Nedd Works For Avoidance Needs

July 13, 2007
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The Hospitalist Is
An Advocate For
At-Risk Groups

During Dr. Khan Nedd’s formative years, his mother, Wapel, was a social worker and reluctant politician in his native Grenada, and it was from her that he learned about service. As a child, Nedd accompanied his mother on house calls across that Caribbean island to work with impoverished families on behalf of the Save the Children organization.

It is ironic that the physician, a Michigan resident for nearly three decades, has become renowned locally for his service on behalf of the indigent, homeless and minorities, yet in his practice he does not make house calls. In fact, Nedd’s specialty is the polar opposite of a primary care physician, focusing on the acute care that occurs within a hospital setting.

“The reality is that physicians who take care of their patients on the outpatient side are very good at it,” explained Nedd, who is the president of Hospitalists of West Michigan. “However, their ability to spend time with patients in a hospital is reserved for early mornings, or before or after office hours. This is not the most effective and cost-efficient way to manage care.”

Nedd was an early adopter of the “hospitalist” model, a term coined in a 1996 New England Journal of Medicine article referring to physicians whose practice emphasized providing care for hospitalized patients.

The general idea is that a group of internists dedicated to a hospital can be more effective and efficient than primary care physicians visiting patients as time allows. It is by far the fastest growing area of medicine today. According to the 10-year-old Society of Hospital Medicine, the number of U.S. hospitalists has increased from an estimated 300 in 1995 to over 20,000 today.

As routine health care increasingly evolves toward the outpatient environment, the cases served by hospitals are becoming comparatively more serious. These are patients who are undergoing surgery or other complicated medical procedures, are being treated for a serious injury or illness, or are dying. By its nature, hospital medicine meets patients’ needs when other avenues of care and prevention have been exhausted, and that is a grave concern for Nedd and his partners.

“What is interesting about medicine is that the whole design, even in drugs, is to treat diseases,” Nedd said. “We have the ability to identify patients who are at risk for certain diseases. We even have the drugs to treat individuals who don’t yet have the diagnosis. The problem is that there isn’t a great deal of reimbursement for identifying those individuals and how to treat them, so the focus has been on people who already have the disease and how to manage them. … The efforts should be continuously moving upstream.”

The 13 doctors and 27 physician assistants at HOWM recognized that they could help the hospitals they partnered with achieve significant cost improvements by attacking areas where preventive and alternative care could head off the need for hospital care. For-profit initiatives that have emerged from their efforts include Infusion Associates, a Grand Rapids-based regional practice that allows for ambulatory patients to receive IV treatment in an outpatient setting, and an addiction center developed in cooperation with Pine Rest Christian Mental Health Services.

“With both of these, we saw a fair amount of patients that were in a hospital for a long time, and often for issues for which they didn’t need to be in the hospital,” Nedd said.

On the addiction side, the patients saw frequent, repeated use of emergency room care for conditions that were actually symptoms of an underlying psychiatric or addiction condition. Yet prior to the Pine Rest service, run by Dr. Bruce Springer, an addiction specialist, the availability of treatment for the root problem was scarcely available.

The group of hospitalists also led efforts to centrally manage the care of indigent patients as they entered the hospital system. Indigent patients — ranging from the homeless to anyone without medical insurance — are also repetitive users of emergency care, primarily because they do not receive the follow-up care normally be administered by a primary care physician. The hospitalists “closed that circle” by assuming responsibility for follow-up care in partnership with Kent County’s public health clinics.

The avoidance initiatives parallel Nedd’s efforts in the nonprofit sector, where he is the region’s foremost advocate for African-American health.

“There are overwhelming disparities in health care, especially for African-Americans,” Nedd said. “When you look at almost any disease entity — whether it’s infant mortality, dementia, cardiovascular — it’s overwhelming how much worse African-Americans do.”

According to the Center for Disease Control, the age-adjusted death rate for cancer was 25.4 percent higher for African-Americans than white Americans. The diabetes age-adjusted death rate and the infant mortality rate was more than twice that of the white population. The U.S. Department of Health and Human Services found that African-American men were 30 percent more likely than non-Hispanic whites to die of heart disease.

Worse yet, critical illnesses among the African-American population tend to emerge as a result of chronic conditions that could be routinely treated. Congestive heart failure is a prime example: Roughly 60 percent to 80 percent of heart attacks among white Americans are caused by coronary artery disease. The same percentage among African-Americans is caused by high blood pressure.

As early as the 1960s, studies have shown the existence of an entirely separate health care system for African-Americans. Not only has that not changed in the nearly half-century since, Nedd said, the disparity grows with each medical advance missed by the African-American community.

“A lot of the energy has been spent on access, but access is not the same thing as meaningful participation,” Nedd said. “Everyone knows how to access the health care system through the ER. The problem is finding the barriers that keep patients from participating.”

For historical and cultural reasons, the African-American community often chooses not to interface with medical infrastructure. Health care has traditionally been a luxury for African-Americans, something not thought about until an illness occurs.

“When you’d ask an African-American if they’d gone to the doctor recently, you would hear, ‘I’m not sick,’” Nedd said. “We are less tied to the concept of preventative care. And we are less tied to the management of chronic disease: It’s ‘How long do I have to take these pills?’”

In addition, there is a general distrust of health care providers by many African-Americans, and for good reason: The Tuskegee Study, which tested the effects of untreated syphilis on African-Americans, concluded barely 35 years ago. According to U.S. Census data, African-Americans represent less than 1 percent of health care professionals.

Through the Grand Rapids Urban League, Nedd drew attention to the disparity issue on a local level.

“One of the things that came out of that was that we needed a fixed point in the community to make sure that the question of disparity — racial disparity — is always in our minds,” said Lody Zwarensteyn, president of the local health care advocacy group Alliance For Health.

In 2003, the Grand Rapids African American Health Institute was launched in Grand Valley State University’s recently constructed Cook-DeVos Center of Health Professionals, right in the midst of Michigan Street’s “Medical Mile.” Nedd serves as the institute’s medical director and chairperson.

“This was really his brainchild,” said Kevin Rose, GRAAHI executive director. “A lot of the things we’ve done programming-wise are through his efforts.”

Over the past three years, the group has reached thousands of African-Americans through churches, schools and community groups with educational programs concerning heart disease, diabetes and general health. It has worked to educate doctors on the issues facing the African-American community, and recently completed a comprehensive study of cardiovascular health of the African-American population in West Michigan. Plans for an inner-city diabetes center are also underway.

Outside of GRAAHI, Nedd has been an advocate of this issue as a board member of Spectrum Health, the Alliance For Health, the West Michigan Physicians Network, and the Pharmacy and Therapeutics Committee of the Michigan Department of Community Health, through which he drove the acceptance of combined drug agents for state reimbursement.

Nedd first came to Michigan when he was 16 to attend Andrews University in Berrien Springs, the flagship college of the Seventh-Day Adventist Church. The first time he saw snow was the blizzard of 1977. After graduation from college, he taught high school for a year in Florida, and then he remembered his calling. He had lost a younger brother a decade before, on the night before the child was to have been flown to the U.S. for medical care. The experience propelled both of the elder Nedd brothers into medicine.

“It was a real puzzling time for all of us. In retrospect, we think he died from lymphoma, but nobody knew what was going on at the time.”

He attended medical school at Michigan State University. For his residency, he selected what was then a most sought-after destination: the Grand Rapids program operated jointly by Blodgett Hospital and Saint Mary’s Hospital. He later joined the staff at Blodgett, where he practiced until the merger with Butterworth Hospital that created Spectrum Health in 1997. He continues to practice there through HOWM.

Nedd is the lead investor in Spectrum Health’s new Wilson Avenue facility near the M-6 highway in Wyoming — an effort, he said, to provide new revenue sources for the 100 physicians who have partnered with him on the real estate venture. Now 47, Nedd lives in Grand Rapids with his wife, Eliza, a West Michigan native, and their three children: Michael, Noah and Olivia.     HQ

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