Name Indianapolis Neurosurgical Group (ING)
Location: Indianapolis, Ind.
Physicians: 26-14 adult and two pediatric neurosurgeons, two orthopedic spine surgeons, two interventional neuroradiologists, three physiatrists, two pain anesthesiologists and a neuropsychologist.
Employees: 143-a CEO, CFO, operations manager, human resource manager, two office managers, 13 clinical nurses, a research nurse, two nurse practitioners, a physician assistant, six surgical technicians, 23 medical secretaries and 91 support personnel.
Facilities: Two large offices, 10 smaller offices; 35,000 square feet in all.
Philosophy
ING specializes in various disciplines of brain and spine surgery. Physicians work in a highly efficient and integrated fashion. A goal has been to attract talented surgeons and encourage them to focus and develop special skills early in their careers. The group maintains a commitment to trauma, emergencies and indigent care. Physicians are encouraged to teach at all levels and to participate in clinical research. ING strives to maintain excellent service to patients, referring physicians and hospitals.
Specialization
The group believes that referring physicians and sophisticated patients want neurosurgeons that have special expertise in specific diseases and surgical procedures. In this practice a patient is usually routed to the physician most experienced with his disorder.
ING’s philosophy of subspecialization has been a key to the establishment of a statewide referral network. For example, three neurosurgeons and two interventional radiologists exclusively perform vascular surgery. Each vascular neurosurgeon averages about 50 to 70 major intracranial vascular cases per year. The neurointerventionalists annually perform approximately 200 endovascular procedures. ING’s present policy is to recruit fellowship-trained physicians who are willing to focus on their area of expertise and to accept some limitations on the scope of their practice.
Practice management.
The CEO, managing partner and four elected physicians form an executive committee, which is entrusted with the day-to-day running of the practice. Other physicians also serve on administrative, financial, education and research, marketing, and quality improvement committees.
An elaborate voice mail system to facilitate rapid communication between physicians and staff has been indispensable for efficient practice. Night call is brutal but is shared equally. Older surgeons who have opted off night and weekend call accept a stiff financial penalty. On-call physicians take the following day off. All physicians practice as clinical equals from their first day at ING. No surgeon has ever left the practice.
Activities
Lack of intra-group competition has fostered physician camaraderie, frequent informal consultations, joint care of patients and operating together. It is our belief that this relationship improves patient care and makes neurosurgery more enjoyable. Formal clinical meetings include a weekly spine conference and a biweekly vascular conference, at which preoperative cases are discussed. ING participates in weekly clinical rounds and coordinates distinguished visitor conferences with neurosurgical colleagues at Indiana University. Regularly scheduled quality improvement conferences for peer review are also held.
Teaching and presenting at national meetings, publishing, and clinical research are encouraged. A senior level resident from the neurosurgery program at Indiana University rotates on ING’s vascular service. Medical students and house staff from other disciplines also rotate through the service. ING sponsors the Think First program for central Indiana and supports a full-time employee for this purpose.
Other initiatives
ING has a program for advanced training in spine for surgeons who have completed residency. ING’s anesthesia pain section offers a fellowship program in pain management. A neuro- interventional fellowship is being planned that will train qualified neurosurgeons or radiologists in endovascular surgery. ING participates in a training program for neurosurgery physician assistants. Recently the group has invested in its first MRI scanner. Although the neurosurgeons in the group who specialize in complex spine are capable of the full range of spinal operations, the addition of two spine orthopedic surgeons has contributed to the expertise of the practice. Physiatrists and pain anesthesiologists that are integrated into the practice have improved ING’s competitive advantage in the spine arena, which has become highly competitive.
Future plans
A concerted effort to measure clinical outcomes is in the planning stage. Disparity in reimbursement for spine versus intracranial procedures is forcing us to rethink a 30-year policy of equally shared income, which has made subspecialization possible. Continued growth with bright, energetic physicians and surgeons is essential for a practice to remain viable in the future.