An Interview with Timothy G. Ferris, MD, MPH

Timothy G. Ferris, MD, MPH, is medical director of the Mass General Physicians Organization (MGPO) at Massachusetts General Hospital and associate professor at Harvard Medical School. Together with a handful of other Mass General physicians and administrators and nurses, he is spearheading a project whose goal is to identify creative ways to reduce the cost of care for high risk, chronically ill patients while still providing top-notch treatment, using small groups of such patients as pilots.

Funded by the Centers for Medicare and Medicaid Services (CMS), the Mass General Care-Management Medicare Demonstration Project is jointly run by CMS, the MGPO and the hospital. In initiating the project in 2006, CMS asked a handful of hospitals nationwide to find the best ways to care for the sickest 15 percent of Medicare beneficiaries who 
account for 75 percent of healthcare spending. Mass General took on the challenge by enrolling 2,500 of its most high risk patients with multiple diseases and chronic conditions. Preliminary data are in, and Dr. Ferris has lots to say about them.

What are the data showing?
We have witnessed declines in inpatient admissions, Emergency Department admissions and readmissions. Patients are also reporting receiving better care and experiencing improved health.

What’s next?
CMS extended the original three-year project for three more years, through July 2012. We’re in the process of enrolling an additional 900 patients to refresh the population and garner new information for this extension. The program will also be rolled out to two additional sites: North Shore Medical Center and Brigham and Women’s Hospital. Each will enroll 1,000 to 1,300 patients. We’ll now see whether the model we created here at Mass General can be sustained and duplicated, which will ultimately help Medicare determine if and how the program can be replicated nationwide. Our hope is that each site can bring its own set of strengths and resources to the model.

What are the innovative ways in which the program approaches patient care?
The 12 nurse care managers, who are embedded into all 19 MGH primary care practices, are 
the crucial component of the program. They identify health risks in their patients; coordinate care between providers and services; and facilitate communications between providers, rehabilitation facilities and home. They help the patients negotiate the healthcare system and call patients to check in and answer their questions. In short, they take a proactive approach to care, rather than waiting for patients to arrive at our doorstep once their health status has deteriorated. It provides patients with an entry point to the clinicians who know them, takes a huge work burden off of physicians and improves care coordination.

Why did you take this support-the-doctor approach?
At the core is a belief in a strong communication link between physician and patient. When doctors are overburdened with visits and calls, that link breaks down. Yet we know through a national survey that physician career satisfaction is strongly correlated with the overall satisfaction of patients — more than any other aspect of the healthcare system. If Mass General is going to continue recruiting and retaining the best doctors, we have to support that physician-patient relationship.

What’s the typical profile of a patient enrolled in the program?
On average, they were 76 years old, had more than three acute-care hospitalizations per year and were taking more than 12 active medications. They incurred an average of $22,000 in annual healthcare costs, though total costs in the year prior to enrollment were closer to $60,000.

How do you measure outcomes?
The enrolled patients were compared to a control group comprised of patients from other Boston hospitals. Comparing apples to apples and oranges to oranges, we have experienced between a four and five percent savings in cost — five percent being the goal CMS had set.

What do physicians think about the program?
Both primary care physicians and specialists have been really pleased. They are witnessing declines in visits to emergency rooms and they know that someone is keeping track of their progress. Many doctors say that it allows them to focus on the patient without spending time on coordinating services which usually means paperwork and phone calls. We paid physicians a small management fee to cover the additional time they spent with the care managers, but as the program progressed they found that the care managers actually saved them a good deal of time.

If the program were rolled out nationally, how much would it save the healthcare system?
Simply extrapolating our results to the whole country suggests savings of more than $50 billion. But few providers of health care have the systems we rely on to operate this program. More realistically, savings could be in the range of $1.5 billion over two years. We have to keep in mind that Mass General is a relatively unique entity where physician and hospital services are integrated, where we have universal use of electronic medical records and advanced clinical and administrative information systems, and where we have an extensive primary care network and the full range of acute and chronic care services. That infrastructure, which not all hospitals have, provides a huge boost to the program. On the other hand, because the patient population in the study was selected from existing MGH patients, these patients were relatively well managed upon entering it — which indicates that there could be an even greater opportunity for improvement in less well-managed populations.