Co-owners of group specializing in brain, spine and peripheral nervous system disorders dish on practice, life, future.
Parkway Neuroscience and Spine Institute is led by co-owners and managing partners Dr. Neil O’Malley and Dr. Brian Holmes.
The group specializes in the diagnosis, management and treatment of disorders of the brain, spine and peripheral nervous system. PNSI offers multiple modalities of treatment at its facilities on Western Maryland Parkway, Hagers-
A few statistics, all since January 2016:
• Parkway Neuroscience and Spine Institute had 43,927 patient visits.
• Parkway Surgery Center performed 14,613 invasive spine procedures.
• Parkway Physical Therapy had 15,385 patient visits and treatments since January of 2016.
O’Malley came to the Hagers-
town area in 1996 after completing neurosurgery training at Thomas Jefferson University in Philadelphia. Holmes arrived about 15 years ago from Scranton, Pa., and prior to that from Hershey Medical Center in Pennsylvania, where he was an associate professor of neurosurgery.
O’Malley took time from clinical, business and personal responsibilities to answer some questions posted by Crossroads Business Journal. The exchange took place by email.
What is the philosophy at the foundation of your business and medical progress?
Our practice has been in existence since 1999 and we are now in our 11th year as Parkway Neuroscience and Spine Institute. Our mission or philosophy at Parkway has remained the same: to provide state-of-the-art diagnosis, management and treatment of disorders of the brain, spine the peripheral nervous system to the local community and the Tri-State area. We have accomplished this by creating a Neuroscience Center of Excellence that offers multiple modalities of treatment, all under one roof. This allows us to maintain continuity and quality of care across the spectrum of treatment for all types of patients. Our therapists and pain specialists, as well as surgeons, are in constant contact with each other about each individual patient, thereby allowing us to offer the most appropriate care for each patient’s particular need. We are often able to avoid the inconvenience of multiple office visits by engaging two or more specialists’ expertise at one visit with no additional cost to the patient. In this respect, our neuroscience center is unique in the region.
How do you balance the demands of being a physician and leading a complex organization?
I would like to think that we are redefining the role of physician executive, but in reality, we are reinvigorating or reprising a classic role that physicians played half a century ago when doctors ran hospitals, as well as large and small practices. We currently employ 70 full-time and part-time staff members here at Parkway. This includes three neurosurgeons, five pain specialists, two neurologists and six physical therapists, as well as eight mid-level practitioners or physician’s assistants. We have had more than 44,000 patient visits since January of 2016. I think it is important, especially as a physician executive, to run the organization as a team and be able to delegate.
Dr. Holmes and I depend on day-to-day help and insight from our managers for input and implementation. Parkway’s success lies in its team members, from physicians to therapists to mid-level practitioners and all staff members, embracing a culture which puts the patient first. It is important to make sure all the players understand our mission at Parkway and do their part to make sure we follow this mission. Everyone’s input is valuable in making sure Parkway runs like a well-oiled machine. Our common denominator is the patient, and all staff members understand and embrace that philosophy.
Can you single out a couple of the most significant changes in medicine since you began practicing?
A few things come to mind. One is the implementation of an electronic health records. This has been a significant challenge and continues to be so as technology expands. Although there are advantages to EHR, including up-to-date and complete information about the patient’s condition in coordinated and thorough fashion, there are disadvantages also. Disadvantages include less time spent with the patient, and more time checking boxes, which offers dubious benefit to the patient especially when seeing specialists. We see this as big problem as patients see their doctors with their head buried in their computer instead of making eye contact. There are also issues of privacy, with the risk of data compromise, ransomware and other malicious problems becoming more common.
Another thing that comes to mind is a greater number of procedures now being performed on an outpatient basis. Patients prefer recovering in the comfort of their own home and environment. This has been much more prevalent as technology advances and incisions become smaller and procedures become increasingly less invasive. This has been a major shift in medicine in the past 10 to 15 years.
Finally, the opioid crisis has dramatically shifted how we as physicians care for patients from a pain standpoint. The issue is a crisis here in the United States and around the world and has had devastating consequences with 64,000 deaths in the U.S. being attributed to drug overdose in 2016. To follow an increasingly greater array of state and federal rules and regulations, we have had to change how we prescribe narcotics and how we monitor their use. Patients were at first uncomfortable with routine urine and blood drug screening but are increasingly aware of the focus on patient safety and our compliance with state and federal regulations.
How has the uncertainty surrounding the Affordable Care Act affected the medical and business side of the institute?
A practice such as ours has not been able to track or monitor any changes related to the ACA. We have done our best over the years to care for as many patients as we can within our practice.
What are your biggest challenges and opportunities in 2018?
In this area of rapidly changing health care rules and policies, the increasing demands on our time and resources as well as the uncertainty surrounding the future direction of health care, make this an uneasy time for everybody. But I believe if we stay on top of things, these changes could offer opportunities to better care for patients. These changes can present opportunities to continue to run a successful company with a healthy bottom line allowing us to employ more than 70 people in our community who could then provide for their families. Parkway recently received recognition from the Washington County Department of Economic Development and the Department of Business Development for our contributions to the community.
Operating costs are increasing, and unlike other business, the payment levels are fixed and we cannot pass these costs onto the consumer. We must find the products or product lines that have the most revenue over cost or the highest margin. This is where being a physician is most helpful, as we can identify which product lines are essential, even though they may have low margins, from a patient care standpoint. Unlike in a non-medical business, not every product can be cut just because the margins are low.
How do you find time for family activities and personal pursuits?
I would again go back to running Parkway as a team. We have several managers we meet with weekly and biweekly to make sure we stay on course. We get feedback every week about potential problems or suggestions to improve the organization to make it a better experience for patients and to treat them more efficiently and quickly. Our employees have a very high level of work place satisfaction which patients notice and appreciate.
This does give us some time to spend with other pursuits and hobbies as I know my patients ae being well cared for by the team. Their input and day-to-day management is valuable when I am in surgery or wearing my “doctor’s hat.”
Any predictions about what we could (should) see in medicine in the next few years?
Currently we’re seeing better and more efficient implants including devices such as disc replacements which cannot only relieve pain in the case of disc herniations, but also can maintain range of motion and thus patient activity levels. I certainly hope to continue to see private payer options for insurance. As I believe that a single-payer system run by the government would be a catastrophe for patients and for medical advancement. A careful assessment of the British National Health Service supports this conclusion. I do not believe the American people want this however, so I believe that is unlikely. The last few years have seen the birth of different types of health care delivery organizations that both maintain the private practice model and its high quality, individualized, patient-centered focus model and the advantages of larger health care systems. Some amalgamation of these models may be in our future. With all its challenges and demands, I believe medicine has an exciting future for patients and providers.