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Baylor Scott & White

Plano - Neurology

A.J. Liu, Iman Rashid, Tu Lai, and Helen Marshall

need to think about the graphs and information we are putting in the slides - don't dump graphs in a presentation

we need to tell a story

This is not coordinated - make a plan - create a storyline from point A to point B

what's going on in this demographic?

high employee insurance - possibly large white population with high ethnic slices - so they can pay but what's wrong with them

what are the competitors doing in neuro - who are the big competitors, not just hospitals - movement disorders, alzheimer's, parkinsons, memory loss

substitutes?

example: if we have a higher young population they are more likely to be in trauma, can look at that and our trauma units, how many head trauma cases are we getting

example: here's bsw plano and here's the population which they have a high older age population - high incident rate of neuro disease - competitor services provided - they do these services

example: maybe you find a genetic problem that happens in a slice of this population - can we test for it?

example: what is the non white population - what problems occur in this population, investigate that

huge changing population in north dallas, what does it mean, genetically, environmental factors, age differences, what does it mean for the mix of patients coming into the hospital

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Our Recommendation

Implement the remote presence robot to combat our shortage of neurologists

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Executive Summary

Changes:	Increase of strokes Aging population
Challenge:	Shortage of neurologists Our competitors have a larger neuro patient volume
Solution:	Implement the Remote Presence Robot
Impact:	Larger patient capacity Increase access Lower per capita costs Increase quality of care

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Competitor Analysis

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Competitor Locations

Baylor Scott & White Plano
UTSW Dallas
Medical City Plano
Methodist Richardson
Texas Health Resources Plano

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Competitor Ratings

https://health.usnews.com/best-hospitals/area/tx/baylor-regional-medical-center-6740259/neurology-and-neurosurgery

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Service Area Analysis

Patients

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BSW Plano Service Area

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https://www.bswhealth.com/SiteCollectionDocuments/about/community-health-needs-assessments/CHNA-2019/FINAL_CHNA_PLANO.pdf

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https://www.bswhealth.com/SiteCollectionDocuments/about/community-health-needs-assessments/CHNA-2019/FINAL_CHNA_PLANO.pdf

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Population Health Issues

https://datacommons.org/place/geoId/4858016?utm_medium=explore&mprop=income&popt=Person&cpv=age%2CYears15Onwards&hl=en

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Health Issues and Implications

Health Issue	Smoking	Obesity	Binge Drinking	Mental Health Problems
Associated Neurology Problems	Stroke SVID Vascular Dementia	Stroke Reduced Cognitive Function Plasticity Brain Volume Altered Brain Structure	Wernicke’s Encephalopathy Korsakoff Psychosis Alcoholic Neuropathy Alcoholic Cerebellar Degeneration Alcoholic Myopathy Alcohol Withdrawal Syndrome Dementia	Stroke Sleep Disorders Depression Anxiety

https://datacommons.org/place/geoId/4858016?utm_medium=explore&mprop=income&popt=Person&cpv=age%2CYears15Onwards&hl=en

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Service Area Analysis

Physicians

The Texas state benchmark for non-physician providers is one provider for every 1,497 residents. The Denton County ratio was one provider to 1,966 residents, or 31.3% higher than the state benchmark. While Collin County was one provider to every 1,828 residents, or 22.1% higher than the state benchmark. The CHNA findings point to a greater need regarding access to non-physician primary care providers within the Plano Health Community.

1/ A portion of the services of each physician in an area to home area and to nearby areas in proportion to both the propensity of patients to travel for medical care and the availability of potential patients.

2/ The longer the time required for a patient to travel to the physician, the smaller the proportion of the physician's services allocated to the patient's area, with the precise relationship determined by a special analysis.

3/The final estimate of the availability of physician services in each small area is the sum of the service proportions of every physician in all of the small areas. The total supply of physician services is the same as the original total, but the distribution is adjusted to reflect the time that patients are willing to spend traveling to obtain medical care.

4/ Cost of travel

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Physicians per Capita

228 Physicians per 100,000 population in Plano

https://www.bestplaces.net/health/zip-code/texas/plano/75025

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External Trends

Physicians

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Physician Specialties with a Projected Shortage by 2032

https://www.dshs.state.tx.us/legislative/2020-Reports/TexasPhysicianSupplyDemandProjections-2018-2032.pdf

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Neurological Surgery Physician Supply Shortage

https://www.dshs.state.tx.us/legislative/2020-Reports/TexasPhysicianSupplyDemandProjections-2018-2032.pdf

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Neurology Physician Supply Shortage

https://www.dshs.state.tx.us/legislative/2020-Reports/TexasPhysicianSupplyDemandProjections-2018-2032.pdf

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External Trends

Neurological Diseases

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Average Number of Neurological Disorders Cases

https://onlinelibrary.wiley.com/doi/10.1002/ana.24897

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US Telemedicine Market By Specialty, 2018 and 2025 (USD Million)

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Environmental Trends

Other

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Percent of Obesity in Texas Compared to the U.S.

Orange Line	Texas
Blue Line	U.S.

https://txohc.org/communication/data-dashboard/obesity/

https://www.ahajournals.org/doi/10.1161/strokeaha.111.639922

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Stroke

Source: Texas DSHS, 2020

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https://www.statista.com/statistics/671251/rates-of-stroke-us-adults-by-age-and-gender/

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Top 10 Causes of Mortality in Texas and the U.S., 2012

https://www.dshs.texas.gov/chs/healthstatustexas2014.pdf

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Age-Adjusted Stroke Mortality Rate, per 100,000 People, All Ages by County, Texas, 2013-2017

Source: Texas DSHS, 2020

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Stroke Costs in the U.S.

In 2010, strokes cost the U.S. $71.55 billion to treat. By 2030, the costs of stroke are expected to double to $183.13 billion. By 2050, the financial impact of strokes in the U.S. could soar to more than $2.2 trillion.

https://www.saebo.com/blog/rising-cost-stroke-america/

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Project Problem Identification

Feels like you are missing a slide with the punch line - so the problem is about stroke - but what about it and this hospital?

I like that first one( “there will be an increase in the population age (65+) and the neurology services will increase since they’re most seen in elderly age group”- Break it up (stroke, neurovascular disease, etc)

Problems are obvious and relevant. Let's start internalizing

How many neurologist are at BSWP, How many are in the DFW area (service line), What’s the number of neurologist in plano per 100,000. Map their location(determine where they are)

If you’re a PA and you refer a patient where do you refer them? Their main campus is in Medical city (which it is)

Can you tie obesity in neurosciences? If it’s compelling enough to prove then go for it and if they are serious issues in plano then talk about it (I would guess that obesity rates in Plano is lower than mesquite, garland and Dallas county)

Go back to your information and PROVE IT TO ME

Think about the cost

I AM PLEASED WITH WHAT AM I SEEING

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Problem Identification

Neurologist shortage at Baylor Scott and White Plano
BSW Plano refers stroke patients to Medical City Plano, resulting in less patient volume

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Reviewing Competitor Comparisons

Baylor Scott & White Plano refers stroke patients to Medical City Plano due to their neurologist and technology shortage.

https://health.usnews.com/best-hospitals/area/tx/baylor-regional-medical-center-6740259/neurology-and-neurosurgery

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Number of Neurologists in Collin County

Baylor Scott and White Plano:

2 MDs in Clinical Neurophysiology
1 MD in Neuromuscular Medicine
2 DOs and 1 MD in Neurology

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US Neurologists per 100,000 Population

As of 2020, the US averages 4.6 neurologists per 100,000 population

https://www.aan.com/siteassets/home-page/conferences-and-community/member-engagement/learn-about-aan-committees/board-planning/2020-insights-report.pdf

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Vascular Neurologists in Service Area

There are only 16 vascular neurologists in the Dallas area

https://www.healthgrades.com/usearch?what=Vascular%20Neurology&entityCode=PS966&searchType=PracticingSpecialty&where=Dallas%2C%20TX&pt=32.780105%2C-96.800008&isMapOpen=true&pageNum=1&sort.provider=bestmatch&=

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Average Wait Time in Days for New Patients

https://advisory-prod.azureedge.net/-/media/project/advisoryboard/shared/research/slsa/research-reports/2019/navigating-the-neurologist-shortage_slsa_2019_pdf.pdf?rev=d5d3fd534f0443f88ea7ece159bd772b&hash=6FD560A9C33C59594FF94121C9662C8E

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Proposed Solution

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Updating BSW Plano’s Stroke Center

Making BSW Plano the number one comprehensive stroke center for EMTs to bring stroke patients to within a 15 minute window.

Introduce the RP-VITA (Remote Presence Virtual & Independent Telemedicine Assistant) robot:

FDA approved in 2012
Available to close to 100 hospitals in U.S. and world in 2014
Human sized robot 5-foot-6
Will allow neurologists to remotely diagnose a stroke and perform a neurological exam from anywhere in the world
Allows shift to growth in telemedicine

https://phys.org/news/2013-01-fda-green-rp-vita-hospital-robot.html#:~:text=The%20RP%2DVITA%20robot%2C%20to,interact%20with%20their%20hospital%20patients.

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Remote Presence Robot

Built-in mapping, obstacle detection, avoidance technology
iPad user interface allows direct connection to hospital and medical records
Supports acute-care scenarios with access to ultrasound and devices like electronic stethoscopes
Active patient monitoring in preoperative, perioperative, and post-surgical settings

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Working to Fix the Neurologist Shortage

Using the remote presence robot to initiate consultations with neurologists who work in other Baylor Scott and White locations with higher expertise
Allows more convenience to treat patients from remote/other locations if neurologists unavailable on site
Serves as a specialized medicine multiplier

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Cost Benefit Analysis Supporting Information

Monthly rental cost per robot: $3,000
Estimated 25 stroke patients per month
87% of stroke patients have ischemic strokes

Ischemic Stroke Patients: Average Cost is $9,100 per stay

Hemorrhagic Stroke Patients : Average Cost is $19,500 per stay

https://health.costhelper.com/treating-stroke.cost.html

https://www.kwipped.com/rentals/product/intelligent-telepresence-robot-sifrobot10/26513

https://pubmed.ncbi.nlm.nih.gov/24961186/

https://gcn.com/articles/2013/01/30/first-hospital-robot-fda-approval-telemedicine.aspx

https://washingtonnational.com/explore/why-insurance/how-to-cover-stroke-cost/

https://www.cdc.gov/stroke/types_of_stroke.htm#:~:text=risk%20for%20stroke.-,Ischemic%20Stroke,87%25

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Hospital Cost Benefit Analysis

Benefit	Cost
Monthly Robot Rental x 5	($15,000)
22 Average Ischemic Stroke Patients per Month	$200,200
3 Average Hemorrhagic Stroke Patients per Month	$58,500

Total Monthly Revenue	$243,700

https://health.costhelper.com/treating-stroke.cost.html

https://www.kwipped.com/rentals/product/intelligent-telepresence-robot-sifrobot10/26513

https://pubmed.ncbi.nlm.nih.gov/24961186/

https://gcn.com/articles/2013/01/30/first-hospital-robot-fda-approval-telemedicine.aspx

https://washingtonnational.com/explore/why-insurance/how-to-cover-stroke-cost/

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Break Even Analysis

Particulars Per Month	Amount
Fixed Cost	$15,000
Price per Patient	$9,748
Variable Cost per Patient	$5,000
Contribution Margin per Patient	$4,748
Break Even Point	3.16 Patients per Month

https://health.costhelper.com/treating-stroke.cost.html

https://www.kwipped.com/rentals/product/intelligent-telepresence-robot-sifrobot10/26513

https://pubmed.ncbi.nlm.nih.gov/24961186/

https://gcn.com/articles/2013/01/30/first-hospital-robot-fda-approval-telemedicine.aspx

https://washingtonnational.com/explore/why-insurance/how-to-cover-stroke-cost/

https://phys.org/news/2013-01-fda-green-rp-vita-hospital-robot.html

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Conclusion

Consults with off site experienced neurologists alleviates shortage
Serves as a force multiplier to existing onsite staff
Improves access to acute and post-stroke treatments
Enhances patient experience and health outcomes
Emphasizes team-based and coordinated care
New, innovative technology attracts patients and increases patient capacity