BID HealthCare grows in Chelsea

Beth Israel Deaconess HealthCare-Chelsea is growing, drawing more patients by adding physicians and services to meet patient demand.

The center located at 1000 Broadway on the Chelsea-Revere line added six new doctors and expanded clinic hours in the last year with more additions planned. In fiscal 2012, which ended Sept. 30, clinic encounters in adult specialties were 32 percent ahead of budget, and internal medicine was 9 percent ahead. Total patient visits were close to 85,000.

"We've always said that at Chelsea, if you build it they will come," says Kelly Orlando, BIDMC's Executive Director for Ambulatory Services, citing new teams in dermatology and hand surgery that started over the last summer and soon had packed schedules.

Currently, 11 primary care doctors and an obstetrician/gynecologist practice at Chelsea; 16 Boston-based specialists hold regular clinics. Several nurse practitioners are integral members of these teams. Chelsea also offers physical therapy, laboratory, ancillary testing and radiology, including mammography and ultrasound services.

From a patient perspective, it's clear why Chelsea works. When patient Frank Palmisano arrived for his appointment he had his choice of parking spaces. Minutes later, he was inside having his lungs tested in the Pulmonary Function Testing clinic. In a room a few doors down, he sat down to talk with his doctor, pulmonary specialist Amit Narendra Anand, MD.

It couldn't have been easier for the retired manager - who now drives one of the Boston Duck Tours' "amphibious vehicles." Palmisano likes the atmosphere of the community setting, and getting an appointment with a BIDMC specialist six minutes from his Revere home.

The center opened in 1995, when the city of Chelsea was beginning an economic recovery. It is now bordered by freshly built loft housing, a new park with an ice-skating rink, and a new shopping plaza. Near Routes 16 and 1, Chelsea serves patients from Chelsea, Revere, Everett, Saugus, Winthrop, East Boston, and Malden - and is committed to serving patients who live or work on the North Shore.

The combination of a newer building, urban renewal, and a convenient location means Chelsea is in a great position to deliver care in the community, in keeping with the current direction of health care reform.

Chelsea also has a clear role in BIDMC's evolving system of care, in which patients get the right care at the right time in the right place. It's a community setting with the resources of a major academic medical center - think shared online medical records and imaging - where patients can start by seeing a BIDMC primary care physician. If they need specialty care, a growing number of specialties are onsite, as is routine diagnostic testing, radiology, and physical therapy.

For patients who need further testing, another BIDMC specialist or an outpatient procedure, a shuttle makes rounds from Chelsea to BIDMC throughout the day, and care is enhanced by continuity and communication within the system. This is also true if patients require inpatient surgery or hospitalization at BIDMC - and afterward they can return to Chelsea for follow-up visits with a specialist or PCP.

This model is one reason Chelsea is part of the recent $5 million grant from the Center for Medicare and Medicaid Innovations Grants, designed to identify ways to improve patient outcomes following hospitalization.

The range of specialties at Chelsea, and the connections to BIDMC, mean local patients and referring physicians don't need to look for services outside the BIDMC network.

"Having a place like Chelsea in our system prevents ‘outward migration,'" says Jayne Sheehan, BIDMC's Senior Vice President of Ambulatory and Emergency Services. "That's a win/win, because patients receive coordinated care and they remain within our network, which benefits our health care delivery system financially."

A new website helps patients and families learn about new services.

Specialists who come to Chelsea find the setting promotes high-quality, coordinated care. "It's great when specialists and primary care doctors can walk down the hall to talk to each other," says pain management specialist Christine Peeters-Asdourian, MD, Interim Chief of the Division of Pain Medicine and Interim Medical Director of the Arnold Pain Management Center.

"Working together face-to-face on challenging cases enhances the care we provide for our patients," adds primary care physician Philip Triffletti, MD, who's been at Chelsea since it opened and serves as medical director.
Specific initiatives also promote high-quality care, including a nursing-lead clinic in Internal Medicine for patients on blood-thinning medications such as Warfarin. Two nurses systematically educate, monitor and follow up with more than 200 patients to prevent adverse effects.

"We use a database, but we also really get to know the patients and families, so we know when extra support is needed to ensure safety," Susan Devito, RN, explains.

"For example, often if a patient has an issue with family support or the actual caregiver is temporarily unavailable, we are aware and can identify possible compliance issues, medication errors or even fall risks, which can be quite serious when patients are anticoagulated, due to increased bleeding. Knowing our patients as well as their family situations allows us to put preventative measures in place. This could mean something as simple as a med box for the patient, or as much as initiating VNA or exploring respite care options."

"It's a critically important patient safety program that provides a measurable, highest quality outcome for serious medical conditions," says Triffletti.

This environment is one reason physician satisfaction with practicing at Chelsea is high.

"It's a very rewarding place to practice," says Allen Hamdan, MD, a vascular surgeon and Clinical Director of Vascular and Endovascular Surgery in the CardioVascular Institute.

Patient satisfaction is high, too. Palmisano is a snowbird, going to Florida each winter when Duck Tours stop for the season. But he tries to have his appointments at Chelsea before he goes. As he says, "I like my BIDMC doctors!"