Watson Meagan M, Kerr Wesley T, Bean Meagan, Strom Laura
Department of Neurology (MMW, MB, LS), University of Colorado, Aurora; and Department of Neurology (WTK), University of Michigan, Ann Arbor.
Neurol Clin Pract. 2023 Aug;13(4):e200179. doi: 10.1212/CPJ.0000000000200179. Epub 2023 Jul 6.
Projections from recent studies suggest that by 2025, there will not be enough neurologists to meet the demand in 41 states. In this study, we investigate the financial impact and improved access to care for persons with epilepsy that is possible by implementing a multidisciplinary treatment clinic for persons with functional seizures (FS), previously referred to as psychogenic nonepileptic seizures, thus separating those patients out of an epilepsy clinic.
This observational retrospective study used real-time data of 156 patients referred to an FS clinic integrated into a tertiary care epilepsy center to simulate its effect on epilepsy division access and finances. Access was measured using simulations of the number of return patient visits (RPVs) and new patient visits (NPVs) of patients with FS to a dedicated epilepsy clinic, based on survey results inquiring about the standard of care without the FS clinic. Finances were simulated using the resultant access multiplied by respective wRVU and reimbursement per code.
Treatment of 156 patients with FS in a multidisciplinary FS clinic resulted in 343 newly opened NPVs, reimbursement of $102,000, and 1,200 wRVUs in our dedicated epilepsy clinic. There were 686 RPVs, $103,000 in reimbursement, and 1,320 wRVUs. Relative to the total number of NPVs with epilepsy clinic epileptologists, 343 NPVs represent a biennial 15.5% increase in available new patient visit slots.
Our findings describe the financial viability of integrating a treatment clinic for persons with FS by directing them to FS-specialized treatment and thereby increasing access for patients with probable epilepsy to the dedicated epilepsy clinic. This study provides a potential solution to the national mismatch in the supply and demand of neurologists and an initial framework to use for those who wish to establish or integrate FS services in their institution.
近期研究预测，到2025年，41个州将没有足够的神经科医生满足需求。在本研究中，我们调查了通过为功能性癫痫发作（FS，以前称为心因性非癫痫性发作）患者设立多学科治疗诊所，将这些患者从癫痫诊所分离出来，对癫痫患者的经济影响以及改善其就医机会的情况。
这项观察性回顾性研究使用了转诊至一家纳入三级医疗癫痫中心的FS诊所的156例患者的实时数据，以模拟其对癫痫科就医机会和财务状况的影响。根据询问无FS诊所时的医疗标准的调查结果，通过模拟FS患者返回专科癫痫诊所的复诊患者就诊次数（RPV）和新患者就诊次数（NPV）来衡量就医机会。使用由此产生的就医机会乘以各自的工作相对价值单位（wRVU）和每个代码的报销金额来模拟财务状况。
在多学科FS诊所治疗156例FS患者，在我们的专科癫痫诊所产生了343个新开放的NPV、102,000美元的报销金额和1,200个wRVU。有686次RPV、103,000美元的报销金额和1,320个wRVU。相对于癫痫诊所神经科医生的NPV总数，343个NPV代表可利用的新患者就诊时段每两年增加15.5%。
我们的研究结果表明，通过将FS患者引导至FS专科治疗，设立FS治疗诊所具有经济可行性，从而增加了可能患有癫痫的患者进入专科癫痫诊所的机会。本研究为全国神经科医生供需不匹配问题提供了一个潜在解决方案，并为希望在其机构中建立或整合FS服务的人员提供了一个初始框架。
