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Monday, May 11, 2015   (0 Comments)
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New model aims to curb health costs with personal care
By  Globe Staff   
Photos by Jonathan Wiggs/Globe Staff

 Rose Fiorino (left) sees nurse practitioner Gail Metcalf at least once a month.

Gail Metcalf takes her patient by the hand, leads her to the kitchen of her East Boston apartment, and helps her step onto a scale.

She checks the weight, then checks her notes. Up four pounds.

Her patient, 86-year-old Rose Fiorino, lives with lung disease and congestive heart failure. If Fiorino isn’t careful about what she eats, her body could swell with fluid, sending her to the emergency room. The last time that happened, in late 2013, Fiorino was in the hospital for a month. Metcalf is here to make sure that doesn’t happen again.

Nurse practitioner Gail Metcalf checked out Rose Fiorino’s lungs on a recent house call.

Fiorino gets her care through the Pioneer Accountable Care Organization run by Beth Israel Deaconess. For her, leaving the house is a project. Just getting down the 18 narrow stairs from her living room to the street, oxygen tank in tow, can take 15 minutes.

Plus, Fiorino hates hospitals; she finds them noisy and lonely at the same time. She would much rather stay at home, resting in her favorite recliner, surrounded by family photos,with her little dog, Elvis, at her side.

At least once a month, Fiorino gets a visit from Metcalf, her nurse practitioner. Metcalf checks her breathing, gait, oxygen levels, and, crucially, weight. When she noticed on a recent visit Fiorino’s weight had jumped four pounds, she suspected it was fluid buildup — a common side effect of congestive heart failure.

She asked Fiorino to increase her medication for a few days to remove the extra fluid. It’s a simple treatment that has helped Fiorino in the past.

"By seeing the person, I can intervene early,” Metcalf says. "I may be able to avoid an emergency room visit.”

Not all providers embrace new payment models and the changes they demand. Dr. Kosta Deligiannidis, a family physician at a UMass Memorial medical practice, said Blue Cross’s quality measures are too specific and not necessarily indicative of a patient’s health.

For example, Deligiannidis said, some of his diabetic patients don’t need a blood sugar test as often as the insurer requires. "It adds cost and waste to the system without any benefit,” he said.

But for Fiorino, the accountable care model appears to be helping. She had a respiratory infection this past winter, but regular visits from Metcalf, her nurse practitioner, allowed her to recover at home instead of in a hospital. When her little dog scratched Fiorino’s leg a few weeks later and caused a serious bleed, she again stayed home while Metcalf monitored the wound.

Fiorino doesn’t know what an accountable care organization is, or that she is part of one, but she knows she enjoys seeing her nurse practitioner in her home every few weeks.

"She’s so good,” Fiorino said, clutching Metcalf’s arm. "I’m so lucky she comes.”

Priyanka Dayal McCluskey can be reached at Follow her on Twitter @priyanka_dayal.


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