An embroidered gold insignia symbolizes the clinical care arm of the School of Medicine, now the third-largest academically affiliated practice plan in the nation, with nearly 1,200 physicians representing more than 65 subspecialties, providing world-class comprehensive care to nearly 200,000 adults and children each year.

So distinguished are its members that Best Doctors In America, 2008 lists more than 300 Washington University Physicians — almost three times more than any other group in St. Louis and more than any other physicians' group in the Midwest.

"I can't say enough about the School of Medicine and the Center for Advanced Medicine," says patient Tom Mouser. Diagnosed with Stage 4 oral cancer just over a year ago, Mouser, 61, says what could have been a grim experience turned into one of hope, thanks to the efforts of medical providers like Brian Nussenbaum, MD, associate professor of otolaryngology, and clinical nurse coordinator Diane M. Athmer, RN, CORLN. "They were wonderful — absolutely professional, positively upbeat."

Today, Mouser is cancer-free. "They told me I was going to be fine and lead a normal life. And they were right."

Stories like this exemplify the dedication to patient care that makes Washington University Physicians an outstanding health care provider.

A plan for the 21st century

Although the School of Medicine's faculty have long provided clinical care, the group's cohesive identity as Washington University Physicians came late in its history.

The School's clinical departments had been independently managed, resulting in administrative redundancies, missed opportunities for synergy, and an uneven experience for patients. Those seeing multiple specialists received separate bills from each department, and surveys showed that patients often did not realize their appointments were with faculty physicians of Washington University School of Medicine — until they received their bills.

Then, in the 1990s, the clinical department heads agreed that they, and their patients, could benefit from greater coordination of care and a stronger public identity for the School's clinical practice. At the same time, the physicians' health care reimbursements were eroding due to the growth of managed care plans and a reduction in government support. The National Institutes of Health leveled its research funding, making clinical revenue even more important to the School's overall financial health. To address these challenges, the clinical department heads developed an integrated Faculty Practice Plan.

Patients would later know it as Washington University Physicians.

Washington University Physicians: Highly trained, well-versed in current research, extensively networked with leading specialists and researchers.

The goals of this new effort were to ensure that the School of Medicine's clinical practice recognized and seized opportunities to become efficient, strategic, and even more responsive to the needs of patients, referring physicians and health care insurers.

According to James P. Crane, MD, associate vice chancellor for clinical affairs and chief executive officer of the Faculty Practice Plan, "WU Physicians allowed the School of Medicine to thrive in an increasingly competitive health care market. And, as a robust multispecialty practice, it provided a clinically diverse patient base in support of the School's teaching and research missions."

WU Physicians now serves as the nexus for charting strategic direction and coordinating clinical activities across the School's 14 clinical departments, establishing school-wide clinical practice standards and policies, enhancing patient safety, providing key administrative services and infrastructure, and advocating public health policy of benefit to the local community and beyond.

Although most of the School's patients live in the St. Louis area, many visit from outstate Missouri and Illinois. Still others come from around the world because of the renowned quality of care found here. The practice is well-known for its outstanding outcomes — examples include a high rate of organ transplant success and skillful management of congestive heart failure.

Only a small percentage of WU Physicians practice primary care. Most of its members provide subspecialty care, seeing patients who are referred by physicians in community practice.

"It's really important that we don't lose sight of where patients come from and their connection back to their primary care physicians," says Crane. "In some cases, patients are referred by their primary care physician. In other instances, the referral source may be a community specialist. When a patient comes to see us, we work hard to document and communicate with both the referring physician and the patient's primary care provider."

This can sometimes be challenging, especially if a patient is acutely ill and transferred to the Medical Center from another facility. In cases like these, full and timely communication is even more important to ensure continuity of care following hospital discharge, Crane says.

"We are partners in caring for their patients," says Crane of primary care and referring physicians. "It is important that we coordinate the care patients receive across the continuum of providers."

The science of medicine

"Washington University provides a highly collaborative environment where physicians and scientists work side by side," says R. Gilbert Jost, MD, current chair of the WU Physicians board of directors and head of the Mallinckrodt Institute of Radiology. "Consequently, some of the best physicians in the world are in a position to offer the latest developments in medical science to our patients."

Translating today's science into tomorrow's medicine is what BioMed21, the School of Medicine's multidisciplinary research imperative, is all about. By bringing together basic scientists and clinician-researchers from many different disciplines, the School can better address some of the biggest questions about disease: its origin, how it affects us as human beings, and how it can be cured.

"Our clinical practice provides an essential platform for bringing new discoveries and the latest medical innovations to the bedside," says Larry J. Shapiro, MD, executive vice chancellor for medical affairs and dean of the School of Medicine.

"It also provides a vital training ground for the next generation of health care professionals," says Shapiro. "The strength of our clinical practice and of our affiliated hospitals — Barnes-Jewish and St. Louis Children's — and the quality of our clinical instruction, are leading reasons why we attract the highest-ranking medical students and top residents."

In addition to scientific advancements, WU Physicians continually strive to enhance all aspects of the patient care experience. But measurement of health care quality is an evolving science. Although hard quantitative data — such as outcome statistics — tell much of the story, "softer" qualitative data can be equally important in guiding improvements. One such qualitative measure is patient feedback.

Patients are randomly surveyed to rate their experience on 16 dimensions of care, including the respect and compassion shown by WU Physicians and staff, the thoroughness and communication skills of their provider, and how well the patient's health concerns are addressed.

"Clear communication is vital," says Crane, speaking as an experienced clinician who still sees patients in addition to his administrative role. "If patients don't understand their illness or the recommended treatment, it's less likely they're going to be compliant and have a better outcome and healthier life."

Nearly 34,000 patients were surveyed last year, says Kelley A. Mullen, RN, senior director of clinical operations. Mullen's staff monitors all responses and follows up when warranted. In addition to responding to survey questions, many patients comment on the outstanding care they receive and praise individual members of the health care team for their compassion, assistance and reassurance amidst an otherwise stressful time in their lives.

Survey data are compiled and sent to physicians and clinical support staff, business managers, division chiefs and department heads. Individual faculty physicians are given information on how well they compare to their peers within a subspecialty in seven key areas, including communication skills and overall patient satisfaction.

"Our mission is to improve the health of people in the community through excellence in patient care and medical discovery," says Stephanie A. Weisenborn, RN, service quality coordinator. "It's not just a lofty statement; we live and breathe it every day."

To foster a service culture, WU Physicians offers ongoing customer service classes, as well as "service boosters" if a practice notes a particular trend on which they need to focus.

"Our goal is to create an ideal care experience and to 'exceed' patient expectations," says Crane. "Our faculty physicians and the clinical support staff are incredibly dedicated to their patients and strive for continual improvement. Patient feedback and benchmark information are important gauges of how well we are doing. Our patient advocation scores are best-in-class and show consistent and statistically significant improvement every year."

While patient perception of WU Physicians is crucial, having an effective business model is also essential to success.

"There are always opportunities to improve the efficiency and quality of patient care," says Crane. "For example, we have put in place sophisticated information systems to reduce costs and ensure more consistent revenue flow. We also have invested several million dollars developing an integrated electronic medical record system for our patients. This technology enhances the quality of care we provide, reduces the risk of medical errors, improves faculty and staff productivity, and facilitates timely communication with referring physicians."

Electronic medical records allow physicians to track and monitor outcomes and to establish best practices.

"For certain chronic diseases, such as diabetes or heart disease, there's good evidence in the peer-reviewed literature as to what is the best way of managing those conditions," says Crane. "The ability to retrieve and analyze clinical data from our electronic medical record system is an important quality assurance tool and ensures that we are consistently practicing evidence-based medicine and optimizing patient care."

Facing the challenges ahead

Economic realities are reshaping the health care landscape.

Changes in Medicaid and employer-sponsored insurance benefits mean less coverage, especially for the most vulnerable populations in the community. Crane worries about the ability of those groups to obtain proper care.

"We have about 350,000 people in St. Louis city and county who either are uninsured or underinsured," Crane says, "and that number is growing. The majority of uninsured people in the city and county have jobs; they just don't have jobs that come with health insurance. That's a worry for us, not just for the faculty practice and the School of Medicine, but for the community as a whole."

Even people who have insurance now pay higher out-of-pocket expenses, which can lead to them delaying care, particularly preventive care measures.

"The earlier you can prevent and diagnose disease, the more you can do to preserve health status and ensure better health outcomes," says Crane. "Prevention also results in lower health care costs, by reducing the high expense of treating advanced disease."

For the faculty and staff who make up WU Physicians, the main focus is and will remain the patients. "I want people to know how committed and passionate our faculty and support staff are," Crane says. "We are fortunate to have such talented people here who are dedicated to providing world-class care. It's not just their job. It's their mission."