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March 2012

Filling a prescription for primary care

Date: March 5, 2012

The expanding Johns Hopkins Community Physicians is tying together a network of patient care in the National Capital Region.

At a community forum several years ago, Suburban Hospital President Brian Gragnolati measured one of health care’s most important “vital signs” when he posed the following question to the audience of mostly retired people: “How many of you have had difficulty, or have a friend or family member who’s had difficulty, finding a primary care physician who accepts your insurance?”

More than three-quarters of the listeners raised their hands. “I was stunned,” recalls Gragnolati, now senior vice president for the Johns Hopkins Health System. “In those days I couldn’t go to a community event where people wouldn’t ask, Why can’t I find a primary care physician in the Bethesda-Chevy Chase area who accepts my insurance?”

The market wasn’t adapting to their needs, he told them, because practices couldn’t afford to bring new people in and were uncertain about the future of health care delivery. National surveys continue to confirm the trend. According to a 2011 study in Archives of Internal Medicine, only 88 percent of U.S. physicians took on private insurance patients in 2008, a decline of 5.5 percent from 2005. At the same time, only 93 percent of doctors still accepted new Medicare patients.

Now, thanks to their ongoing integration with Johns Hopkins Medicine, both Suburban and nearby Sibley Memorial Hospital can claim a growing number of primary care physicians and specialists who accept private and federal health insurance. When the D.C.-area hospitals joined the JHM family, they not only gained access to Hopkins’ academic research and clinical operations but also to its network of primary care physicians.

A primary care leader

Johns Hopkins Community Physicians (JHCP), the state’s largest primary care physician program, employs more than 370 health care providers who handle about 800,000 patient visits each year at more than 35 locations. Its recent growth in the D.C. suburbs, however, has been particularly significant, says JHCP President Steven Kravet. In 2009, the system maintained two primary care locations with less than 10 physicians in the National Capital Region, the area served by Suburban and Sibley. There are now 26 primary care physicians practicing at six primary care locations. One opened last July in downtown Bethesda and another is operating in the medical office building at Sibley.

In addition to primary care, JHCP has helped Suburban expand its base of specialists, such as vascular surgeons and cardiologists, who accept insurance. Specialists are being recruited similarly for Sibley.

“If you include our hospital-based providers—intensivists and hospitalists—we now have 60 providers in 13 different specialties in the National Capital Region,” Kravet says. This year, Community Physicians will open primary care practices in Bowie, Germantown and central D.C.—the latter an important market extension for Sibley.

“JHCP is helping to meet the community’s need for access, an employment need for physicians who don’t want to establish a private practice on their own, and the hospital’s need to have young primary care physicians who will practice for a long time and accept insurance,” says Robert Sloan, president and CEO of Sibley Memorial Hospital.

Extending help, filling gaps

In theory, each primary care physician can take care of about 2,500 patients. That means the 14 new JHCP doctors practicing in the National Capital Region can provide for roughly 45,000 patients, points out Gragnolati, who heads the Health System’s community division. He emphasizes that all new JHCP physicians, including specialists, are enhancing, not competing with, those community physicians in private practice who still work with Suburban and Sibley. However they also provide a reliable bridge to future health care delivery.

“Without having the private practices replenish themselves the way they did in the past, a community hospital can find itself one retirement away from the disaster of scrambling to find a specialist,” Gragnolati says. “JHCP physicians complement the existing base of community physicians who want to finish out their careers in private practice but who aren’t willing to take on the risk of recruiting new people.”

In addition to providing access to primary and specialty care doctors who accept insurance, the new relationship should help Suburban and Sibley reduce preventable patient readmissions—a key goal of health care reform—by strengthening their connections to outpatient care, says Robert Rothstein, vice-president of medical affairs at Suburban.

 “Running practices is not a core competency that hospitals have,” Gragnolati says. “It’s fabulous that our health system has an organization like JHCP that has such a long history of doing a great job running physician groups.”

As it expands, Community Physicians also is improving the way it delivers medical care—and getting national acclaim for it. Last year, five of its primary care sites, including one in Montgomery County, received the highest level of recognition from the National Committee for Quality Assurance for proficiency at using a patient-centered medical home model of care. (See sidebar).

Administrators at Suburban report a “pretty impressive” increase in patients who are seeing Hopkins physicians, particularly primary care providers. “Although some patients may have lost the doctors they were seeing for the past 20 years, we’ve gotten really good response and feedback from those referred to JHCP providers,” Rothstein says.

—Linell Smith