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Family practice to take over congestive heart failure program

WILLMAR -- Family Practice Medical Center is launching a congestive heart failure program to fill the gap left last month when Rice Memorial Hospital dropped its outpatient congestive heart failure clinic.

The new initiative will be modeled after the hospital's program, which provided intensive education and day-to-day management for people with congestive heart failure. The family practice clinic has even hired the same clinical nurse specialist, Aimee TeBrake, to manage the program.

TeBrake has already started seeing a handful of patients.

"We've had people calling in and scheduling appointments," she said.

The hospital's heart failure clinic and its outpatient Diabetes and Nutrition Center both closed last month as part of $3 million in budget cuts by the city-owned hospital. Nearly 500 patients -- 90 in the heart failure clinic and 390 in the diabetes program -- were directly affected.

Within days, local medical clinics began developing alternatives for diabetes care.

Addressing the gap in congestive heart failure management was slower to come, however.

Physicians and clinical leaders at Family Practice Medical Center feared that once Rice's congestive heart failure program was gone, these patients would be left with unmet needs, said Dr. Drew Hoffman, a family practice doctor at the clinic.

"We know this is a good service. It's helping people," he said. "The fear was that their quality of life would be worse without it."

Patients with congestive heart failure tend to be complex. They're typically older, on multiple prescription medications and often have extra conditions such as diabetes or kidney disease. They frequently need close attention in order to prevent complications and avoid costly hospitalization, TeBrake said.

"Education is a major component of managing this," she said. "That takes time to look at barriers and to start knocking some of them down and helping patients to self-manage."

Hoffman said the family practice clinic could have absorbed most of this, but the barrier was time.

"It's just that we have so many other things that need to be done," he said.

By creating a new initiative to bridge the gap for these patients, it can be "a win-win situation" that improves patient care as well as supports physician practice, Hoffman said.

"There certainly was an unserved population out there which created a gap," said Stacey Zondervan, patient services director for Family Practice Medical Center. "We looked at this as an opportunity to bring that service within our four walls."

More than that, Family Practice Medical Center hopes it will be the starting point for an expanded emphasis on the whole range of cardiovascular care.

The clinic already was exploring the expansion of cardiovascular care when the chance came along to pick up the heart failure program that the hospital was dropping, Hoffman said.

The timing is especially favorable for Family Practice Medical Center to increase its stake in prevention and chronic disease management, he said.

First, there's new state legislation aimed at the development of "medical homes" and improved coordination of care, he said.

Second, the clinic's electronic medical record system has significantly improved its ability to identify specific patient populations, track how they're doing and adopt strategies shown to lead to better outcomes -- more consistent prescribing of beta blockers, for instance.

"The goal is really to show and prove we can make people's lives better," Hoffman said.

Officials with the family practice clinic aren't sure whether they'll be able to avoid the financial losses -- mainly due to inadequate reimbursement -- that led to Rice Hospital's decision to drop the program.

Hoffman said officials think they can make it cost-effective.

"Is it going to work? We don't know," he said. "But the goal always has been to put patients first."

TeBrake said some aspects of the program will have to be redesigned.

"We are exploring options within a model that may be somewhat different," she said.

The program will remain physician-directed and nurse-managed, however. It'll also be open -- no referral necessary -- to any patient with congestive heart failure, regardless of who their primary care doctor is.

Hoffman said they'd like to re-enroll all the program's former patients and pick up new patients as well.

Zondervan said the clinic is eager about the program's potential.

"Truly this is an opportunity for Family Practice Medical Center to expand the type of care they do. I feel excited and happy that we're doing something about it," she said.