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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