Title Headline Goes Here. Preferrably in All Caps and No More ...

Title Headline Goes Here. Preferrably in All Caps and No More ...

REINVENTING AND REBUILDING the Neurological Surgery Service at The University of Washington Medical Center Manny Ferreira Jr. MD, PhD SERVICE IN 2014 Decline in Neurosurgical presence at the UWMC. Surgical Volumes decreased to a nadir of approximately 400 operations/year. OR blocks to 5/week. Unaligned Hospital Administration and SOM 2 UWMC SWOT ANALYSIS

Voted #1 Hospital in WA SOM campus Admin/SOM disconnect Cancer hospital Uncoordinate d services New Alvord Brain Tumor

Center Poor transfer/refe rral system SCCA/FHCC/ SCH Multidiscipli nary team location UW Medicine expansion

Elective Surgery RVU comp. model Strength s W Weaknesses Cumulative Community competition

Insurance networks and contracts World Expert colleagues S O Opportunitie s T Threats

3 BUILDING MOMENTUM Choose a program to lead (Minimally Invasive Skull base and pituitary) Housed in the Neurosurgical clinic. New volume and profitable. Will drive the mission for other subspecialty development (e.g. functional and spine). Multidisciplinary alignment (across departments around a program) Capacity: OR block, equipment and hospital (floor/ICU beds). 4 MULTIDISCIPLINARY TEAM ALIGNMENT ENT Department: 4 Endoscopic skull base, 1 otologist, 2 H/N surgeons, 2 laryngologists. Endocrinology (Medicine Department): 3

neuro-endocrinologists. Ophthalmology Department: 1 dedicated neuro-ophthalmologist. Radiation Oncology: 4 CNS rad oncs Medical and Neuro-oncology (Departments of Medicine and Neurology). APP team (2 dedicated to program). 5 MULTIDISCIPLINARY TEAM ALIGNMENT 1. ENT and Neurosurgery profit sharing (50/50 RVU split down the middle) Equal Partners in the business. 2. ENT and Neurosurgery combined capital requests (OR and clinic) Endoscopic Equipment in OR and towers in Neurosurgery clinic. 3. ENT and Neurosurgery funding of neuroendocrinologists. MTF Clinic staffing

M-F Inpatient service coverage Outreach. 6 BUILDING OPERATIVE BLOCK (RALLYING THE TROOPS) Saturday Incentive surgery (double block time). Additional Compensation for elective surgeries. Funded by Department and Profitable for Hospital. After Hours surgery (out of block time). Wednesday (Grand Rounds/ Academic Day). 8:30AM start Partnerships with colleagues (ENT and Ortho). In 2 years 5 blocks/week to 13 blocks/week, with 2 bump/open blocks. 7

MULTIDISCIPLINARY TEAM ALIGNMENT Growth leads to program expansion: ENT Department: 1 otologist, 1 H/N surgeon and 1 laryngologist (9 total). Endocrinology (Medicine Department): 1 neuro-endocrinologists (4 total). Neurosurgery: 2 skull base surgeons (4 total). 8 CONTINUED GROWTH WITH ALIGNMENT Neurological Surgery Growth at the UWMC 1200 1000 800 600

400 200 0 2015 2016 Total Cases 2017 Skull Base/Tumor 2018 Functional 2019 Spine

9 SKULL BASE/TUMOR AND PITUITARY PROGRAM Neurological Surgery Growth at the UWMC 800 700 600 500 400 300 200 100 0 2015 2016 Skull Base/tumor 2017 Endoscopic

2018 2019 Craniotomy 10 VOLUMES AND HOW THIS IMPROVES RESIDENT TRAINING Skull Base exposure to junior/midlevel residents (early fellowship application) Intern (PGY1), PGY3/4 and PGY7 Partnership with Skull Base and Rhinology Fellows ENT training of the neurosurgical resident Endoscopic Towers and Scopes in Neurosurgery clinic. Pre and postop Scoping by

neurosurgery residents and skull base fellow. NS resident first assist for all Endoscopic and otology procedures 11 LEARNING POINTS FROM SWOT Strengths and Opportunities outweighed Weaknesses Elective Hospital for growing the program. Neurological Surgery Department could lead the alignment between departments (address Weaknesses). Allow focus on Threats. 12 KEY INITIATIVES NEXT 1-3 YEARS Further Development and Integration of the Alvord Brain Tumor Center. Hospital acquisitions and integration

(NWH and VMC). Insurance Carrier direct contracting for developed subspecialty programs. 13 SUMMARY/CONCLUSIONS Neurological Surgery Department leads the vision and alignment between departments. Financially profitable areas of growth (drive the mission) lead the way for all subspecialty development. Movement Disorders program (neurologist in neurosurgery clinic). Endoscopic spine (pain and physiatry support). 14

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