Boston Medical Center Department of Family Medicine Briefing Report for Kate Walsh, CEO Report to BMC Medical Executive Committee ADFM CHC Presentation Prepared by: Larry Culpepper, MD, MPH Chief / Chairman, Family Medicine Kevin Casey Administrative Director February 5, 2010 Faculty = 58 Administrative & Clinic Support = 69 Research & B.U. Personnel = 21 TOTAL FTEs = 148 Total Annual Visits (2009) = 115,176

Department of Family Medicine (DFM) The glue that ties CHCs to BMC Structure “Franchise” clinical units – DFM employs physicians in CHCs as BU faculty and manages the CHC FM units – CHCs pay for >90% of total compensation for CHC based time – CHCs preferentially replacing MD departures with family physicians Virtually all CHC based faculty staff our adult inpatient service 6 wks/yr –Become familiar with BMC specialists and services – Attend on CHC patients and assure close coordination and communication with CHC staff about inpatients CHC attendings make up most of the department’s L&D service attending – Anchor L&D admissions and high risk and Gyn referrals from their CHCs DFM Residency Units Existing DFM Units

Department of Family Medicine (DFM) Key Clinical Functions Ambulatory Primary care (# faculty at site or service participants) – YACC2 Practice (20) – East Boston Neighborhood Health Center (9) – South Boston Community Health Center (6) – Codman Square Health Center (8) – Dorchester Health Center (4) – Roslindale Health Center (5) Occupational Health (1 FT and 2 PT Attendings; double boarded Occ Health &Family Medicine) – BUMC employee health; service to EMS, BPD, Fire Dept, area businesses, consults BU Student Health (Services for ~30,000 students) Sports Medicine (4 Attendings, 1 fellow) – Services at BU, BC, MIT, UMass Boston, Pine Manor College, area high schools – BMC Lead in developing Sports Medicine Institute with Sargent College and Orthopedics Nursing Home and Home Visitation (3) Complementary and Alternative Medicine (3) Inpatient Adult Medicine: Admitting Service for most Boston HealthNet CHCs, BU Student Health (4) – 24x365 inhouse attendings – 2 PA teams, 1 family medicine resident team – Census ~32; ALOS ~3.6 Labor and Delivery (14 faculty; 5 w C’Section privileges) – Collaboration with Dept of OB/GYN (single business unit; share responsibility for all L&D patients and teaching) – 24x365 inhouse attendings; 12 or 24 hr shifts – ~70-80 deliveries /mo Nursery & Postpartum “Mother-Baby Service” – Close collaboration with Peds and OB – 1 attending daytime - ~1/3 of nursery and their mothers – Attending serves as Pediatric attending for CHC patients

Department of Family Medicine (DFM) The glue that ties CHCs to BMC Benefits To BMC CHC based DFM physicians refer/admit only to BMC; CHC employed physicians admit to multiple hospitals FY2000 to FY2007 growth in HealthNet Admissions – 57% CHCs with FM Units – 29% CHCs without FM Units – 1183 additional admissions in FY07 Amby-Inpatient coordination supports short LOS (ALOS ~3.6 days) Low cost physicians for inpatient roles Ability to add to PCP base at cost of ~$25-30K/ FTE To Department Large pool of faculty for hospital coverage (e.g., evenings and nights) and teaching roles Critical mass of faculty for faculty clinical and academic subgroups Ability to embed faculty with few clinical hours due to other roles in functional clinical units Research base, source of collaboration on international projects TO CHC Rapid recruitment of high quality PCPs, including >50% of our own residency grads Very high retention of PCPs long-term Greater breadth of family medicine core competencies not available from internists / peds (eg minor surgery, skin care, eye, musculoskeletal) “Wrap-around” community services provided by DFM (e.g., sports medicine, nursing home care) Versatility in urgent care, evening, night, weekend coverage Inpt LOS financial benefit to CHC-ESP programs Improved inpatient and referral care and communication – >95% of inpatients attain communication “bundle” of Attending-PCP communication on days of admission and discharge + discharge summary signed and to CC w/in 24 hrs of d/c To Faculty Mix of inpatient and outpatient compensation allows higher reimbursement than CHC salaries BU benefit package Diversity of clinical and academic opportunities Ability to tailor personal job (hours & roles) Engagement with mission and colleagues

Department of Family Medicine Communication Quality Initiative Met all 3 criteria for bundle: 1.Attending -PCP contact day of admission 2.Attending-PCP contact day of discharge 3.Discharge Summary signed and sent to CHC by noon day after d/c Met all 3 criteria for bundle: 1.Attending -PCP contact day of admission 2.Attending-PCP contact day of discharge 3.Discharge Summary signed and sent to CHC by noon day after d/c