Toledo-area hospitals plan for health law

Care teams gain acceptance

Dr. George Darah speaks with David Hensel, 79, as his granddaughter Shaintell Hensel, far left, and their 'care navigator,' Brenda Mullen, listen. The navigator concept is to guide patients through the health-care system.

When David Hensel has an appointment with Dr. George Darah, the Swanton Township man and his Sylvania Township physician are not alone.

Mr. Hensel is accompanied by his caregiver, Shaintell Hensel, the granddaughter whom the 79-year-old man raised and adopted. And for about 18 months, a registered nurse also has attended Mr. Hensel's appointments and subsequently helped them schedule visits elsewhere, answered questions, and even filled out paperwork.

"It's just kind of good to have an extra person for me to call," said Ms. Hensel, 22, whose grandfather has diabetes and other health problems. "They call occasionally and check on him and see how he is doing."

So-called care navigators are increasingly being used in ProMedica's physician offices as part of a concept known as patient-centered medical homes, where a team from a primary-care office works with a patient to navigate the health-care system.

The medical home concept has been around for decades, but it has been recently resurrected and is favored in federal health-care reform.

Increased use of tests, medications, and other medical services has complicated health care, and the goal of medical homes is to decrease duplication and inefficiency while improving outcomes for patients, said Dr. David James, ProMedica's chief quality and integration officer.

"The system is crushed under its own weight," he said. "There's simply too much to do."

Hospitals, doctors, and other health-care providers are aligning their operations to fit outcomes of federal health-care reform, which aims to extend health-care coverage to more Americans and control skyrocketing costs.

Providers also face reduced Medicare payments, and with reimbursements being tied to quality and efficiency, finding ways to improve those intertwined goals have become high priorities.

The Ohio Hospital Association has assembled quality collaboratives statewide to work on issues. One in northwest Ohio has as participants all Toledo-area hospitals and many beyond.

Toledo-area hospitals also participate in other quality initiatives, such as those geared toward reducing hospital errors, complications, and readmissions, as the reform effort proceeds over the next few years.

"We're preparing for the phase-in," said Berna Bell, the Ohio Hospital Association's director of health policy.

Just what shape federal health-care reform will ultimately take remains questionable.

Requiring Americans to have health-care coverage, for example, is contentious for residents of many states, including Ohio and Michigan.

Such coverage is needed for insurers to stop denying health insurance to people with pre-existing conditions, reform advocates say.

More than 546,000 registered Ohio voters have signed petitions seeking a constitutional amendment on the Nov. 8 ballot to reject the federal law's mandate that residents get health-care coverage by 2014 or be penalized.

The Thomas More Law Center in Ann Arbor filed a lawsuit, one of many nationwide alleging the law is unconstitutional, and will ask the U.S. Supreme Court to hear the case.

No matter what final version reform takes, health-care providers are making preparations. Hospitals are working on mandated electronic medical records systems, which Mercy started in 2004, and other efforts.

Mercy will build on its electronic offerings in October, when it opens a secure online system where patients can view their test results, send messages to their doctors' offices, request prescription refills, and schedule appointments. Doctors also will be able to send secure notices to patients, such as reminders to get flu shots, said Dr. Ken Bertka, Mercy's vice president of physician clinical integration.

With more Americans to be insured under reform -- and a national shortage of doctors, nurses, and other health-care providers looming -- the University of Toledo Medical Center, the former Medical College of Ohio, in recent years has increased the size of its medical school classes from 145 to 175 students and has added students preparing for other professions.

Plus, it has boosted by more than 25 percent the number of residents it oversees, to 268 doctors, and has increased graduate medical education opportunities, said Dr. Jeffrey Gold, UT chancellor, executive vice president for biosciences and health affairs, and medical college dean.

Toledo's Neighborhood Health Association wanted to expand services at facilities as well as add a clinic with federal grant money, but funding that was promised to expand community health centers nationwide has not materialized, officials said.

Doni Miller, Neighborhood Health's chief executive, said the association seeks funding to open another clinic within a community agency. Such a move would cost about $300,000 a year and could reach more residents. About 70 percent of the association's adult patients are uninsured.

As part of reform, patients will need to be more involved with their care and making decisions, such as with participating in medical homes, Mercy's Dr. Bertka said. Mercy and UT are working on incorporating the medical home concept.

ProMedica decided to use the medical home concept about two years ago, and 15 offices , including Dr. Darah's, with roughly 50 primary-care doctors have been recognized by the National Committee for Quality Assurance.

Additionally, 11 offices are going through the process, and eventually it will be at all primary care offices, said Dr. James, the chief quality and integration officer.

Dr. Darah's office was one of the first in ProMedica's pilot program, and Mr. Hensel was among 25 patients initially enrolled.

Brenda Mullen, who has worked with Mr. Hensel, said care navigators help patients get the services they need.

When Mr. Hensel needed $650 compression stockings not covered by insurance, for example, Ms. Mullen and nurse navigator Marilyn Antonini helped his granddaughter fill out paperwork to get assistance from the manufacturer. A grateful Mr. Hensel said he ended up paying $15.03 for them.

Care navigators helped get the Hensels into a diabetes education program so they could talk with a nutritionist and others, and they also arranged to have them meet with a pharmacist to revamp his list of medications.

"I can fly an airplane and drive a truck, but I don't know about medicine," Mr. Hensel said.

Contact Julie M. McKinnon at: jmckinnon@theblade.com, or 419-724-6087.