med_59421.ppt - powerpoint presentation

James I. Ausman, M.D., Ph.D.

EditorSURGICAL NEUROLOGY

Professor of NeurosurgeryUCLA &

University of Illinois at Chicago

Clinical Healthcare ConsultantNavigant Consultants, Inc; Strategic Planning and

Market Research for the Healthcare Industry

Medical Expert KMIR 6 TV

What your Future will be Like

And

How to Plan for It

What is the likelihood that what we are doing today in Medicine and Neurosurgery will be the same at

the end of the 21st century?

NONE

The World We Live In:Present and Future

The Future of Healthcare

• We are in a wartime economy- will last for years

• Our GNP will grow at 3% / year not 7%

• Healthcare is 16% of the GNP in the USA-2006• Health insurance premiums went up >7% this year

• In 2015 it will be 20% of the GNP

• 2 trillion dollars will be spent on healthcare this year

• The Government controls 45% of healthcare expenditures; this % will rise to 49%

• Others bill at Medicare or % of Medicare rates

• There will be no more money available for doctors or hospitals

The Future of Healthcare

•How will you make money in this environment?

•Cut costs

•Larger group

•Efficient operation

•Volume with good payers

•Find other ways to generate revenue

The Economy in the Future

• We are in a global economy

• What is happening in Industry?• Mergers and acquisitions• Large corporations• Multinational corporations• Competition on the basis of price; companies need to

survive; have become larger, global

• Healthcare costs increasing to industry• Employees have larger copays• Healthcare costs are going up; no one likes it• Companies are cutting retirement benefits


• Healthcare• Has large players: Government, Insurance Co, Hospitals

• Physicians • 50% solo or small group (3 or less)• Disunited• How can you play effectively in this market?

• Failing business strategy


•How do you survive in this market?

• Become larger for greater market power• Greater market share• More political power

• What are you doing to help the community in this time of limited funds?

Neurosurgery: The national picture

• 3000 neurosurgeons in the USA• Few specialized• Most selling the same products• Most in major cities

• Competition• Interventional neuroradiology- advancing technology• Ortho, plastic, vascular surgery: spine, peripheral nerve,

vascular

• Because less pay from payers• Increased volume• No time for R&D• No chance to advance

• Where are you going to be in 10 years with this strategy?

Neurosurgery: The national picture

• This is a formula for certain business failure• No R&D • No new products • No differentiation from competitors

• Solution:• Merge with others• R&D• New strategy: larger group

Neurosurgery: The case market

• 17,000 new primary brain tumors ( 5/ neurosurgeon/ year)

• 100,000+ metastases (33/ neurosurgeon/ year)

• 700,000 new strokes per year

• 25,000 SAH , aneurysms & AVMS

• 200,000 carotid endarterectomies

• Epilepsy: 2,000,000 +people

• 1-2% have Parkinsons’s

• Back pain most common cause of loss of work • only 10% need surgery

• Pain is the most common symptom of patients

Neurosurgery: The case market

•Solutions:

•Concentrate on large volumes in market

•Expand market share: Provide full service

•Need to have a larger group to do this

•Need time for R&D

•Subspecialize

•What neurosurgeons are doing with the figures above

•If you choose a niche, be a “Focused Factory”

Physicians: A psychological analysis

• Intelligent, Individualistic

• Ego driven

• Know it all

• “Do what I tell you”

• Cannot work together

• Unwilling to change

• Politically naïve

• Poor negotiators and business mentality

• Used to arguing

• Risk Averse

Your business adversary: A psychological analysis• Goal Directed

• Intelligent

• Ego driven

• One leader speaks, the rest follow

• Have a strategy

• Organized, work as a team

• Will change to gain market share and succeed

• Politically savvy

• Good negotiators and business mentality

• Work as a team (I pay your salary: do what I say)

• Risk Takers

Which of these two opponents will win at the negotiating table?

Your business adversary: A psychological analysis

•The world you compete in is a business world not the OR

•Learn the RULES

Physicians: A psychological analysis

• Solutions• Hire people who believe as you do

• Those who do not fit don’t hire or fire• Change your way of dealing with people• Get a Strategic Plan

How to negotiate to get what you want

• Physicians say, “ Do what I say now”

(no negotiation)

“Be happy with half-victories and come back for the rest later”-

Lyle French, M.D. As he went from Chairman of Neurosurgery to VP of Health Sciences

What your patients think of your service

• Hard to get an appointment; Automated answering service

• Waits to see doctor; patient’s time is not valuable

• Fragmented care; specialized care; go to multiple doctors; lost time & $

• “96,000 patient deaths per year caused by doctors”

• Doctors make too much money; (look at the cars they drive)

• Expectations are unlimited• Press; doctors; self-centered generation (boomers)

• Patients do not want to pay co-pays• But rather spend on VCR, golf or etc

• They understand some of the system problems affecting you

What your patients think of your service

• Solutions:• You must deal with patients’ perceptions, not reality! The

customer is right!• Change your way of doing business• Better PR: locally, nationally• Academic Centers are the worst at service

• can only leverage their unique treatments• You must work like you never have enough business

(Avis)• Do you have an unlisted phone number?• Is your office phone automated?• YOU ARE IN THE SERVICE INDUSTRY; PROVIDE

SERVICE!

The Future: Nursing and other paramedical professions

• Nursing• Shortage now• Worse in the Future• Nurses seeking other careers with better respect, pay and

independence• Climbing pay

• Paramedical Professions• Growth industry• Climbing pay

•What did you learn from analyzing your business from the available information

today?

Solutions so far• Healthcare environment

• Cut costs; larger group; efficient operation; volume- payer

• Global Economy• Larger group for market and political power

• Neurosurgery: national market place• Present formula is a business failure; Differentiate yourself from your competition• Merge; R&D; larger group

• Neurosurgery: case market• Concentrate on large volume: Tumors: mets and others; pain and spine; Movement disorders; epilepsy;

vascular disease; need larger group

Solutions so far

• Physician personality• Hire people who believe as you do • change your behavior• Get advice and strategic plan

• Opponent’s personality• You are playing in a business marketplace not the OR; Learn the rules

• How to negotiate• Be happy with 1/2 victories and come back for the rest later; Change; learn to negotiate

• What do your patients (customers) think of your business?• Change; PR; Customer focus; You are in the Service Business

What about your own Personal Future?

Do you have enough money to retire?

If you retire at 65 and live to 90sHow much money will you need to allow you to

live the way you want for 30 years?

At least 10 million dollars in the bank at retirement or more

The Future: Trends in Neuroscience Research

Where research is leading us

Where Neuroscience Research Is Taking Us

• Neurosurgery:• Less invasive approaches to neurosurgical diseases

• Aneurysms, AVMs, pituitary tumors, some spine• Successful molecular treatments for neoplastic diseases

• CML, medulloblastoma, meningioma, ALL• Will eliminate skull base surgery for tumors, and other

grossly invasive approaches for neoplasms • Imaging indicating functional significance of every part of

brain.• damage to cognitive brain functions by standard

neurosurgical procedures• Will change neurosurgery to a minimally invasive

technical specialty


• Neurosurgery:• Understanding molecular level dynamic genetic and

biochemical processes • Will need constant evaluation and changes in treatment

• Trauma, ischemia, spinal cord injury, spinal cord repair• Care of the Recovering and Injured Brain

• Neurointensive Care. • Will overlap interests of neurologists who will be

treating different diseases similarly• Neurosurgeon will become less surgical. Will there be

a neurosurgeon?


• Neurology: chronic and progressive diseases

• Will have genetic and molecular bases• Imaging will reveal causes of these• Neurology and Neurosurgery will overlap

• Pain: Genetic differences; Fiber tract differences

• Will require knowledge of psychiatrist, neurologist, neurosurgeon and rehabilitationist to treat patient successfully


• Psychiatry:

• Cognitive & Functional Diseases will have a genetic basis.

• These disorders will be understood in molecular terms.

• Imaging will reveal basis for cognitive and functional disorders

• Psychiatry and Neurology will merge with Neurosurgery


• Neurosurgery, Neurology and Psychiatry: • We are all looking at the same brain

• INTERDISCIPLINARY RELATIONSHIP

• In academic centers, Basic Neuroscientists will join clinical neuroscientists• Grants will be awarded to teams of neuroscientists• Examples at present:

• Stroke• Pain• Epilepsy (MINCEP)• Movement Disorders

The Future: The Neurosciences Market

The Neurosciences Market Is Large But Diffuse

4,600

4,000

2,500

2,000

1,000

400 350 350250 200

30 300

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Stroke Alzheimer’sdisease

Traumatic braininjury

Epilepsy Parkinson’sdisease

Lumbar spinalstenosis

Brain tumor Multiple sclerosisSpinal cord injury Dystonia Amyotrophiclateral sclerosis

Huntington’sdisease

Estimated Prevalence in U.S. (in thousands)

Total = 15 million – 90 million(with cognitive, functional and behavioral disorders contributing

75 million 1 /3 of the population)

Value of a Neurosurgeon

$3.1

$2.4$2.2

$1.9 $1.9$1.8 $1.8

$1.0

$0.0

$0.5

$1.0

$1.5

$2.0

$2.5

$3.0

$3.5

CardiovascularSurgery

Neurosurgery Vascular Surgery Cardiology Orthopedic SurgeryGeneral Surgery Hematology /Oncology

Neurology

Average Hospital Inpatient and Outpatient Revenue Generated Annually (millions)

Inpatient Care Is More Concentrated at Teaching Hospitals

27%

23%22%

21%20% 20%

18%

0%

5%

10%

15%

20%

25%

30%

Nervous System Musculoskeletal/Connective TissueCirculatory System Mental Diseases/Disorders Digestive System Pregnancy/Childbirth Diseases & Disorders of the

Respiratory System

All Discharges = 22%

Percent of U.S. Discharges at Teaching Hospitals

1

Market Realities: Emerging Physician Shortages

Supply and Demand

Availab

le U.S

. Neu

rosu

rgical P

ositio

ns

Neu

rosu

rgeo

ns

Pra

ctic

ing

in U

.S.

Neurosurgery

Supply

Demand

Source: AANS Bulletin; Winter, 2003; Too Many? Too Few?

Shortages Continue for Other Specialists

• Spurred by declines in specialty residencies, demand for select specialists are expected to rise (1994 vs. 1999)Orthopedic residents

declined 9%Radiology residents declined

13%Oncology residents declined

63%

Market Realities:A Sellers Market

Neurosurgeon WantedFebruary 3, 2005

• $600,000 salary 1st year (maybe higher)

• 1 in 5 call

• Southern Ohio metro city

Two Neurosurgeons Wanted

February 10, 2005

• $650,000 base salary

• $50,000 sign-on bonus

• 18 months to partnership

• No managed care

• Team support and group approach in the OR

• Located in Midwest

How Competitive Is Your Market/Organization?

ED Coverage Forcing the Issue

% Hospitals Naming Specialty Among Hardest to Secure ED Coverage

(n=1,501)

0.3%

0.5%

1.5%

1.9%

4.0%

4.7%

5.9%

7.2%

7.7%

15.8%

15.9%

20.3%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

Urology

Pediatrics

Behavioral Health

Plastic Surgery

OB/Gyn

Orthopedics

Oral Surgery

Ophthalmology

General Surgery

Cardio/Thoracic Surgery

Neurology

Neurosurgery

% Reporting DifficultyAverage Daily Stipend Range

$1,000 - $2,000

$150 - $300

$1,000 - $1,200

$800 - $1,200

$800 - $1,000

$800 - $1,000

$1,000 - $2,000

$400 - $600

$800 - $1,000

$100 - $300

$150 - $300

$800 - $1,000

For facilities with resident

coverage, this situation has

been particularly problematic due to new residency work week limits

#1

Source: Tiber Group analysis; AHA and The Lewin Group TrendWatch (March, 2001); Governance Institute

Less Hospital-Physician Competition

Solo 2 Person 3 Person4 to 8 Person

Over 8 Person

All Physicians 33% 11% 9% 22% 25%

Neurologists 47% 7% 4% 22% 20%

Cardiologists 16% 7% 12% 27% 38%

Distribution of Physicians by Group Size (2001)

Capital Cost of Neuroscience Equipment

Aging Populace Requires More Hospitalization

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75-84 yrs 85+ yrs

Days of Care Hospital Discharges

Source: National Hospital Discharge Survey, Center for Disease Control and Prevention, 1998

Rate Per 1,000 Population

50% of 50% of Today’s Today’s

PopulationPopulation

Baby Boomers today

Expect Long-Term Rise in U.S. Hospital Admissions

30

31

32

33

34

35

36

3719

81

1983

1985

1987

1989

1991

1993

1995

1997 19

99

U.S. Hospital Admissions

(Millions)

The Neuroscience Market-Summary

• There is a large volume of people with neurological and functional disorders- 90 million

• The number of neurosurgeons and neurologists is decreasing

• Many in solo or small group (<3) group practice

• Neuroscience is “expensive-equipment intensive”

• Complex neurological conditions seen more at academic or major centers

• Neurosurgery is big IDP revenue generator, second to cardiac; hospitals need to find other sources of revenue

• Baby boomers will increase demand for services in the next 20 years; neurosciences will benefit

• People are living longer with chronic diseases

• Research dollars are increasing

• Neuroscience is next big area for hospital program growth

The Neuroscience Market-Summary

• How should you take advantage of these changes and opportunities?

• Should you do what you are doing or change?

• Academic Medical Centers? What strategy?

Future-Neurosciences & Healthcare Delivery

• Scientific knowledge doubles every 7 years• Impossible for one physician to know everything

• HOW ARE YOU GOING TO KEEP UP IN THIS RAPIDLY CHANGING WORLD?


YOU WILL HAVE NO CHOICE BUT TO SPECIALIZE

THUS, YOU MUST WORK IN GROUPS

THE LARGER, THE BETTER

You will be more satisfied professionally

Have more time to be good

To be with your family

To learn

BUT

What will you give up to get there?

Some independence

• New methods of compensation in a group. Who is most important?


What if you decide not to Change?

Where will you be?

Alone

With less satisfaction, less knowledge than your peers, no power,

And less money


What happened to the Mom and Pop Store around the corner?

WALMART

What happened to Chrysler, the Steel Companies

What happened to the community hospital?

What Happened to the University of Minnesota Medical Center?

Does the Mayo Clinic have it right?

Given all the things you have learned About

The world we live in

Your Personal Family NeedsThe Neurosceinces market

The Progress of Neuroscience

What is you Plan to Succeed in this World?

Will your present Strategy Work?

NOT A CHANCE

The Minneapolis-St.Paul Neurosurgical Market

Good NeurosurgeonsKnow & respect each other

Fragmented; Competing

Hospitals have the PowerNeurosurgeons don’t

Is there a better solution?

Some Solutions

•Do your market research

• Assess your strengths and weaknesses

•Get a strategic plan

Solutions: What can we do?

•Implementing your strategic plan

•Add neuroclinicians

•Select programs

Solutions: General Principles

•Form a larger group to gain power in the marketplace

•Start with (?size) group (How are you going to build this corporation?)

•Recruit•Costly

•need financing•Get loan; partners at risk

•Advantages•Build with people who have your interest•No arguments•New knowledge with young people


•Form a larger group to gain power in the marketplace

•Merge•Shortens time to build•Already tested people; experience•Disadvantages

•Independent•Set in ways•Philosophy differences

•Become Employed•Work with hospital for win-win


Physician Compensation (continued)

Neurosurgery

NeurosurgeryMean 25th %'ile Median 75th %'ile 90th %'ile

Overall 576,880 413,370 533,562 708,076 891,336 Region Specific

Eastern 593,275$ 500,000$ 637,384$ 698,211$ 742,190$ Midwest 593,380$ 434,887$ 533,456$ 728,327$ 899,184$ Southern 625,029$ 446,474$ 562,000$ 820,000$ 951,737$ Western 450,453$ 344,335$ 410,006$ 474,718$ 810,808$

Source: MGMA - Physician Compensation and Production Survey

2004 Report Based on 2003 Data (n=169)

Physician Productivity (continued)

Neurosurgery

How productive are your physicians?

Source: MGMA - Physician Compensation and Production Survey

2004 Report Based on 2003 Data (n=169)

NeurosurgeryMean 25th %'ile Median 75th %'ile 90th %'ile

Compensation 576,880 413,370 533,562 708,076 891,336

Total RVUs 18,115 15,053 17,967 21,716 24,679 Work RVUs 8,637 6,364 8,715 10,593 12,520

Comp per TRVU 32.54$ 26.31$ 29.35$ 35.81$ 49.90$ Comp per WRVU 63.85$ 45.80$ 55.73$ 71.47$ 97.50$

•Select Programs for Development

•Super-specialize (Can everyone do everything in your corporation?)•Concentrate cases

•Vascular, spine, peds, tumor•Expand (How can you get the best products for your customers?)

•Neurologists•Screen patients

•Psychiatry•Pain evaluation; other

•Rehab•Imaging

•interventional•Plastics•Ortho•Psychologists

•Other ideas


•Other ideas: How are you going to make this corporation successful?

•Serve community needs•Get community on your side

•PR•R&D•Education

•Industry •Schools

•Compensation•May need new compensation schemes


•Satellites•Allows expansion and produces income for growth; direct to bottom line•Win Win for community and AMC•Do not drain from satellite to AMC•Do what can be done there; transfer rest;•“Close beats far”•Develop neurosurgery there•They want to make money too!


•Other businesses•Franchise care to others•TV monitoring•Sell services to other hospital - ER

•Politics-get involved•Local, state,

•Focus cases at one hospital; complex cases•You are running a multimillion dollar corporation•Large group has power to do this

•Disease Management & Interdisciplinary care


•Other ideas•Finances

•Loan•Need BUSINESS MANAGER

•Compensation Schemes•Eat what you kill•Redistribute•Combined economy- value point system•Socialism won’t work


•NEUROSURGEONS DON’T GET IT!•How do you subspecialize? I want to be a generalist. I am as good as X. I just want to practice medicine. Those d--n administrators!

•GET ADVICE, GET ADVICE, GET ADVICE•What do you do if you have a clinical problem?•You have to spend money to make money•PR, Consultants, Business advice

•Retired CEO•Think like the head of a multimillion dollar corporation, not like a neurosurgeon


•Academic Medical Centers (AMC) are failing in the market place

•Because of need for money, forced clinical enterprises to support center•Less time devoted to research•Competition with referral sources•Cannot compete on amenities and convenience•Lose leverage that distinguishes AMC from community•Failing strategy•Doctors do not understand economics, market principles, or business strategy•Teaching, Research and Practice is the fall back position

Solutions: Academic Medical Centers

•AMC•Need to leverage strength

•huge resources and research base•For future that is interdisciplinary and disease management,

•AMCs can do this easier than anyone in the market •Need to leverage research, basic science, engineering, other disciplines•Be in forefront of medicine and science•Compliment community physicians•Doctors need to change! ( So does the administration) •Pursue strategies outside the administration; You will not make money with their plans

•AMCs are suffering from ACADEMENTIA

Solutions: Academic Medical Centers

Spine Program

250,000 instrumented fusions done in 2004, 3X as many as in 1994

$750,000,000 in 2004 by Gov’t on fusions

National bill for hardware is $2.5 billion a year

“Little scientific evidence fusion works better than laminectomy..”

Up to 4X more money for a fusion……( for the doctor)

2-4X as much for the hospital

“Fewer than 50% necessary”- Ed Benzel

NEJM; 350; 2003

NEJM 355: 522-523, 2005

•A Molecular Cure for Arthritis

James I. Ausman, M.D., Ph.D.

Surg. Neurol. 60:469, 2003;

61:313, 2004

•Spine Centers: Is this the way to go?•Pays $•Instrumentation costly for hospital•No proof treatments work•Government will interfere; NY is already interfering•“Death of Spine Surgery”•Surgery is only 10% of the market; What about the other 90%

Solutions: Special Centers

•What to do: Set up a SPINE AND PAIN CENTER•Captures rest of Spine Pain market (other 90%)•Interdisciplinary•Psychologists•OT, PT•Physiatry•Accupuncture, blocks•Other•Surgery

•Strategy is to keep the patient whatever happens to the politics or reimbursement

Solutions: Special Centers

Pearls of Wisdom from the Business Community

• The Secret of Innovation:• “Find our what everyone else is doing, and don’t do it!

• The Ultimate Market Control:• “You physicians are the only ones who can do what you do. You can

control the market totally, and no one can do anything about it. I do not understand why physicians have given up their power in the market place!

Pain and Spine CentersComprehensive Stroke CentersNeurointensive CareFunctional NeurosurgeryDepression, Obsessive Complusive disorders, Functional disordersRehabilitationRadiosurgery Cancer Teams EpilepsyPsycho-neuro-endo-immunologyNano medicineTrauma neurosurgery & carePeripheral Nerve Treatment

Future fields of opportunity

Hospitals vs Doctors

•“Silo Mentality” from the 20th Century

•Hospitals, doctors and suppliers compete with each other for the healthcare dollar

•New relationships required•Hospitals and doctors will have to cooperate and share risk and reward to compete

•Joint ventures

•Hospital administrators will also have to change

•Those who get it will win in the market place

Hospitals, Doctors and the Healthcare System of the Future

Doctors’ Secret Weapon

•There will be a shortage of physicians in 10 years•There is and will be a shortage of neurosurgeons•The population will be increasing•Baby boomers will want more care•Supply Demand equation for physicians

•Will physicians drop Medicare?•Will the government make medicine a “right”?•People will pay for quality or……•Only if physicians utilize this power properly will they succeed

•You can decide to work for the hospital and forget all of this aggravation!

The Secret Weapon of Doctors in the Future

What a Futurist says about our Future

Ray Kurzweil; The Futurist. January February 2006

The Future by Ray Kurzweil

• The Past 200 years (1800’s)

•Women lived to 35 years old; today to 85

•1/2 day to prepare a meal

•Physical labor for most things

•No social safety nets

•Still Billions live in this manner-2000


•Human scientific progress in Exponential

•All of the discoveries of the 1900s are equal to 20 years of discoveries at the rate of progress in 2000;

•By 2100 1000X more progress than today

•20 years of progress will be made by 2020

•20 years more in 2027


•Overlapping Revolutions:

•Genetic

•Nanotechnology

•Robotic


•Genetic Revolution:

•Genomics

•Proteomics

•Gene therapy

•Targeted drug therapy

•Cloning of cells, tissues , and organs


•Nanotechnology Revolution: 2030

•Microchips under the skin

•100s of medicines from wells responding to metabolic changes

•Telepathic communication

•Expansion of memories

•Nanorobots in our bodies destroying disease


•Robotic Revolution: 2030

•Artificial Intelligence (AI)

•By 2100 will be trillions of times faster than the human brain

•Will exceed biological intelligence by 2040

•AI can handle more complex data than the human brain

•Computers will have lifelike intelligence


•The Next 100 years

•Eliminating 50% of preventable diseases will extend life expectancy to 150 years

•Eliminating 90% to 1000 years

•Technology will eliminate poverty, disease, pollution and other problems

•“It can’t be done”•“I can’t do it”•“I am too busy”•“That will never work”•“I can’t work with that guy-he’s…..”•“It’s the system”•“What can one person do?”•“You can’t fight the government”• “But medicine is not a business!”• “It’s the government; it’s the HMO or insurer…..”•“This guy is out of touch” •“These changes will take years”

•Have you become accustomed to losing? Are you a loser?

The Language of Failure

“I know all the reasons why it can be done, now find a way to do it!”

The Language of Success

“I don’t take NO for an answer!”

I am not interested in popularity

I am interested in results

•Will I be successful and make money with these ideas?

What choice do you have?The strategies being used by your colleagues are failing. (Practice and academia)

You have no choice but to change

Final Question

Do you think you are going to RETIRE?If you live into your 90’s, do you have enough money put away

to support your idea of retirement?

Are you Happy?

A few last notes

What about this idea of Retirement?

Can you or the country afford it?

Can you stand it?

Does the Brain Grow with Age?

What are you going to do with the rest of your life?

Nature 420: 788-794; 2002

•THE PATIENT COMES FIRST

•If your put the patient first, you will never have to worry about money,

•If you put money first, you will lose both

There is only one RULE

What is the likelihood that what we are doing today in Medicine and Neurosurgery will be the same at

the end of the 21st century?

NONE

Thank You

“THINK DIFFERENT”Apple Computer

[email protected]

Future Trends and Predictions

AMA News: 2/9/06

Whom do people trust?

•World Population is 6.5 Billion ; 9.0 billion by 2050

•1 billion are connected to each other by the Internet•In 15 years , majority of world will be connected

•Increasing numbers of people are poor, unhealthy and lack access to education

•60% of our life support systems are gone or in danger of collapse

•Forests and oceans absorb 3 -3.5 billion tons of carbon/year•We generate 7 billion; Rest goes into atmosphere•With 2.5 billion more people by 2050; 14 billion will be generated


•1.1 billion people do not have access to safe water

•2.6 billion lack adequate sanitation

•Only 17% of world’s people live in countries with free press

•Conventional military force has little effect on civil war, terrorism and crime

•WMD will be available to many

•Oil reserves have peaked and will decline


•US traffic jams alone waste 2.3 billion gallons of gas

•Military Spending is 1 billion dollars•Income from crime is 2 billion dollars

•3-4 billion have access to good health and living conditions

•The Futurist Jan-Feb 2006, Glenn, J and Gordon, T: Update on the State of the Future


How we are delivering healthcare now

SPECIALTY CARE

Patient must see a series of specialists to obtain solution for medical problem

Inefficient

Delays diagnosis

Patient loses time and money by waiting

Industry loses time and money of employee

How will we deliver healthcare in the future?

DISEASE MANAGEMENT

Back Pain is the Disease Management Category

vs.

The fragmented specialty care of Neurosurgical/ Orthopedic treatment, Rehabilitation, Epidural injections from Anesthesiologists,

Psychological care, or Rehabilitation

With DISEASE MANAGEMENT the patient sees all the specialists in one setting and the disease problem is solved in that setting. This is

“One Stop Shopping” or “The Focused Factory Concept”

HOW WILL YOU BE DIFFERENT THAN YOUR COMPETITION?


• INTERDISCIPLINARY CARE and DISEASE MANAGEMENT will Distinguish you in the marketplace from others

• The INTERDISCIPLINARY relationship of neurologists, neurosurgeons and psychiatrists with the basic neuroscientists will

• give the neuroscience group power in the academic center and the ability to obtain research grants.

• This relationship will also promote the pre-eminence of the neuroscience group in the community.

Relationship between Genetics and BehaviorExperiment:

Two groups of subjects: 1/2 with long form, 1/2 with short form

Each presented fear image

fMRI scanned brain and found R amygdyla activity

R amygdala activity was significantly increased in those with short form who also had more fearful response

Study links genetic variation to differences in brain activityDid not verify serotonin activity in brainsReason for differences in behavior of individuals?

Criminal activity, suicide, affective illness, abnormal levels of anxiety

Bio-psychosocial aspects of pain

Pain can become a learned behavior

imaging shows more activation of primary motor sensory cortex and

patient has more sensitivity

H. Flor ( Lancet 357:1763, 2001)believes that structural changes occur in pain pathways with chronicity

leading to heightened excitibility in pain

Feeling pain may be generated without stimulus

Phantom limb

Stimulation of limb can reduce somatosensory field of pain (Adv Neurol 93: 195-204, 2003)

A New form of treatment based on Plasticity of Neurons

Bio-psychosocial aspects of pain

Chronic back pain- Flor, H.(Arthritis Rheum. 53:343-350, 2005)

With “solicitous spouse” present

exacerbated response

Imaging shows increased activity in Anterior Cingulate Cortex

Anticipation of pain can produce pain ( Brain 127:2339-2347, 2004)

Physician Compensation

2004 Neuro Physician Compensation

National Comparison

$891,336

$994,180

$233,315

$485,249

$213,362$161,344

$485,121

$190,973

$533,562

$333,535

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

Neurosurgery Neurology Orthopedic - Spine Psychiatry Physiatry

Median90th %ile

Source: MGMA-Physician Compensation and Production Survey – 2004 Report based on 2003 data

Physician Productivity

Median RVUs

17,967

8,612

16,079

5,330

8,244

3,7444,3804,597

8,7159,082

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Neu

rosu

rger

y

Neu

rolo

gy

Ort

hope

dic - S

pine

Psyc

hiat

ry

Phys

iatr

y

Total RVUsWork RVUs

Source: MGMA-Physician Compensation and Production Survey – 2004 Report based on 2003 data

med_59421.ppt - powerpoint presentation

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