RURAL HOSPITALRURAL HOSPITALTERTIARY CARE LINKTERTIARY CARE LINK

Thomas H. Cogbill, M.D.

Gundersen Lutheran Medical FoundationLa Crosse, Wisconsin

Challenges of Rural SurgeryChallenges of Rural Surgery

Professional IsolationProfessional Isolation

Acquisition of New Technology/SkillsAcquisition of New Technology/Skills

Call CoverageCall Coverage

ReimbursementReimbursement

Administrative DutiesAdministrative Duties

Education/CME RequirementsEducation/CME Requirements

Research OpportunitiesResearch Opportunities

Volume-Based Quality InitiativesVolume-Based Quality Initiatives

Gundersen Lutheran Health Gundersen Lutheran Health SystemSystem

Fully IntegratedFully IntegratedPhysician-LedPhysician-Led

453 Physicians453 Physicians6159 Employees6159 Employees

Main Clinic – La Crosse, WisconsinMain Clinic – La Crosse, Wisconsin(population 51,000) (population 51,000)

12 General Surgeons12 General Surgeons

Branch Clinics – 25 LocationsBranch Clinics – 25 Locations9 General surgeons9 General surgeons

Regional Surgeon OperationsRegional Surgeon Operations

EndoscopyEndoscopy 28%28%GynecologyGynecology 21%21%HerniaHernia 10%10%ColorectalColorectal 9% 9%Biliary TractBiliary Tract 8% 8%OrthopedicOrthopedic 7% 7%Cesarean SectionCesarean Section 5% 5%BreastBreast 5% 5%OtherOther 7% 7%

CommunicationCommunication

Med-Link Telephone SystemMed-Link Telephone System

Distance-Learning SitesDistance-Learning Sites

Admission/Referral NurseAdmission/Referral Nurse

E-mailE-mail

TransportationTransportation

Med-Link Helicopter SystemMed-Link Helicopter System

Ground TransportationGround Transportation

3 States, 19 Counties3 States, 19 Counties

All Levels of CareAll Levels of Care

Call CoverageCall Coverage

Main Clinic – Skill Set MismatchMain Clinic – Skill Set Mismatch

Other Regional SurgeonsOther Regional Surgeons

New Technology AcquisitionNew Technology Acquisition

Surgical Skills LaboratorySurgical Skills Laboratory

Main Clinic Case ParticipationMain Clinic Case Participation

On-site ProctoringOn-site Proctoring

Administrative HelpAdministrative Help

Salary and BenefitsSalary and Benefits

Coding and ReimbursementCoding and Reimbursement

Patient Satisfaction SurveysPatient Satisfaction Surveys

Department-Wide Registry of CasesDepartment-Wide Registry of Cases

Maintenance of CertificationMaintenance of Certification

EducationEducation

CME OpportunitiesCME Opportunities

Surgical M & M ConferenceSurgical M & M Conference

Distance LearningDistance Learning

TeachingTeaching

Rural Surgery ElectiveRural Surgery Elective

ATLS InstructorsATLS Instructors

RTTDC CoursesRTTDC Courses

Residency LecturesResidency Lectures

ResearchResearch

Landercasper et al: Landercasper et al: Spectrum of ruralSpectrum of rural general surgerygeneral surgery, , Arch SurgArch Surg 1977 1977

Bintz et al: Bintz et al: Role of rural surgeon in Role of rural surgeon in traumatrauma, , J TraumaJ Trauma 1997 1997

Callahan: Callahan: Experience of rural general Experience of rural general surgeonsurgeon, , JACSJACS 1994 1994