Becker's Hospital Review

Service Line Leaders' Roundtable 22 Debbie Spielman Dr. Colavita: One attempt to overcome challenges is to create a community — a community of providers. If someone has heart failure, we should try and ensure that their care is uniform, whether they go to a primary care physician or a specialist or come to the hospital. The care should be similar and evidence-based. Ms. Bringardner: Recognizing that we are evolving, we are challenged to be patient as our teams learn new skill sets. A stronger emphasis on sharing best practices so time is not wasted on initiatives, which ultimately, will not add value, is needed. Leveraging the talent of our team members to design innovative, streamlined approaches to transform the way we provide care is essential. Strong data systems and analytics are foundational elements. Q: What advice do you have for service line leaders for the coming year? Dr. Colavita: My advice for them is to listen to all the members of their team and formulate plans with input from all those members. Dr. Stys: My advice would be to definitely stay on top of the newest and latest developments. This is a very rapidly developing field. Also, they should try to secure interdisciplinary collaboration at the institution. We have to work as a team rather than as individual care providers. Neurology Q: What are some of the biggest developments or opportunities for growth in the neurology service line in the coming year? Debbie Spielman, Assistant Vice President, Florida Hospital Neuroscience Institute (Orlando): For us particularly, the biggest development will be the expansion of our pediatric epilepsy program into an adult program. This program is designed for patients who are not responding to medication for their seizures and includes very comprehensive, integrated, diagnostic technology including a PET/EEG, fMRI, MEG and cEEG to determine if a surgical approach is indicated. Along similar lines, we have also invested Kim Springer, MSW in our neurodiagnostic infrastructure by including continuous EEG technology in our 40-bed neuro critical care unit. This allows us to detect sub-clinical seizure activity in our neuro critical care patients. Kim Springer, MSW, Executive Director of St. Vincent Neuroscience Institute at St. Vincent Indianapolis Hospital: Within neuroscience, as is true with all service lines, the most pronounced opportunity lies in responding to our changing healthcare environment. At St. Vincent, we specifically recognize the opportunity to strengthen physician alignment strategies to better respond to changing patient populations, physician availability, reimbursement models and technological advances. Programmatically, this year will provide the opportunity to enhance our stroke system of care through the development of a statewide telestroke strategy. We will also see growth in the areas of epilepsy/ seizure, spine care, neurovascular surgery and neuro-oncology, as well as trauma services and pediatric support. Q: What are some of the newest technologies or applications that are being used in the neurology service line? Ms. Spielman: Continuous EEG is one new technology which we have integrated with other neuro monitoring for better care of our most critical patients. We are also investigating the NeuroBlate, which is a minimally invasive laser approach to inoperable brain tumors and lesions. It utilizes our intra-operative MRI technology for guidance. For our brain attack program, we are using the Solitaire and the Trevo, both of which are clot retrieval devices utilized in interventional neuroradiology for stroke patients beyond the window for tPA. David Houghton, MD, MPH, Vice Chairman of Clinical Development and Division Chief of Movement and Memory Disorders, Ochsner Neuroscience Institute (New Orleans): Teleneurology and that remote ability to manage patients is number one on the list. We are well-established in its application for stroke, and we are expanding it quickly to all aspects of neuroscience. We are also using more functional brain imaging, including DaTSCAN, which is a David Houghton, MD, MPH David Charles, MD technology that helps in the differential diagnosis of tremor disorders such as Parkinson's disease. Q: What are some of the challenges currently facing the neurology service line? David Charles, MD, CMO, Vanderbilt Neuroscience Institute at Vanderbilt University Medical Center (Nashville, Tenn.): Payors are reluctant to pay for new technologies that are expensive. In neuro, we have a range of new technologies in different areas, but it is happening at a time when there is huge pressure to reduce healthcare costs. Ms. Spielman: Probably standardization of care. That's probably a real challenging one that we are going to have to start tackling as it relates to spine disorders as well as many other neurorelated conditions. The challenge within that is bringing our physicians together to be a part of this process and endorse standardization in the areas where the evidence supports it. Dr. Houghton: The number one challenge, regionally and nationally, is the financial pressure being brought on by the reimbursement models of Medicare, Medicaid and the commercial insurance companies. Q: How would you recommend overcoming some of the challenges facing the neurology service line?

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