BOSTON -- A unique model of care born in Boston, and now nationally recognized, is celebrating 30 years since its inception.
Urban Medical Group developed a vision for bringing primary care to the underserved populations of Boston in 1978. This line of thinking differed from the norm because it focused on using physicians, physician assistants and nurse practitioners to bring primary care to elderly, chronically ill or minority patients at home, in a nursing home, or at the hospital. Urban Medical chose then Beth Israel Hospital as a partner due to similarities in mission and care, according to Elizabeth Kass, MD, Medical Director, Urban Medical Group.
"Our founders looked for a partner and found that partner in Dr. Mitch Rabkin," Kass, a 19-year veteran of Urban Medical, says. "Beth Israel already had a home care program. They were already thinking what our founders were thinking, 'how do people get care when they leave the hospital.' Having a hospital partner that understood that was such a gift."
Beth Israel Hospital's Home Care Program was launched in 1954 and was the first comprehensive program of its kind in Boston. Physicians would see patients in their homes in and around the Boston area, according to an interview with one of the program's founders, George Altman, MD, in the July 1972 edition of B.I. News. Mitchell Rabkin, MD, CEO Emeritus, Beth Israel Hospital and CareGroup, was at the helm of BI when Urban Medical approached the hospital in the 1970s.
"At the time, other teaching hospitals segregated Medicaid and indigent patients in open wards to be cared for by residents, with their own doctors excluded," says Rabkin. "Beth Israel treated patients of all socio-economic brackets identically in rooms from single to quadruple, and the staff doctors who cared for them on the outside could maintain continuity of care within the hospital as well." Rabkin remains connected to Urban Medical, chairing the event committee that organized a symposium and gala on Friday, April 4 to mark the non-profit's 30-year anniversary.
The Urban Medical Group's doctors, physician assistants and nurse practitioners admitted patients to Beth Israel Hospital and continue to admit patients to BIDMC today. Kass says taking care of the elderly and chronically ill portions of the population became increasingly difficult when Congress enacted the Prospective Payment law in the 1990s connecting reimbursements to the length of a patient's stay. Thus, Urban Medical Group created its House Calls Program to meet the gaps left when regulatory challenges caused the hospital's Home Care Program to change.
"We created our House Calls Program with nurse practitioners in charge of the clinical care piece," Kass says. "Actually Gail Metcalf, now a core NP in our House Calls program, originally worked with us as a BI Home Care Program nurse practitioner."
In addition to staff connections continuing to link Urban Medical Group and BIDMC today, so, too, do the two institutions' shared philosophies. In the 1972 interview, Altman said the home care program was important because it allowed the homebound to receive care, but it also allowed for "managing the family and environment as well as the patient." This "social-side" of medical care continues to thrive.
"You know all of the pieces ... patients, their families, who they were before they became frail," says Kass about the social benefits to the model of practitioners partnering with NPs and PAs. "You understand the person's baseline, rather than bouncing them back and forth between doctors and locations."
Mark Zeidel, MD, Chair pf BIDMC's Department of Medicine, said Urban Medical's approach to providing medical care not only benefits its patients, but also serves an important lesson for BIDMC's residents.
"Urban Medical Group provides superb care to vulnerable patients in multiple settings," Zeidel says. "The doctors and nurses at Urban do a wonderful job of teaching our residents, and make important contributions to the life of the hospital. We are proud indeed to have the privilege of working with such wonderful colleagues, who make a difference in people's lives every day."
Stan Lewis, MD, Senior Vice President of Network Integration and Interim CEO of the Cardiovascular Institute, hailed Urban Medical as "a jewel among physician organizations and medical centers."
"Urban Medical is a wonderful primary care group provider with a niche in geriatrics," Lewis says. "They are a real partner and visionaries in the many ways to provide care in and out of the home."
Looking ahead to the next 30 years of an Urban Medical and BIDMC connection, Kass hopes the two entities can continue to collaborate in creating a seamless continuum of care between the hospital, office, home, nursing home/rehab and office settings. Promoting excellence of care outside the hospital shift not only saves money by cutting out costly hospital fees, but it also benefits the patients' overall health and quality by keeping older, chronically ill patients in their homes to the extent possible. Kass also hopes BIDMC and Urban Medical can attract clinicians to a professionally rewarding field whose population of providers is dwindling as the number of underserved patients continues to soar.
"With the baby boomers retiring, we need more clinicians, but this type of job does not pay as well as the specialty practices," Kass says. "So the challenge is you want someone to come in and do it for the future because it is enormously gratifying work."