HYDE PARK — When a patient ends up at the hospital, a team of doctors and researchers at the University of Chicago are betting that seeing the familiar face of a family doctor will help that patient get better faster and cheaper.
Dr. David Meltzer, a physician and economist at the University of Chicago Medical Center, is recruiting 2,000 patients for a clinic where he and other doctors will attempt to mimic "Marcus Welby, M.D.," the affable TV doctor who saw patients in the clinic and then dropped in on them in the hospital to help oversee their care.
“Patients who are frequently hospitalized — or hospitalized generally — don’t get care from a doctor that already knows them,” Meltzer said.
Meltzer is a hospitalist, a doctor who only sees patients once they enter the hospital. He knows how difficult it can be to identify a subtle limp, a facial tick or a sudden drop in cognition that may never appear on a chart but could signal something has gone wrong.
“Someone is there to know you’re not yourself,” Meltzer said of the wager he’s placing on the value of maintaining the doctor-patient relationship that existed outside the hospital.
The idea for Meltzer’s clinic is simple: Patients see the same doctor in the clinic and in the hospital. He said frequently hospitalized patients could account for as many as half of all inpatient days at many hospitals, and reducing those visits could greatly reduce the costs of care.
Meltzer is inviting patients who are intrigued by the idea to sign up for the clinic.
“It’s actually incredibly simple,” Meltzer said. To qualify, a patient, must be enrolled in Medicare Part A and B and have been hospitalized at least once in the last year.
Unlike clinics that focus on cancer or heart disease, Meltzer’s clinic does away with the disease-specific rules.
“It’s not one disease — there is no one disease — that’s the wrong way to think about it,” Meltzer said, adding that many of the patients already recruited suffer from end-stage renal disease, blood infections and other maladies unrelated to each other.
The concept behind Meltzer’s experiment does not come from the hospital, but from his tutelage under Nobel Prize wining economist Gary Becker at the University of Chicago. The venture could be more cost-effective, Meltzer said
“Every time we divide our tasks, we add new costs,” Meltzer said.
According to Meltzer, medicine has fallen under the spell of productivity that works so well in other fields. By increasing specialization among workers, costs can be reduced by shifting simpler tasks to lower-paid employees.
But having a group of people working on a problem is not always good, according to Meltzer. The cost of coordinating different tasks increases as you add people, he said. In medicine that means a nurse takes a patient’s blood pressure and fills out forms, the physician performs the examination and another nurse may administer medicine.
“It really just isn’t practical not to use that model anymore,” Meltzer said of a health care system he believes rewards quantity over quality. “Right now, we pay for effort, we don’t pay for outcomes.”
Meltzer believes health care is moving away from a system that rewards doctors for seeing as many patients as possible and billing for service to a system that rewards physicians for results.
“There is a part of me that would be surprised if this wasn’t a better model,” Meltzer said of his clinic, which in July of last year got a $6.1 million, three-year grant from the Center for Medicare and Medicaid Innovation.
Half of patients who join the experimental clinic will be paired with one of five doctors Meltzer has picked for their ease with patients and expertise inside and outside the hospital. The other patients will go into a control group, where their care will continue to be monitored by University of Chicago physicians, but they will not get that extra personal touch.
Meltzer continues to enlist patients through other doctors and the hospital’s referral line, but anyone who qualifies can enroll by contacting 773-702-4444 or ccpresearch@bsd.uchicago.edu.
