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Group Practice Without Walls:

Mischer Neuroscience Institute Expands Its Citywide Neuroscience Network

Before the 2012 arrival of neurologist Philip Blum, M.D., on the Memorial City Medical Center Campus, patients could expect a minimum three-month wait to see a neurologist after referral from a primary care physician. Today, thanks to Dr. Blum’s full-time practice, the addition of other specialists affiliated with Mischer Neuroscience Associates (MNA) and a new structure for the practice of neurology, the average wait time for patients in the highly populated Memorial City community is a matter of days rather than months.

Without Walls 1“We faced a number of challenges related to the practice of neurology on our campus,” says Keith Alexander, CEO. “We had an ample number of affiliated private-practice neurologists, but their practices were and continue to be very busy. Because of the high caseload they carry, fewer and fewer were willing to provide the 24/7 emergency department call coverage we need to maintain our Joint Commission designation as a Primary Stroke Center. They also had less time to round on hospitalized patients.”

The solution at Memorial City and other hospitals in the Memorial Hermann Health System is a more highly specialized neurology network that includes private practice physicians, physician practices and community-based physicians who have signed lease agreements with Memorial Hermann, and neuro-hospitalists or intensivists who provide emergency coverage and care for inpatients. Under the new structure, neurologists are no longer caught between the demands of the office and hospital.

“The traditional model of the neurologist running back and forth between hospital and clinic, seeing patients in both settings, is no longer viable,” says Dr. Blum, a general neurologist who sees outpatients at Memorial City under an agreement with Mischer Neuroscience Associates. “With healthcare reform and changes in Medicare reimbursement, there’s just not enough time to run a busy neurology practice and see seriously ill inpatients. So we’ve split neurology into outpatient care and inpatient care using a hospitalist neurology model. My focus is on the outpatient side, relieving the overburdened private practice neurologists and ensuring that patients gain access to the healthcare system quickly. Even the most common neurological diseases aren’t good, and having to wait months to see a specialist adds to the patient’s emotional anxiety and stress.”

Without Walls Dr Daniel KimWorking on the inpatient side at Memorial Hermann Southwest Hospital is neurointensivist John Ownby, M.D., who is triple boarded in internal medicine, neurology and critical care medicine. Dr. Ownby, who has expertise in ethics, end-of-life issues and palliative care, offers inpatients prompt access to a neurologist and also provides emergency coverage.

“Many discharged neuroscience patients are seriously ill and fragile, and unless they’re seen quickly on the outpatient side, they’ll bounce back into the hospital,” Dr. Ownby says. “Those transitions must be managed efficiently and rapidly. Squeezing patients who need a rapid transition of care into a busy neurologist’s schedule creates chaos, and everyone suffers. The presence of our outpatient neurologists has relieved some of that pressure.”

MNA Neurology complements the citywide neurosurgery expansion begun in 2008 by Dong Kim, M.D., director of the Mischer Neuroscience Institute (MNI) and professor and chair of the Vivian L. Smith Department of Neurosurgery. “The neurology program at Memorial Hermann-Texas Medical Center has always been strong,” says Amanda Spielman, chief operating officer for neurosciences. “After Dr. Kim arrived, established MNI and strengthened the neurosurgical side, we began to build neurosurgery capabilities across the Memorial Hermann Health System, choosing outlying facilities based on demand and potential for growth. Once the neurosurgery capabilities were in place, we needed general neurologists to manage the care of their patients. We also knew that as an accountable care organization under healthcare reform we had to build our infrastructure to include the entire continuum of neuroscience in order to provide care for large employee populations.”

At the same time, Spielman and Dr. Kim began to hear from neurologists who refer to Memorial Hermann for neurosurgery that they felt pressured by changing reimbursement patterns. Some wondered if they could survive in private practice. “Many neurologists with long-term established practices wanted to maintain their own identity, so we worked with legal and financial experts at Memorial Hermann to create a model – other than outright acquisition – to integrate neurologists across the city,” Spielman says. “Our model has proved to be mutually beneficial: leased neurology practices benefit from Memorial Hermann’s market leverage, and Mischer Neurosciences can offer employers, managed care providers and patients a larger network of affiliated physicians.”

Spielman met with CEOs across the Memorial Hermann system to identify high-quality physicians with whom they wanted to align. “This has been a year of identifying potential partners and investigating opportunities,” she says. “The goal is to have at least one anchor practice near each of Memorial Hermann’s acute care hospitals to support the outpatient needs of neurology patients. We’re growing but we’re doing it cautiously, making sure that we have the right network of providers as the healthcare market changes. The practices we’re adding are of the highest quality.”

Among them is Houston Neurological Institute (HNI), led by Kim Monday, M.D., who is board certified in adult neurology, clinical neurophysiology (EMG/EEG and intraoperative monitoring) and sleep medicine. Dr. Monday has been repeatedly named a Texas Monthly Super Doctor and a Top Doctor by both H Magazine and The Consumer’s Guide to Top Doctors. HNI, the first private group to join Mischer Neuroscience Associates, provides outpatient care to Houston and surrounding areas, including Pearland, Pasadena, Deer Park, Clear Lake and Dickinson.

Without Walls 3“We’d been interested in the idea of a virtual group practice for some time,” Dr. Monday says. “Dr. Kim’s vision of a group of community neurologists and neurosurgeons located across the Houston area was in keeping with my own vision, and we are delighted to be working together to improve care for patients in the area.”

In the last year Memorial Hermann and UTHealth have also recruited 15 physicians to join MNA, MNI and UTHealth Medical School. “Our aim is to extend the exceptional care we provide in the Texas Medical Center to patients across Houston through Mischer Neurosciences, a citywide neuroscience network,” Dr. Kim says. “The presence of these new team members moves us closer to our goal of recruiting the highest-quality group of providers to deliver the full continuum of neuroscience care throughout the Greater Houston area. These new additions to the growing MNA Neurology team allow us to provide the full range of neurology services in the community, from stroke care to electromyography to deep brain stimulation.”

Dr. Blum believes the high-quality pipeline between neurology and neurosurgery brings great benefit to the city. “Dr. Kim has built a large group of first-class neurosurgeons,” he says. “That original MNA group and the patients they serve deserve a first-class group of neurologists to collaborate with them hand in glove. That is a tricky thing to accomplish. Hats off to Dr. Kim, who as a neurosurgeon had the skill to build this network by crossing the line from a surgical to a medical specialty. Neurology runs on a completely different model. Building a citywide network that includes both neurology and neurosurgery requires a lot of work from our side to help neurosurgeons better understand our specialty.”

Dr. Monday appreciates having the freedom to focus on improving patient care. “Dr. Kim is a good partner for us,” she says. “It’s been a joy to work with Dr. Kim and Amanda. We’ve been continually impressed by the support they’ve given us. When there are hiccups, as there are bound to be in building anything new, they haven’t abandoned ship. This is the model of the future.”