Although neuroscience volumes have been one of the best areas of recent growth for hospitals, high growth for some procedures may not be sustained in future years. In fact, volumes for some neuroscience procedures are even predicted to decline in the hospital setting.
Across some services, the drop will result from a shift in site of service, migrating out of hospital settings. For example, the advent of portable sleep monitoring is pushing many hospital-based sleep services to the patient home. Even though total sleep study volumes are projected to increase 66% by 2020, hospital outpatient department (HOPD) volumes will decline by an estimated 12%.
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While many neuroscience programs have robust direct-to-patient marketing programs for stroke and spine, traditional consumer marketing methods may not have the same return on investment for all subspecialty services, such as epilepsy or Parkinson’s disease. Many of these programs may have existing capacity issues due to high demand and/or a limited number of specialists.
Patients also tend to come from specific demographics, and self-referrals are often less common than for other neuroscience areas, such as spine. Given these characteristics, it is unlikely that expensive, mass marketing techniques will result in large returns for these services.
Determine whether to market subspecialty services
Some programs may not need to market their subspecialty services at all. When deciding whether to market services, programs must consider internal capacity, competition, and profitability. Programs experiencing capacity issues and long wait times may derive little benefit from marketing their subspecialty offerings and may better use resources for other services.
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Although spine procedures are considered to be a bread and butter service of hospital business units, there are a number of challenges that will affect the pace at which these procedures are poised to grow in the future. The traditional growth drivers of the past, such as demographics and advances in technology, may actually temper growth in coming years. The utilization of certain spine procedures, spinal fusion in particular, may begin to slow as baby boomers continue to age—the utilization of spine surgery peaks between ages 45 and 64.
Advances in technology and treatment techniques may also reduce inpatient volumes by pushing procedures to outpatient settings (see the Marketing and Planning Leadership Council’s Service Line Forecast Compendium for inpatient and outpatient forecasts).
Commercial payers and government agencies are also increasing their scrutiny of spine surgery utilization, putting additional pressure on growth prospects. For example, CMS recently announced (and then postponed) plans to launch a demonstration in 11 states evaluating the appropriateness of high-end procedures, including common spine procedures, by conducting prepayment reviews to ensure medical necessity before providers are reimbursed. Such efforts, along with news coverage putting “unnecessary” utilization of spine procedures in the spotlight, are likely to push providers to offer more conservative therapies as penalties and denied payments increase.
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Developing a multidisciplinary stroke service is an emerging imperative for institutions looking to drive outcome improvements and extend patient care coordination across the broader continuum. Multidisciplinary care consists of the following components:
1) Interdisciplinary team structure: The ideal model includes:
- Medical director
- Clinical stroke coordinator
- Vascular neurologists
- Neuroscience nurses
- Rehabilitation specialists
- Operations coordinator
The collaborative nature of this type of stroke services allows the clinicians to develop a robust and individualized, nuanced treatment plan for each patient. Previous research has shown that such models result in incremental improvement in both outcomes and patient satisfaction by facilitating streamlined decision making and standardization of processes and goals.
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