It may sound like an oxymoron, but high-performing, economically stable safety-net providers actually exist, according to a new Commonwealth Fund case study.
One such provider, New York-based Montefiore Medical Center in the Bronx, sees a high proportion of lower-income, medically complex and government-insured patients. Medicare and Medicaid pay for nearly 80 percent of the non-profit academic medical center's patients. Yet its operating margin was 1.3 percent--and its total margin 2.5 percent--in 2009, thanks to a mix of improvements, including innovative practices for managing chronic disease and targeted care management.
For example, Montefiore has integrated critical care expertise into medical-surgery units outside of the ICU. Dr. Vladimir Kvetan, director of critical care, 10 years ago noticed that some end-of-life patients and others who would not benefit from the high-level staffing were filling ICU beds. What they needed was the clinical knowledge and decision making of an intensivist physician who could go to wherever the patients were.
In response, he created an "ICU without walls" initiative that offers a critical care medicine rapid response system wide. Intensivists trained in critical care, palliative care, family care, and bioethics make up a team that offers medical consults and triage 24/7.
Montefiore also is working toward creating patient-centered medical homes at two primary-care centers. One--the Family Health Center--now holds 50 to 75 same-day appointment slots open every day to accommodate patients with urgent care needs. This helps to ensure that there's no long wait between the time a patient sees the first available provider and when he or she actually receives care.
To learn more:
- read the Commonwealth Fund case study
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