rural hospital tertiary care link thomas h. cogbill, m.d. gundersen lutheran medical foundation la...
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RURAL HOSPITALRURAL HOSPITALTERTIARY CARE LINKTERTIARY CARE LINK
Thomas H. Cogbill, M.D.
Gundersen Lutheran Medical FoundationLa Crosse, Wisconsin
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Challenges of Rural SurgeryChallenges of Rural Surgery
Professional IsolationProfessional Isolation
Acquisition of New Technology/SkillsAcquisition of New Technology/Skills
Call CoverageCall Coverage
ReimbursementReimbursement
Administrative DutiesAdministrative Duties
Education/CME RequirementsEducation/CME Requirements
Research OpportunitiesResearch Opportunities
Volume-Based Quality InitiativesVolume-Based Quality Initiatives
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Gundersen Lutheran Health Gundersen Lutheran Health SystemSystem
Fully IntegratedFully IntegratedPhysician-LedPhysician-Led
453 Physicians453 Physicians6159 Employees6159 Employees
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Main Clinic – La Crosse, WisconsinMain Clinic – La Crosse, Wisconsin(population 51,000) (population 51,000)
12 General Surgeons12 General Surgeons
Branch Clinics – 25 LocationsBranch Clinics – 25 Locations9 General surgeons9 General surgeons
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Regional Surgeon OperationsRegional Surgeon Operations
EndoscopyEndoscopy 28%28%GynecologyGynecology 21%21%HerniaHernia 10%10%ColorectalColorectal 9% 9%Biliary TractBiliary Tract 8% 8%OrthopedicOrthopedic 7% 7%Cesarean SectionCesarean Section 5% 5%BreastBreast 5% 5%OtherOther 7% 7%
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CommunicationCommunication
Med-Link Telephone SystemMed-Link Telephone System
Distance-Learning SitesDistance-Learning Sites
Admission/Referral NurseAdmission/Referral Nurse
E-mailE-mail
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TransportationTransportation
Med-Link Helicopter SystemMed-Link Helicopter System
Ground TransportationGround Transportation
3 States, 19 Counties3 States, 19 Counties
All Levels of CareAll Levels of Care
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Call CoverageCall Coverage
Main Clinic – Skill Set MismatchMain Clinic – Skill Set Mismatch
Other Regional SurgeonsOther Regional Surgeons
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New Technology AcquisitionNew Technology Acquisition
Surgical Skills LaboratorySurgical Skills Laboratory
Main Clinic Case ParticipationMain Clinic Case Participation
On-site ProctoringOn-site Proctoring
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Administrative HelpAdministrative Help
Salary and BenefitsSalary and Benefits
Coding and ReimbursementCoding and Reimbursement
Patient Satisfaction SurveysPatient Satisfaction Surveys
Department-Wide Registry of CasesDepartment-Wide Registry of Cases
Maintenance of CertificationMaintenance of Certification
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EducationEducation
CME OpportunitiesCME Opportunities
Surgical M & M ConferenceSurgical M & M Conference
Distance LearningDistance Learning
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TeachingTeaching
Rural Surgery ElectiveRural Surgery Elective
ATLS InstructorsATLS Instructors
RTTDC CoursesRTTDC Courses
Residency LecturesResidency Lectures
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ResearchResearch
Landercasper et al: Landercasper et al: Spectrum of ruralSpectrum of rural general surgerygeneral surgery, , Arch SurgArch Surg 1977 1977
Bintz et al: Bintz et al: Role of rural surgeon in Role of rural surgeon in traumatrauma, , J TraumaJ Trauma 1997 1997
Callahan: Callahan: Experience of rural general Experience of rural general surgeonsurgeon, , JACSJACS 1994 1994