Specialists will join to fight against multiple sclerosis
February 6, 2004
Jeanne Lang Jones
Puget Sound Business Journal (Seattle)
A group of local doctors is forming an innovative treatment-and-research hub for multiple sclerosis, a mysterious, debilitating disease that, on a per capita basis, afflicts more people in Washington than in any other state.
The newly formed not-for-profit MS Hub plans to serve MS patients in a five-state region that includes Washington, Idaho, Montana, Alaska and Hawaii.
If it opens as planned in July, in a 40,000-square-foot clinic in Seattle's Metropolitan Park office complex near South Lake Union, it will be the largest such MS center in the world, said founding neurologist Craig Smith.
But the new center must first overcome a number of challenges, including raising $20 million to set up its facility and programs. Just over $2 million has been pledged so far from donors that include pharmaceutical companies interested in running clinical trials at the MS Hub.
The doctors' group must also figure out how to support time-consuming patient office visits that typically are money-losers at other medical institutions.
"Our guidance to Craig has always been it's a great vision, but we do think it is challenging financially to support it," said Marcel Loh, chief operating officer at Swedish Medical Center's Providence campus.
The state's large base of MS patients, estimated at more than 10,000, will enable the medical hub to become "a model for other systems," as well as a leading MS research center, said Smith.
Smith is an internationally known expert on MS who left Swedish Medical Center's MS Center last fall to set up the hub. He describes the newly formed group as a sort of neutral "Switzerland" bringing together MS specialists from a number of prominent local medical institutions but not governed by any institution. Physicians affiliated with the center will form the MS Hub Medical Group.
The MS Hub program initially will include six neurologists, as well as nurse practitioners, registered nurses and a rehabilitation doctor, Smith said. The group plans to operate a $3 million state-of-the-art magnetic resonance imaging (MRI) center. Over time, the Seattle-based group hopes to set up satellite locations, with its first outreach clinics in Bellevue and Anchorage.
Multiple sclerosis, or MS, is a chronic disease in which a substance surrounding the nerves is destroyed, impairing their function. Symptoms vary widely between individuals and over time, with patients experiencing bouts of sharp deterioration followed by periods of recovery.
"It's a terrible disease and the people in need of service really need it, but from a financial standpoint there is not really reimbursement for the costs associated with delivering that service," Loh said. "A lot will depend on fund raising and philanthropy and Craig has some good support in that area."
Unlike the typical 15-minute office visit, examinations of MS patients usually take more than an hour, Smith said. "Even in a non-managed-care environment, you don't get paid to spend that much time with a patient."
"We were seen in various institutions as non-profitable centers, so we were not supported to actually care for patients in the way they should be cared for," said Smith. "Taking care of an MS patient's needs can take a long time.
"Now we are driven by what matters most to the patient, not what matters most at the institution, and we are small enough that we can actually consider that," Smith said.
Smith and his colleagues hope to make up for those costs by relying more on nurse practitioners for routine care and by providing lucrative ancillary services such as MRI scans and physical and occupational therapy themselves, rather than relying on a hospital.
"The way health-care reimbursements work now, these ancillary activities are more profitable than the patient seeing the doctor in their office," said MS Hub administrative director Michael Uradnik.
They also plan to hold down costs by relying on electronic patient record-keeping that will allow patients to use a secure Web portal to schedule appointments, check billings and communicate with their doctors.
MS Hub, whose nonprofit status is pending, has established a foundation board to help with its fund-raising campaign and an operating board to help hone its business plan. If the hub is successful as a comprehensive treatment center for MS patients, Loh said Swedish would not duplicate its services. Other medical centers may take the same approach. That would allow the MS hub to capture most of the revenue from patient treatment while allowing hospitals to cut infrastructure costs.
The hub is in its startup phase and will be working out its relationships with area hospitals going forward. It does plan to work closely with Veterans Affairs medical centers in Seattle and Portland, which are collaborating to improve MS patient care under a four-year federal grant establishing a regional MS medical center for excellence.
The MS Medical Hub grew out of an informal dinner club where local doctors specializing in treating MS could talk about their most difficult cases and share ideas for treatment.
"One of the biggest challenges they had was the high incidence of MS relative to the proportionally small number of doctors available to care for persons with MS," said Patty Shepherd-Barnes, president of the Greater Washington chapter of the National MS Society, which also raised the issue at a board retreat three years ago.
Because there are so many MS cases here, it can take as long as six months for a newly diagnosed patient to be seen by a neurologist specializing in MS, Shepherd-Barnes said.
The MS Society will work with the MS Hub to provide educational materials. The MS Hub's plans include operating an on-site multimedia learning center and a Telehealth program integrated with a nationwide consortium of MS centers.
No margin, no mission
A key challenge will be tweezing better reimbursements out of insurers. Uradnik plans to argue the MS Hub provides more comprehensive care that will produce better outcomes, reducing the need for more costly hospital care.
"We have a critical mass of MS patients and that should mean something to those insurance companies we work with," Uradnik said.
But it may be difficult to persuade publicly funded insurance plans, such as Medicare and Medicaid, that typically provide substantially lower reimbursements for their care, said Bob Perna, director of health-care economics for the Washington State Medical Association.
"What we've seen is very often the cost of delivering care outstrips the revenue stream that comes from seeing those patients. A number of practitioners have gotten themselves into difficulty and some even have closed as a result of having too open an access portal for patients," Perna said. "It's a sad commentary but if the delivery network is to stay viable there has to be some degree of screening and constraint to maintain some healthy economic balance."
But Smith expects the hub's business model will allow it to subsidize care for patients who cannot afford the cost of treatment.
"This has never been done -- and there are many reasons it's never been
done -- all of which is putting gray hairs on my head," Smith said.
Copyright © 2004, American City Business Journals Inc.