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26 PATIENT SATISFACTION New recovery protocol, robot expand spine care at Marcus Neuroscience Institute By Alan Condon N eurosurgeons at Marcus Neuroscience Institute in Boca Raton, Fla., com- pleted the center's first spine surgery using the enhanced recovery after surgery protocol in June. Brian Snelling, MD, and Timothy Miller, MD, the institute's director of functional neurosurgery, fused 10 vertebrae during a six-hour complex spine procedure. The enhanced recovery after surgery protocol takes a multidisciplinary approach to achieve optimal outcomes through extensive planning, testing, pain manage- ment and follow-up. "It's a comprehensive start-to-finish checklist that is followed from the time the surgery is booked," Dr. Miller said. Preoperative imaging revealed that the patient had debilitating issues with the curvature of his spine, misalignment with his hips and posture and severe de- generative disc disease, so advanced planning for this spine surgery was critical, according to Dr. Miller. "At the time of surgery, there [are] additional things we do, such as giving pain medication preoperatively or using medication to help control bleeding," he said. "Postoperatively, we have an advanced, evidence-based pain management regimen that is not heavy on narcotics, so patients are more alert, get out of bed sooner and can be ready for discharge earlier." Marcus Neuroscience Institute is expanding its spine program, which recently added Medtronic's Mazor X robot. Dr. Miller performed the institute's first ro- botic spine surgery with Frank Vrionis, MD, in March. n St. Louis Heart & Vascular teams with concierge provider to up patient experience By Ariana Portalatin S aint Louis Heart and Vascular bolstered its practice by adding the Con- cierge Choice Physicians' Hybrid Choice program this year. The program allows patients to personalize their care based on their needs, providing additional access to physician availability, medical advocacy and a more personal doctor/patient relationship. For example, patients being treated for more complex cardiovascular diseases and conditions can ask for more time with their physician, while patients receiv- ing more episodic care or who don't need enhanced treatment care can be seen in a more traditional way. Additional options include same-day/next-day appointments, little-to-no wait times, access to cardiologists after hours and a more comprehensive annual ex- amination. The program is available to patients by paying an annual membership fee. Saint Louis Heart and Vascular has six practice locations in St. Louis, St. Charles and Bridgeton, Mo., and Granite City, Ill. Concierge Choice Physicians, based in Rochester, N.Y., offers medical care programs and has worked with nearly 500 physicians in 29 states. n Medicare Advantage plans don't significantly improve care, experiences: study By Nick Moran A recent Commonwealth Fund study found that Medicare Advantage and traditional Medicare enrollees have comparable healthcare experiences and concerns about costs. The study found that enrollees on the two types of plans did not differ in terms of age, income, chronic condi- tions or Part D subsidy eligibility, according to the Oct. 14 study, which excluded special needs plan members from its findings to adjust for expected variance. The only demographic difference was the likelihood that traditional Medicare beneficiaries lived in metropolitan areas or in long-term care facilities. When including special needs plan members, Medicare Advantage plans included higher percentages of Black and His- panic members compared to traditional Medicare plans. Similarly, both Medicare Advantage (7 percent) and traditional Medicare beneficiaries (5 percent) reported dif- ficulty getting healthcare. Wait times at hospitals and primary care facilities were similar between both camps. Reasons for both types of enrollees included high costs, a lack of coverage, physicians not treating or being too busy to treat an ailment, or specialist referral issues. The only hurdle that affected traditional Medicare patients more was access to transportation. Ultimately, satisfaction with both types of coverage was within one percentage point across five aspects of care.