those practices several years ago.

We also need to look at what we're doing in the inner potions of Cuyahoga County and make appropriate services available to them as well. So we're going to be looking to expand what we do in those locations too.

FH:  As part of a larger shift toward outpatient care, how is MetroHealth dealing with increased competition from the dramatic growth in freestanding facilities and retail clinics? 

Lewis: I think patients want to have their care delivered in a system. They want to know that this care is not just one-stop-shopping; it is going to be delivered as a part of their overall healthcare. Going to a doc-in-the-box, if you will, is not contiguous care with a primary care physician. It is care that's delivered on an interim basis and therefore the records are not stored in a singular location. There's no continuity of the physician care in those kinds of circumstances. Our proposal is to be able to provide that convenient care, but to do it as part of a continuous, collaborative relationship with a primary care physician.

FH: Are patients catching on to the trend of bringing care away from hospital campuses? How have they responded?

Lewis: Patients love this. They love to see a cardiologist in their community, they love to see specialists in their community and they like to see their primary care physician.

What people worry about in seeing physicians in their community is the quality of the care. They want to be sure that the quality of the care they're going to get is high.

MetroHealth has consistently provided and has been given awards for the type of quality care we provide. As I mentioned, our physicians are all faculty of Case Western Reserve University. Patients can walk into a MetroHealth facility with the confidence that the physician quality is going to be excellent. So I think that patients love to see their physicians in a location that is convenient, as long as they can be assured the quality is going to be high.

FH: What advice would you give to other healthcare organizations looking to use outpatient care to save money and improve access to care?

Lewis: They should look at the way healthcare is going to be delivered in several years, not the way it is delivered today. At MetroHealth, we're building for the future. And when you build for the future, you look and try to predict how healthcare is going to be delivered then. The old days of having monstrous hospitals and having patients come from all over the city or county to see you, those are going to be over very soon. And healthcare is going to need to be efficient, high-quality and also convenient for patients.

Editor's note: This interview has been edited for length and for clarity.

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