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The financial contribution of the multiple sclerosis specialist.

ABSTRACT: To examine the financial effect of the multiple sclerosis (MS) specialist on the academic health center (AHC).Using data derived from an academic MS center with respect to patient numbers and practice pattern regarding diagnostic studies and disease-modifying therapies (DMT) coupled with reasonable assumptions regarding the profit margin for tests and treatments, 1 full-time MS specialist (1 clinical full-time equivalent [cFTE]) may annually generate downstream revenue exceeding $8,000,000. If all diagnostic studies and therapies were obtained at the facility, the potential revenue generated for the facility can exceed $25,000,000 per 1 cFTE. These calculations do not include the professional net revenue generated by referrals to other professionals.With current models of reimbursement for health care, the MS specialist provides an enormous potential source of revenue for the AHC. This information is critically important in obtaining institutional support for the provision of labor-intensive MS care.

SUBMITTER: Berger JR

PROVIDER: S-EPMC6081969 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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The financial contribution of the multiple sclerosis specialist.

Berger Joseph R JR

Neurology. Clinical practice 20170601 3

<h4>Purpose of review</h4>To examine the financial effect of the multiple sclerosis (MS) specialist on the academic health center (AHC).<h4>Recent findings</h4>Using data derived from an academic MS center with respect to patient numbers and practice pattern regarding diagnostic studies and disease-modifying therapies (DMT) coupled with reasonable assumptions regarding the profit margin for tests and treatments, 1 full-time MS specialist (1 clinical full-time equivalent [cFTE]) may annually gene ...[more]

PMID: 30107024

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Project description:Next to the disseminated clinical symptoms, cognitive dysfunctions are common features of multiple sclerosis (MS). Over the recent years several different MRI measures became available representing the various features of the pathology, but the contribution to various clinical and cognitive functions is not yet fully understood. In this multiparametric MRI study we set out to identify the set of parameters that best predict the clinical and cognitive disability in MS. High resolution T1 weighted structural and high angular resolution diffusion MRI images were measured in 53 patients with relapsing remitting MS and 53 healthy controls. Clinical disability was inflicted by EDSS and cognitive functions were evaluated with the BICAMS tests. The contribution of lesion load, partial brain, white matter, gray matter and subcortical volumes as well as the diffusion parameters in the area of the lesions and the normal appearing white matter were examined by model free, partial least square (PLS) approach. Significance of the predictors was tested with Variable Importance in the Projection (VIP) score and 1 was used for threshold of significance. The PLS analysis indicated that the axial diffusivity of the NAWM contributed the most to the clinical disability (VIP score: 1.979). For the visuo-spatial working memory the most critical contributor was the size of the bilateral hippocampi (VIP scores: 1.183 and 1.2 left and right respectively). For the verbal memory the best predictors were the size of the right hippocampus (VIP score: 1.972), lesion load (VIP score: 1.274) and the partial brain volume (VIP score: 1.119). In case of the information processing speed the most significant contribution was from the diffusion parameters (fractional anisotropy, mean and radial diffusivity, VIP scores: 1.615, 1.321 respectively) of the normal appearing white matter. Our results indicate that various MRI measurable factors of MS pathology contribute differently to clinical and cognitive disability. These results point out the importance of the volumetry of the subcortical structures and the diffusion measures of the white matter in understanding the disability progression.

Project description:Neuroinflammation is the coordinated response of the central nervous system (CNS) to threats to its integrity posed by a variety of conditions, including autoimmunity, pathogens and trauma. Activated astrocytes, in concert with other cellular elements of the CNS and immune system, are important players in the modulation of the neuroinflammatory response. During neurological disease, they produce and respond to cellular signals that often lead to dichotomous processes, which can promote further damage or contribute to repair. This occurs also in multiple sclerosis (MS), where astrocytes are now recognized as key components of its immunopathology. Evidence supporting this role has emerged not only from studies in MS patients, but also from animal models, among which the experimental autoimmune encephalomyelitis (EAE) model has proved especially instrumental. Based on this premise, the purpose of the present review is to summarize the current knowledge of astrocyte behavior in MS and EAE. Following a brief description of the pathological characteristics of the two diseases and the main functional roles of astrocytes in CNS physiology, we will delve into the specific responses of this cell population, analyzing MS and EAE in parallel. We will define the temporal and anatomical profile of astroglial activation, then focus on key processes they participate in. These include: (1) production and response to soluble mediators (e.g., cytokines and chemokines), (2) regulation of oxidative stress, and (3) maintenance of BBB integrity and function. Finally, we will review the state of the art on the available methods to measure astroglial activation in vivo in MS patients, and how this could be exploited to optimize diagnosis, prognosis and treatment decisions. Ultimately, we believe that integrating the knowledge obtained from studies in MS and EAE may help not only better understand the pathophysiology of MS, but also uncover new signals to be targeted for therapeutic intervention.

Dataset Information

The financial contribution of the multiple sclerosis specialist.

Publications

The financial contribution of the multiple sclerosis specialist.

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