The following article first appeared in The Arlington Advocate on August 19, 2004. To return to the list of In the Press articles, click here.

Practice is a Renaissance: New Medical Office Works Proactively

By Brooke Leister

Like the name of their primary care practice implies, doctors Rushika Fernandopulle and Pranav Kothari believe it's time for an overhaul of the health-care system.

Their new Arlington practice, Renaissance Health, seeks to do just that. The physicians believe so strongly in their new health-care model, which encourages patients to take an active role in their treatment and care, they are not taking salary until the business nets a profit.

"We are fed up with the fact that we knew there's a better way to do it and no one's doing it," said Fernandopulle of Medford. "We want to prove that if a small practice can do it, you can do it."

Dr. Amy Schoenbaum, formerly of Brigham & Women's Physician's Group in Chestnut Hill, is the third member of the practice. Schoenbaum and Rushika treat patients, while Kothari handles the business end. They hope to build a practice with 1,000 patients per doctor.

As soon as one walks through the door of the Massachusetts Avenue practice, it's clear it isn't an ordinary doctor's office. Instead of a receptionist greeting you, there are inviting couches and a café table. The goal was to create a homey feel so patients feel at ease.

Patients are typically greeted by their doctors and offered drinks and fruit before heading into exam rooms, featuring warm colors on the walls and natural wood floors. The rooms also offer comfortable chairs so patient and doctor can talk more naturally.

"We examine them, have them dress and the rest of the time is the human exam," said Kothari of Newton. "We sit on chairs and talk to them."

The practice is primarily paperless as the doctors do not keep paper charts, rather they opt to do their work electronically. Instead of carrying records via a standard folder, the doctors carry wireless electronic tablets connected to the practice's main server. They can also connect to the main server at home.

Patients have full access to their medical records. The doctors also encourage patients to e-mail them with any questions or concerns. Often a simple question such as, "If I want to take a trip to Thailand, do I need a shot?" can be answered via e-mail - saving the patient and doctor a phone call, or two.

"Our job is to help you maximize your health and not just be reactive," said Fernandopulle, 37. "When you do need us, we believe it's important for you to reach us. Patients get our direct office number, which forwards to our cell phones."

The proactive approach includes placing patients on a regular review cycle, depending on their particular diagnosis and demographics. The doctors regularly review the conditions and charts and contact patients if they feel a change should be made.

Because everything is stored in a main database, the doctors can easily perform cross-reference searches. For example, if a new study changes the average for women's cholesterol levels, they can do a quick search and identify patients who fall above the new range.

By taking this proactive approach, patients can enjoy the peace of mind that their physicians are looking out for them, even when they may not be aware if anything is amiss.

Of course, this all comes with a price.

While Renaissance Health accepts insurance, patients must pay a monthly $40 fee. The practice is designed to encourage patients to be proactive in regards to their health, which should eventually lead to fewer medical visits and reduced costs.

With strategic health visits, the doctors will examine their patients' health on a deeper level.

"It takes as long as it takes," said Kothari, 30. "We send out a packet in advance and say here are some questions we'd like you to answer and here's what we'd like to talk about."

Fernandopulle added, "The goal is to develop a plan... Most practices are reactive. Unless you walk in the door, they don't know you exist."

The idea for the practice grew out of The Harvard Interfaculty Program for Health Systems Improvement, a program started at Harvard University's president's level to tackle big health-care issues.

"Despite all of the great technology we have, the actual way we deliver medicine has not changed in 50 years," Fernandopulle said. "We decided to try and innovate that.

"People recognize it as a problem, but the way they try to fix it is really an incremental approach... We decided, 'Why don't we change everything?' We want a new model. The best way to do that is to start from scratch."

To begin their practice, they decided to gain insight from various models around the world.

"A year ago, we convinced ourselves that there was a much better way to do it," Fernandopulle said. "The typical response is to publish it, which we are, but also to build it."

Kothari agreed.

"The model as it is today is an innovative primary care model. It starts and ends with relationships with our patients," he said.

When Schoenbaum worked at Brigham & Women's Hospital, her patient roster totaled 3,000. The Brookline resident is looking forward to being in closer contact with her patients at Renaissance.

"I was getting frustrated working for a big hospital practice... I felt like we were almost putting up this wall between me and the patients," she said. "Because I was seeing so many patients, it was very hard for me to call them back."

At her new office, she has heard her patients comment about the homey and inviting feel.

"It is much friendlier and homier and it definitely does foster that. People can feel closer to their doctor and foster a relationship," said Schoenbaum, 36.

At Renaissance Health, the doctors plan to host seminars and discussion groups in the central, glassed-in room, featuring an inviting dark wood dining table and local pottery adorning the shelves along the back wall.

"We think people, particularly with chronic illnesses like diabetes, there's a lot you need to know. If we get 10 people together in a group, you not only learn from me, but you can learn from them," Fernandopulle said.

 

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