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Quality & Practice

Innovative Models of Care Delivery

Michael Hatzakis, Jr., MD

Physiatrists in Practi​ce: Unique Delivery Models of Patient Care for the Future

AAPM&R’s Public and Professional Awareness Committee is seeking AAPM&R members who are involved in unique or innovative health care delivery models who would be willing to share their experiences. An innovative delivery model offers an improved patient experience, improved outcomes or quality, or decreased cost. The committee will use the information to document the value and diversity of the specialty of PM&R. It will help AAPM&R position the specialty within the future of the changing health care environment. . As the committee catalogs the different ways AAPM&R members are practicing, it will be shared with Academy members as a resource for those considering a transition to a new practice model. If you’ve missed any of the previous interviews, find them here.

In the months ahead, the committee will share some of the member stories it collects in The Physiatrist. This month, the focus is on a unique practice model developed by Michael Hatzakis, Jr., MD.

Q: What is your specific model of care?
A: We have successfully revived the coordinated, multidisciplinary physiatric care model well studied for many years. The novel aspect of this model, in our clinic, is that we have accomplished this in a financially viable, small clinic environment, focused on quality of care and health promotion. Under one tightly coordinated practice environment, we have a physical therapy department, two physiatrists (adding one to two additional within the next three to six months), three massage therapists, a registered dietitian, a psychologist, and an athletic fitness trainer. We also employ a highly automated electronic medical record (EMR) system that not only allows us better cost efficiency, but permits new and novel methods of care coordination.

There are three notable strengths to our clinic philosophy. One, the model draws from the improvement in quality of care derived from a coordinated, multidisciplinary team approach. The second strength is based on a system of care that is devoted to a full spectrum of rehabilitation care, from restoration of function after a disabling injury to improvement of overall functioning through exercise, diet changes, and mental health promotion to injury and disability prevention. The third strength is in the quality of our communication. Our team works effectively together through regular team didactics as well as an in-house electronic communication system built into our EMR to facilitate constant coordination of care.

Once a person has engaged in an effective therapeutic rehabilitation program, we start working with them on improving overall health status through exercise, weight loss, smoking cessation, and formulation of health and fitness goals.

Q: How do you deliver physiatric care differently than most physiatrists?
A: In the state of Washington, there are few facilities that offer such coordination of physiatric care alongside physical therapy, massage, and psychology as well as other disciplines in a setting that is not a “formal pain management” clinic or an academic facility. Many of the conventional multidisciplinary rehab clinics have either closed due to the inability to be financially viable or have moved toward a procedure-based care model. Our model is continuously moving toward a comprehensive care model from severe disability and injury rehabilitation that require procedures or possibly surgery to health promotion, injury prevention, and achieving optimal fitness goals.

Q: How does your model lead to specific changes in the overall delivery system of health care?
A: While we offer all conventional interventions, our clinic focus is primarily on rehabilitation and improvement of health conditions and on training individuals to take personal responsibility for their health. We have optimized our care model based on improved fitness, weight loss, smoking cessation, and psychological well-being, which have all been shown to reduce long-term utilization of opioids and emergency room admissions as well as surgery.

Q: How and why did you get involved with this model/how did you successfully implement this model? How long did it take to implement this model?
A: While an academic professor at the University of Washington, I was the medical director of both an acute rehab unit and director and founder of a subacute rehabilitation unit as well as a cofounder of a multiple sclerosis Center of Excellence, and it was here that I appreciated the power of the multidisciplinary care approach. After moving to private practice—like the vast majority of physiatrists in my area (except for specialized environments)—I worked solo with only loose coordination with therapists who were often too far removed for effective coordination of care. For more complex patients, or those with multifaceted needs, I felt my care was not optimal. I then moved to a new office and hired a physical therapist, and over time, we added disciplines that were pivotal to effective rehabilitation management of patients with complex injuries.

Our team has been developing over the last five years, and we continue to grow, adding dimensions of care that helps to optimize long-term outcomes. However, we want the focus of our clinic to be on conservative care and not interventional care, as we feel this will position ourselves best if we join an accountable care organization-type network in the future that offers high-quality/cost outcomes.

Q: How has this model impacted patient care, satisfaction, outcomes, and cost and time savings?
A: Regular feedback both in terms of surveys and anecdotal feedback from patients and referring physicians says that the most valuable aspects of our clinical environment are the full spectrum of care offered by providers who offer many aspects of a patient’s needs. Patients truly appreciate working with providers who are in close communication with one another. Some of the most common complaints I hear from patients is that their providers do not communicate with one another and do not coordinate well and that they do not have ready access to health information whether it be when they call or when referred to another physician. Patients also tell us that they appreciate that our clinic considers their entire spectrum of health, from diet to mental health to disease or injury prevention, and not just drugs or procedures.

We are currently implementing both cost and clinical outcome tracking methods through our EMR and clinical databases. We have built an Oswestry variant outcome scale into our EMR that can be imbedded into our underlying database. This can be segregated by diagnoses and time to achieving a desired outcome, and as such, a cost per unit of improvement can be derived.

We are in the midst of implementing a cost-quality metric. Our EMR allows us to track the in-house costs of care, and every occurrence of referral outside to a magnetic resonance imaging or procedure. As such, we can create a model of cost/quality as discussed above.

If you are involved in a unique practice model, please share your story with AAPM&R. Email pracmod@aapmr.org, and an Academy staff member will contact you. ​​​​​