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Service Lines Put the Patient First

This summer, Johns Hopkins Medicine will embark on one of its biggest sea changes in patient care: the creation of service lines that integrate multidisciplinary services across the Johns Hopkins enterprise in three key areas.

Historically, a patient with low back pain wanting care at Johns Hopkins may have had to choose from multiple phone numbers or links on websites to navigate his or her way to a first appointment, which could have been with an orthopaedic surgeon, a physiatrist or an internist. From that point, the patient would then have to work through the system piecemeal as needed.

In the new service line model, such a patient would call one number and be scheduled with the most appropriate specialist in the ideal type of setting for his or her needs, whether an outpatient appointment or a presurgical consultation, at any Johns Hopkins location, says Susan Phelps, executive director for the Johns Hopkins Medicine Office of Integrated Health Care Delivery.

“We’re really thinking about service lines as being organized around a population or disease state,” adds Phelps. “It’s a way of getting out of that siloed approach by department and looking at patient journeys from a much more interdisciplinary perspective.”

These service lines, which start July 1, will focus on solid organ transplantation; hip, knee and low back pain through a musculoskeletal service line; and transgender health needs. The Johns Hopkins Comprehensive Transplant Center already involved experts in multiple departments, so it served as a good starting point, explains Theodore DeWeese, director of radiation oncology and molecular radiation sciences and vice president of interdisciplinary patient care for Johns Hopkins Medicine.

Bundled payment structures being adopted by other states are largely oriented around musculoskeletal disorders, like joint replacements and back pain management, so creating those service lines made sense, he says. Transgender health was added to provide holistic care in an arena where many patients just have individual interactions with providers as needed. “Patients now will have easier access and can move through the system in a way that would be much harder if not oriented in a service line,” says DeWeese.

“Our access process, for many reasons, has not always been very easy,” says Phelps. “We are creating a system that will provide a much faster process for patients to enter our system at the right place, and into a care path that hopefully will lead to shorter episodes of care and a quicker return to work and daily living.”

Each service line has shared leadership, including department chairs for the specialties involved and representatives from community hospitals, primary care and finance, Phelps says. Not only are they creating validated, patient-centered care pathways in each service line, but they also are creating new financial models for these joint efforts and working with the Office of Managed Care to match payers’ needs.

The service lines have a number of goals to support other parts of Johns Hopkins’ mission, including promoting departmental clinical research efforts, improving training opportunities for medical students and fellows, and meeting quality and safety metrics, says DeWeese.

“That’s what makes us very different,” says Phelps. “But we believe that’s just core to who we are.”

“This is a culture change for us in many ways,” she adds, “But Johns Hopkins leaders, including CEO Paul B. Rothman and Executive Vice President Ronald R. Peterson, have been incredibly supportive of these efforts to really move our work forward to provide a more integrated, patient-centered approach to care.”

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