March 18, 2002
courtesy of The Post

CONTACT: Tom Rosenberger, APR, Communications Department (513) 569-5260
CONTACT: Cindy Starr, MSJ, Communications Department (513) 584-2214

'Virtual medicine' a literal boon

The Mayfield Clinic & Spine Institute has put a dent in Greater Cincinnati's shortage of neurosurgeons with a new ''virtual medicine'' treatment path for patients with spine problems.

Spine patients referred to Mayfield by a primary care physician see a neurosurgeon face to face only after they have been screened by telephone and the surgeon has reviewed their cases.

The procedure, dubbed Priority Consult, has slashed the number of spine patients who actually see a neuro-surgeon, has enabled earlier treatment for non-surgical patients and has halved the waiting period for those who really do need a neurosurgeon's care.

Some patients, launched on an alternate treatment path of physical therapy and/or medication, are feeling better in the six to eight weeks they would have spent waiting for their first doctor's visit, Mayfield officials say. Conversely, patients with serious problems are flagged immediately and brought in for treatment.

''We're not seeing patients, but we see their test results, or plain X-ray films or MRI,'' said Dr. Bradley Mullen, a neurosurgeon at Mayfield's Northern Kentucky office. ''It's virtual medicine, it's where we're going, and we're really excited and happy with the results.''

Mullen said he and other doctors were initially skeptical as to whether patients would accept recommendations for treatment without seeing a physician.

''But I found that ultimately patients seemed to like the fact that instead of waiting six to eight weeks, they were able to start getting some care,'' Mullen said. Jon Marie Hautz, a senior health-care consultant at William M. Mercer Inc., praised the program as a vehicle for ensuring access for those who need it. ''If we think there are not enough physicians to go around, then these are precisely the measures we need.''

But she cautioned that excellent screening would be needed because patients do not always represent their symptoms accurately.

''It would take a very, very skilled interviewer to leave enough room for people to describe what's going on without being seen,'' she said.

After testing the program for several months with three surgeons, Mayfield made a complete conversion last October.

The program, the brainchild of Mayfield CEO Michael Gilligan, has enabled Mayfield, which employs 14 of the area's 21 neurosurgeons, to increase its case load by 35 percent.

The total number of surgeries has also increased, Gilligan said, because more patients are being processed, but the percentage of patients undergoing surgery has not changed. For those who need to see a neurosurgeon, the average wait has dropped from four to eight weeks to fewer than three weeks.

Clinical program coordinator Theresa Greenwald said a 24-year-old patient who began losing feeling in his legs following an automobile accident was flagged immediately by an intake specialist and admitted to a hospital within 24 hours.

The program has not eradicated the shortage of neurosurgeons, but it has helped.

''We have made significant advances in meeting the demand for referring physicians who call on us,'' Gilligan said. ''We are still busier than we would like to be, and therefore we do have some recruitment plans that are taking shape.''

Mayfield has hired a new neurosurgeon, Gilligan said, and is recruiting two more.

The only drawback to Priority Consult, Gilligan said, is that Mayfield's surgeons are working more hours to review the consultations but are not able to bill patients for those hours.

Only one insurance company, Anthem Blue Cross and Blue Shield, has agreed to provide some reimbursement, he said.

''There's no mechanism to bill for this,'' Gilligan said. ''This is new, unique, innovative. Billing systems haven't caught up yet.''

The new program, which Mayfield will market to other practices, works like this:

A patient referred by a primary care physician is contacted and interviewed for 20 to 30 minutes by a trained intake specialist.

The patient sends any available x-rays or other diagnostics to Mayfield.

The intake specialist may ask for additional diagnostics, such as an MRI.

The surgeon spends 10 minutes reviewing an electronic summary of the intake specialist's interview, which includes 80 pieces of medical information.

The surgeon either schedules an appointment with the patient or prescribes another treatment path which might include physical therapy and medication.

''Before the program, 100 percent of patients would come in to see the surgeon before getting additional or further direction about what to do,'' Gilligan said. ''Seventy percent are now given some things to do before seeing the neurosurgeon and 30 percent are given the appointment with the surgeon. So instead of 100 people clogging the door trying to get in, we're down to 30, and we can get 30 in sooner.''

Of the 70 percent who go off into other care paths, half will elect not to see the surgeon at the conclusion of their therapy, he said.

''The patient has avoided the time and expense, has gotten into a care path sooner, has recovered sooner and gone back to work sooner.'