RURAL HOSPITAL TERTIARY CARE LINK

1. RURAL HOSPITALTERTIARY CARE LINK Thomas H. Cogbill, M.D. Gundersen Lutheran Medical Foundation La Crosse, Wisconsin

2. Challenges of Rural Surgery Professional Isolation Acquisition of New Technology/Skills Call Coverage Reimbursement Administrative Duties Education/CME Requirements Research Opportunities Volume-Based Quality Initiatives

3. Gundersen Lutheran Health System Fully Integrated Physician-Led 453 Physicians 6159 Employees

5. Main Clinic – La Crosse, Wisconsin (population 51,000) 12 General Surgeons Branch Clinics – 25 Locations 9 General surgeons

8. Regional Surgeon Operations Endoscopy 28% Gynecology 21% Hernia 10% Colorectal 9% Biliary Tract 8% Orthopedic 7% Cesarean Section 5% Breast 5% Other 7%

9. Communication Med-Link Telephone System Distance-Learning Sites Admission/Referral Nurse E-mail

10. Transportation Med-Link Helicopter System Ground Transportation 3 States, 19 Counties All Levels of Care

11. Call Coverage Main Clinic – Skill Set Mismatch Other Regional Surgeons

12. New Technology Acquisition Surgical Skills Laboratory Main Clinic Case Participation On-site Proctoring

13. Administrative Help Salary and Benefits Coding and Reimbursement Patient Satisfaction Surveys Department-Wide Registry of Cases Maintenance of Certification

14. Education CME Opportunities Surgical M & M Conference Distance Learning

15. Teaching Rural Surgery Elective ATLS Instructors RTTDC Courses Residency Lectures

16. Research Landercasper et al: Spectrum of ruralgeneral surgery, Arch Surg 1977 Bintz et al: Role of rural surgeon in trauma, J Trauma 1997 Callahan: Experience of rural general surgeon, JACS 1994