American College of Physicians: Internal Medicine — Doctors for Adults ®

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The 'Nordstrom model'

Academic medicine makes a move to the 'burbs

From the March 1997 ACP Observer, copyright 1997 by the American College of Physicians.

The idea is to transform an urban faculty into a suburban multispecialty group practice. Patients will amble from the ample free parking lot past the potted palms to their doctors' modules. There, they will interact with both professors and patient service representatives. They will even be able to take healthy cooking courses on the premises.

The concept behind Penn Medicine at Radnor—a new satellite of the University of Pennsylvania Health System that will be fully open for business in April—is to bring customer service philosophies to top-quality academic medicine and deliver the combination to patients in a convenient suburban location.

"This is revolutionary for an academic center," said Valerie P. Weil, MD, a general internist who recently started working two days a week at the new satellite clinic. "Paying attention to patient care, efficiency and making it easier for patients—wow!"

Three days a week, Dr. Weil continues to treat patients and teach medical students and residents at the Hospital of the University of Pennsylvania (HUP) in West Philadelphia. But here at Radnor, she reports to the clinic's medical director, not her department chair. She is one of 160 full-time clinical faculty members who will rotate through the satellite on a regular basis.

The Penn Medicine at Radnor satellite is one prong of Penn's strategy to become a dominant health provider in the Delaware Valley, dominance that the university needs to sustain its academic mission. Satellite clinics are a way to attract the patients needed to feed Penn's 1,000-bed hospital and dozens of training programs.

Penn officials hope the Radnor satellite will attract patients seeking primary care to an academic organization generally regarded as the place to go only for highly specialized services. It will also allow Penn's newly acquired primary care physicians a convenient way to keep patients in the system without having to send them downtown to HUP.

"We want people to think of Penn for their doctor, with the full recognition that if it's routine preventive care that they need, they can get it by a Penn doctor. And if it's quaternary care, they can get that too, and they never have to leave the health system," explained Michael A. Grippi, FACP, a pulmonologist who is the new satellite's medical director as well as vice chairman for clinical affairs in Penn's department of medicine. "It's a different way for patients to look at Penn. We want people to think of us at the beginning of the health care process, not just as the court of last resort."

Dr. Grippi calls it "the Nordstrom's model," after the department store chain renowned for its top-notch customer service. Doctors will work alongside "patient service representatives" who are trained to attend to all a patient's non-clinical needs, from insurance to scheduling and referrals. Doctors also will be compensated differently than they are at the downtown location, with salary incentives tied to patient satisfaction.

"Down at Penn, it's primarily a number thing," Dr. Weil said. "You are expected to see X number of patients per year. Here [at Radnor], it's not just numbers but also patient satisfaction."

There even are multispecialty modules designed to make it easier for patients to do one-stop shopping for their health care. At the "Penn Health for Women" module, for example, Dr. Weil is paired not with other internists, but gynecologists, rheumatologists, orthopedic surgeons, dermatologists, gastroenterologists, nutritionists and social workers, all of whom have a particular interest in women's medical needs.

"There's nothing like this downtown," Dr. Weil said. "The gynecologists are on the fifth floor of Penn Tower and the internists are mostly on nine. GI is in another part of the hospital. Here, not only do we have everybody in one building, but we have as many subspecialists as possible practicing in our module, so we can walk out of a room and say 'Is there a gastroenterologist here? I have a patient with irritable bowel syndrome.' ... And this can be done because it's been planned this way from the beginning."

The new Radnor facility was also planned with Penn's academic mission in mind. Each module includes conference rooms, libraries and banks of Internet-connected computers for students and attendings. In a few months, the satellite location will become a major ambulatory teaching site, Dr. Grippi said.

The hardest part right now, Dr. Weil said, is juggling the logistics of working in different locales on different days. "Making sure all the messages get to where they are going is tough," she said.

"I never really worried so much before if something was convenient for the patient," Dr. Weil said. "But now there is a lot of competition and we need to be competing not just on the basis of providing excellent medical care, but on convenience as well."

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