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Using an Innovative Delivery Model, Mischer Neuroscience Associates Extends High-Level Care Across the Region

mna citywide groupMischer Neuroscience Associates (MNA) has enjoyed a highly successful year of recruitment, which brings the organization’s total count of physicians practicing in MNA clinics in the Greater Houston area to 61. That number includes 21 neurosurgeons, four pain management specialists, two neuro-oncologists, two radiation oncologists, nine critical care intensivists and 23 neurologists.

These specialists work together in an innovative model that ensures high-quality, cost-effective care with a strong focus on the patient experience. In addition, 36 advanced practice providers, 16 residents and eight fellows at McGovern Medical School at UTHealth are now providing care at the 24 MNA practices located across the city.

“The reputation of Mischer Neuroscience Institute and UTHealth has helped us recruit high-quality, high-service physicians who deliver outstanding care at Memorial Hermann’s network of hospitals,” says Amanda Spielman, President of Mischer Neuroscience Associates and Vice President of Neurosciences at Memorial Hermann Health System. “Building on a core group of expert academic physicians at Memorial Hermann-Texas Medical Center and UTHealth, we’ve created multidisciplinary teams that work across our 24 MNA locations to serve our patients, hospitals and the medical staff. They collaborate closely to develop consistent care protocols, regardless of the site of service, and look for ways to improve on the quality of care they deliver.”

Creating a Citywide Group Practice

To arrive at this point, Spielman and Mischer Neuroscience Institute director Dong Kim, M.D., took a close look at the complement of physicians within the Institute, and asked the question, “How do we develop a comprehensive network of neuroscience providers, both specialists and generalists, with a connection to the Texas Medical Center and access to its tertiary-care resources?” The solution was a citywide group practice, grounded in best practices and protocols, that allows patients to access neurological care, including complex spine and intracranial medicine, often closer to home. “The large recruitment of providers that followed allowed us to think strategically about the specific needs of each hospital and the community it serves,” Spielman says.

Among them is a multicenter, coordinated neuroendovascular program focused on getting the right patients to the right hospital, depending on their needs. “Without the expansion of MNA and the ability to leverage our existing team of providers for full coverage, we would have had to hire two neurointerventionalists to serve each area of the city,” Spielman says. “Instead, with a large group of physicians and other providers who work closely together and rotate at MNA clinics and hospitals, we’ve created coverage that extends our team’s expertise across the Greater Houston area.”

Developing Better Facilities

The innovative practice model also made possible the extension of neurocritical care to Memorial Hermann Southwest Hospital. As a Primary Stroke Center certified by The Joint Commission, the hospital was already equipped for rapid diagnosis and treatment of stroke. Thanks to MNA, its new state-of-the-art Neuroscience ICU is staffed 24/7 by physicians affiliated with the Mischer Neuroscience Institute and UTHealth, all of whom are fellowship trained in neurocritical care. These neurointensivists work hand in hand with neurosurgeons and neurologists to provide superior care. Also through its affiliation with Mischer Neuroscience Associates, the hospital now has full emergency department call coverage for all neurosurgery specialties. Critical care fellows started rotating at Memorial Hermann Southwest last July; by next summer, the hospital will be on the rotation list for critical care residents.

The hospital is also adding a sophisticated hybrid operating room where neurosurgeons can perform emergent or elective endovascular and skull base procedures. Diagnostic angiography is available onsite, and patients of referring physicians have access to a spectrum of neuroendovascular services through the hospital’s affiliation with the Mischer Neuroscience Institute. The expanded neuroscience program supports Memorial Hermann Southwest Hospital’s application for certification as a Level II trauma center – the facility serves a large population in an area with a shortage of higher-level trauma care.

MNA is also building out complete neuroscience programs at Memorial Hermann Memorial City Medical Center and Memorial Hermann The Woodlands Medical Center. “Each program is slightly different based on the needs of the local community,” Spielman says. “Memorial City has added neurocritical care and diagnostic angiography to complement its existing neurosurgery and inpatient and outpatient neurology programs, which have been in place for many years. High-level services are also available through the MNA practice in The Woodlands, which means that residents of North Houston and The Woodlands no longer have to make the long drive to Houston for certain procedures.”

At Memorial Hermann Memorial City Medical Center, “we’re growing up and evolving,” says Meredith Wells, RN, NEA-BC, associate vice president for neurosciences. “We already have 19 beds dedicated to neuroscience – a mix of ICU and acute care beds – which gives us a competitive advantage because it allows patients to stay on the same floor as they get closer to discharge with consistent expert nursing care. We also now have in-house nighttime neuroscience coverage, which gives us 24/7 availability of neuroscience provider expertise. When you put that together with our MNA neurosurgeons and neurologists, two neurointensivists and six advanced practice providers supporting critical care, you have a dedicated neuroscience unit that is uniquely capable of taking care of higher-acuity patients in a community hospital setting.”

Memorial Hermann The Woodlands Medical Center is now served by 12 MNA providers, including a newly recruited pain management specialist who joined the team in summer 2016. The multidisciplinary team includes neurosurgery, inpatient and outpatient neurology, neuroendovascular services, pain management and neuro-oncology. In-house nighttime neuroscience coverage and Neuro 1, a one-stop number that allows referring physicians to access the appropriate on-call neuroscience provider quickly, have been added. The hospital is gearing up for certification as a Level II trauma center.

Virtual Care

In conjunction with UTHealth, telemedicine services are now available at nine Memorial Hermann hospitals, connecting them with stroke experts at the Mischer Neuroscience Institute. At Memorial Hermann Katy Hospital, this has resulted in a wait time of less than 10 minutes for a patient to come face to face with a stroke expert on a remote monitor. Before the implementation of telemedicine, Memorial Hermann Katy Hospital logged 0 to 1 cases of acute ischemic stroke treated with tPA each month. Post-implementation, the hospital has had as many as nine. Collaboration with emergency care team providers, standardizing access and escalation protocols and providing a common language to request a consult through Neuro 1 has also improved the quality of care. The expansion of MNA has also led to the opening of new practices in Sugar Land and Cypress. Pain management specialists have been added at MNA-Katy, MNA-Memorial City and MNA-The Woodlands. “Having pain management specialists in our spine clinics improves service for patients and offers them comprehensive care.” Spielman says. “Having a coordinated team of physicians and advanced practice providers is really good overall for a hospital campus and its medical staff, but most important, we bring the services to our patients in a coordinated manner.”