Introduction: Although there is evidence that surgery produces superior outcomes than medication therapy alone in patients with medically refractory focal epilepsy, it has been woefully underutilized in the United States. One possible explanation is that patients may not be referred to centers proficient in surgical treatments. University of California, Irvine (UCI) is the only adult Level 4 epilepsy center designated by the National Association of Epilepsy Centers (NAEC) in Orange County, California. Recently, UCI entered strategic partnerships with two large nearby epilepsy centers without epilepsy surgeons to surgically treat patients who have completed pre-surgical work-up.
Methods: We analyzed surgical data associated with all patients undergoing epilepsy surgery before and after institution of strategic partnerships with two large nearby epilepsy centers. Patients underwent all pre-surgical work-up at the referring center and were presented during epilepsy management conference by the referring neurologist. After the perioperative period, patients were transitioned back to the care of the referring center. Number of patients and surgeries performed, types of surgeries performed, and charges and revenue were evaluated during this timeframe.
Results: Five patients underwent nine epilepsy surgeries during the year prior to initiation of partnerships while 68 patients underwent 105 surgeries during the subsequent year (a tenfold increase in number of surgeries). The Case-Mix index increased from 2.982 to 3.058 and case complexity increased to include hemispherectomy, extratemporal resections, and stereoelectroencephalography (SEEG). The total revenue generated during this timeframe also increased from $615,326 to $3,111,473.
Conclusions: We describe a novel means to increase access to surgical care by creating strategic partnerships with large nearby epilepsy centers that cannot offer epilepsy surgery treatments. We believe that these partnerships are reproducible in other centers, can be mutually beneficial to all centers involved, and ultimately improve patient care.
Patient Care: Here we describe a situation where there was a need to handle a large patient volume, which led to collaboration between centers that improved patient care. Ideally, this study will provide ideas for how those in attendance can potentially develop partnerships with other nearby facilities to improve the care of their patients.
Learning Objectives: By the conclusion of this session, participants should be able to do the following: 1) Describe how partnerships among nearby epilepsy centers can improve patient care, 2) Discuss the pros and cons of receiving additional patients from nearby epilepsy centers, and 3) Identify potential strategies to collaborate with other centers to increase surgical volume and access to care.