Michael Mello comes to a Kaiser Permanente facility in San Rafael where the medical team knows his name.

He goes to the Ambulatory Treatment Center to receive diuretics for reducing the swelling in his legs caused by liver cirrhosis.

On the second floor of the Kaiser Permanente San Rafael Park Medical Offices, the center includes a check-in area, 2 private rooms, and 5 treatment bays where hospital-based physicians oversee short-term treatments, such as IV diuretics, IV antibiotics, or infusions. Daily treatment plans are developed based on clinical evaluation, diagnostic testing, and lab work.

“The care is excellent,” said the San Rafael resident. “I’ve gotten to know the caregivers, and they made a point of knowing my name.”

The best part? After treatment, the retired professor returns to his childhood home to enjoy his garden of roses and fruit trees.

Mello’s outpatient experience at the center is a new approach stemming from Kaiser Permanente Northern California’s multifaceted senior care strategy. The strategy outlines care approaches aimed at addressing the myriad needs of aging patients.

In addition to San Rafael, ambulatory treatment centers exist in San Francisco, San Jose, and 12 other locations across Northern California.

The centers serve patients who are stable enough to be discharged from the hospital or emergency room and would rather complete treatment in this outpatient setting. Patients who are struggling to manage their condition are also referred to the center.  

Giving patients choices

This new model of care boasts numerous benefits, said Vivian Reyes, MD, associate executive medical director of The Permanente Medical Group and an executive sponsor of the senior care strategy.

“It’s generally better not to be in the hospital longer than you have to,” Dr. Reyes said. “Many people would rather be at home surrounded by family, where they can sleep better, and generally heal faster.”

Since these centers launched in spring 2024, about 2,000 Emergency Department visits have been avoided, hospital days have been reduced by about 9,000, and hospital readmissions within 30 days of discharge have declined by hundreds.

Dr. Reyes acknowledged that ambulatory treatment centers are not for everyone. Some patients and their families might find it easier to receive care in the hospital.

“It’s not one-size-fits-all,” Dr. Reyes said. “But people should have different options of care, and these centers are giving people additional choices.”

San Rafael is home to the region’s first Ambulatory Treatment Center.

“The Ambulatory Treatment Center is a new way of caring for our members, and this required collaboration and education with providers across the entire medical center,” said Alexandra Wen, DO, chief of the hospital-based specialists, who oversees the San Rafael location.. “We are finding that patients are much more relaxed compared to the hospital setting, and consequently patients are better able to absorb medical information to help them understand their disease process. The impact is invaluable, which provides great patient and physician satisfaction.”

Heart failure is the most common condition among Ambulatory Treatment Center patients, who are largely 65 and older. With heart failure, patients can develop shortness of breath and water retention, which may require IV diuretics to remove excess fluid.

Itamar Bikszer, RN, associate chief administrative officer at Kaiser Permanente in San Rafael, said the organization’s integrated care model makes this outpatient program possible.

“We talk to specialists as needed,” Bikszer said. “It’s a different setting, but the same high-quality care.”

Mello appreciated that he had this option. He was in the Emergency Department and then in the hospital for 10 days before coming to the Ambulatory Treatment Center.

“I can come here and go home,” he said. “I’m very happy with that arrangement.”