Home Neurology How a rural hospital became a neurology hub — and stayed independent

How a rural hospital became a neurology hub — and stayed independent


Since 2010 when Aburashed was hired, Memorial Healthcare’s neurology inpatient market share has grown, increasing to 20 percent in 2018 from 15 percent in its primary Shiawassee County market.

Outpatient neurology has held steady at 49 percent, but that doesn’t account for a large increase of patients coming in from outside of the hospital’s immediate markets, Long said. Other competing systems in neurology include hospitals part of McLaren Health Care, Sparrow Health System, Genesys and Covenant HealthCare.

“We are seeing the piece of the (market share) pie grow in MS and as it grows we are drawing a lot more numbers outside of our primary and secondary markets. Overseas, Alaska, the Deep South, the Southwest, Mid-Michigan and Indiana,” said Long.

Since 2011, neurology visits have increased 729 percent at Memorial from 1,738 to 14,424 in 2019.

In the U.S., some 1 million people are affected by MS, including about 20,000 in Michigan. Patients come to Memorial from all over, officials said, some traveling more than 15 hours to receive specialized care.

“We started out with a single neurology practice and we now have eight neurologists that are employed and providing services,” Long said. “We’ve had revenue growth in many areas, mostly attributed to the (80) employed doctors, but neurology is a big service segment and it’s responsible for a good deal of this growth.”

After hiring Aburashed, who is chief of neurology and also heads up Memorial’s Institute for Neurosciences and Multiple Sclerosis, Margaret Frey, D.O., was recruited to become director of the hospital’s muscular dystrophy, neuromuscular and epilepsy program.

To make the neurology investments, Long said the agreement he struck with Aburashed was that the doctors would be able to specialize in certain areas, but they also must agree to focus on the hospital’s general neurology population.

“We brought on Dr. Frey and her interest in muscular dystrophy. That also meant we had two individuals that could provide general neurology services for our patients,” Long said.

But to build out the neurosciences institute for the regional expansion and research projects envisioned by Aburashed, Memorial needed more neurologists interested in MS.

Neurologists Robert Pace, M.D., and Jeanie Cote, M.D., both of whom specialize in MS, were hired to help Aburashed with patients and research.

Through the first six months of this year, Memorial has treated 1,700 multiple sclerosis patients of a total of 3,390 patients with complex neurological conditions.

Most recently, Anthony Brune III, D.O., joined Memorial’s MS program. Like Aburashed and Frey, Brune graduated from Michigan State University’s College of Osteopathic Medicine. He has completed two specialized fellowships at the University of Michigan and Johns Hopkins University.

Three other neurologists were recruited to broaden the neurology department’s specialties. They include Cara Leahy, D.O., director of cognitive disorders, focusing on Alzheimer’s disease and memory care; Ali Saaed, M.D., specializes in stroke; and Gregory Dardas, M.D., a board-certified general neurologist who practices in Auburn, is the former chair of neurosciences at Mid-Michigan Regional Medical Center.

In December, a ninth neurologist, Amit Masih, M.D., an assistant professor at Michigan State University, will join the team and head up the division of headache and facial pain. The hospital also will replace next July a neurology fellow who left for another position.

Because of the increase in neurologists and expanded specialties, Memorial has reversed its patient mix. From 2010 to 2015, Memorial treated 80 percent general neurology patients and 20 percent MS and specialty neurology patients. Now, those numbers have flipped with 85 percent specialty neurology and 15 percent general neurology patients.

“I had my MS patients who came into the general clinic and I would diagnose them and take care of them. It grew organically, patient to patient. Then I started to get a bunch of MS patients because they’re a very tight knit community online,” Aburashed said.

When Cote joined Memorial from the University of Michigan, “She had a belief like I did that the way we were approached the disease was wrong,” Aburashed said.

“MS is a disease that, dogmatically, we would say, look, you’re going to get worse. You may end up in a wheelchair. This may be devastating for your family,” Aburashed said. “We said, ‘Why are we watching people get worse when we have options that may help them, and why aren’t we at least presenting them with options and letting them decide if they are interested in a risk or not.'”

Aburashed said a growing number of neurologists like his peers at Memorial are treating people earlier with MS, using newer drugs and seeing positive results.

“As long as patients are willing to take those risks what we’re seeing is a fairly robust improvement of quality of life and decrease in disability,” he said.

One of the misunderstood aspects of MS is that it is a disease that does not change life expectancy. But it does alter life and it is a progressive disease that may cause patients to end up in a wheelchair.

“That has changed and the newer treatments are showing that we are able to stabilize patients for long periods of time,” he said. “We have something called disability improvement. We’re able to improve patients, which we never would have thought of before.”

Aburashed said Memorial’s neurologists believe using advanced diagnosis and treatment they can slow down MS progression.

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