It's not every day that a new physician's office opens with the goal of seeing six patients a day by the end of the first year of operation.
Yes, just six patients a day. Perhaps later the total will rise to eight to 10 patients a day.
And it's perhaps rarer yet that a hospital sponsors a new venture that it knows is likely to cost it money and resources.
The venture is Touro Infirmary's senior health center, which opened earlier this year in a residential neighborhood near Lake Pontchartrain in New Orleans.
The senior center is designed to meet the medical needs of patients older than 65-therefore, qualified for Medicare. The plan is to build and staff several of these centers in areas of perceived community need.
The senior center has five employees: a full-time physician, a full-time registered nurse, a full-time board-certified social worker, a medical receptionist and a program director.
Services include not just physicians' care but community health education, social skills development, help with bills and psychological problems, and consultations with pharmacists, nutritionists and home health nurses.
Geriatric patients often suffer from chronic illnesses and multisystem problems. Their regular internist isn't always in a position to coordinate all the necessary ancillary care, plus manage their social problems, depression, money shortfalls, loneliness and poor eating habits.
"This environment gives a comfort zone to the patient," said Susan Weyer, M.D., the on-site physician who is board-certified in internal medicine and geriatrics. "We like to serve them punch, coffee, cookies." Weyer's solicitude for the elderly was visible in her concern for her own parents, who attended the inaugural open house.
The object of this weave of services and support is to keep the elderly person functional at home, Weyer said. Her staff can arrange referrals for transport, Meals on Wheels and home health nursing. They can help patients understand their bills-and find ways for them to get the care they need but can't afford.
"We've already seen two patients who we put on drug company indigent programs," Weyer said. "We did all the paperwork. The patients came to us off medication because they ran out of samples and didn't want to go back and ask the doctor for more samples."
Another woman came in with high blood pressure. It turned out she was worried about her mother in a nursing home. The senior center used relaxation therapy to reduce her stress, and the social worker helped her with her mother's situation.
Consultations like that, obviously, are time-consuming. "In a typical primary-care office," Weyer said, "that's the issue: time constraints. . . . We had a patient the day before yesterday, we ended up spending three hours with a lady and her son. She had been taken to nine specialists. There was no integration of clinical treatments." The woman was 80 years old, and her son had been trying to determine why she wasn't improving.
"This operation has a lot more overhead than a normal physician's office," noted Touro Infirmary Vice President and Chief Financial Officer Suzanne Haggard. "Community education is not charged for. Social work is not charged for. Medicare pays you no more than they pay you for a physician's office."
The project, Haggard said, will be "break-even or a little below." There will be some incremental added business for the hospital, but not enough to cover all the costs associated with the senior center.
The only reason to do it is to support Touro's charitable mission, Haggard said. "We did have a desire from a community service standpoint to serve the geriatric community."
As a part of that mission, Touro Infirmary operates a center of excellence in geriatrics. In 1997 it launched a day program for senior citizens with Alzheimer's disease. The primary caregiver can drop off the patient at the day program while on the way to work, or simply for a respite.
By placing the new center in an outlying neighborhood in the city that is heavily populated by older people, Touro is hoping to bring medical care to the patient instead of hauling the patient to the medical center.
Most hospitals in New Orleans, including Touro, are clustered downtown or near the Mississippi River. The lake side of town is somewhat lacking in institutional healthcare infrastructure; therefore, doctors' offices are scarce.
That point wasn't lost on June Kissgen, 73, who's been a Touro patient "for years," she said.
"I can walk from my house to here," she said to a visitor at the facility's opening reception. Her regular doctor is moving to North Carolina, and she's shopping for a new one.
"If you go to a senior center, you assume that the doctor is knowledgeable about old people's health," she said. "As I think about the future, I want to have everything convenient so I don't have to be driven to the hospital."
The actual office is a 2,400-square-foot ground-floor storefront in a small shopping center. The facility is run by Dallas-based Cornerstone Health Management under a three-year contract with Touro.
Leigh Allen, a Cornerstone employee, will be the on-site manager. Touro hopes to open another senior center by December, and that too will be supervised by Allen.
Cornerstone operates senior centers throughout the nation, said Carol Richardson, who works with hospitals in Mississippi, Oklahoma, Texas and now Louisiana from her base in Dallas. The company helps hospitals determine where to locate their facilities, how to negotiate the rental space, optimal size, and the kinds of doctors that should staff the center, she said.
Cornerstone also has experience with visual cues that seniors like. "Visibility from the street, access to parking, ground-level entry-those are all important things," Richardson said.
Cornerstone walked Touro through the regulatory steps to obtain approval from the state's Department of Health, and it develops working relationships with departments at the hospital, including medical records, patient-care, facilities management, billing and reimbursement, and the laboratory and pharmacy.