URMC Neurology and Neuromedicine

5 Year Strategic Plan

Overview of 5 year goals

  1. Aggressive expansion of translational research efforts Institution of a coordinated, pan- departmental effort to apply preclinical research to clinical targets. To develop new translational research-based treatment programs unique to Rochester. Will enable UR to become a unique referral center for wide spectrum of new disease targets. Expansion of administrative resources and basic research necessary to achieve this goal. Includes recruitment of 10 new basic and clinical academic faculty from strategic plan.
  2. Establish research center-based funding. Establishment of regional centers of excellence in neuro-oncology, Alzheimer's, Parkinson's, HD and MS. Achieve Udall Center grant for PD, ADRC status for AD, SCORE grant for glioma.
  3. Program integration. Integration of neurology and neurosurgery ICU/critical care with joint training. Integrate neurology and neurosurgery clinics and schedules to permit concurrence of combined specialty clinics in neuro-oncology, epilepsy, movement disorders. Establish spinal cord injury unit with neurosurgery, rehab, orthopedics.
  4. Expand training. Expansion of residency to 6 residents/year; aggressive retention of best UR students intending to match in neurology, neurosurgery, neuropathology; aim for 2 of 6 MD-PhDs/year, and aim to keep these after training. Institution of fellowships in neuroimmunology, neuro-critical care and neuro-oncology.
  5. Expand general neurology base. Enlist a cadre of full-time clinicians at each institution: SMH, HH and RGH; Institution of neurohospitalist program at SMH. Additional full-time clinical recruits in MS/neuroimmunology, critical care, Alzheimer's. 7-12 new clinicians.
  6. Expand referral base. Enlarge both size and geographic draw via aggressive outreach, as well as new treatment programs.
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URMC Neurology 5 year goals: Clinical

  1. Institution of new translational research-based treatment programs:
    • multiple sclerosis and the demyelinating diseases
    • neurodegenerative diseases - HD and PD
    • pediatric hereditary and metabolic disorders
    • brain tumors
    • spinal cord injury - SCI will mandate a new division, coordinated with neurosurgery, orthopedics and rehab. Will coordinate each program with expansion of the relevant neuromedicine research personnel and infrastructure.
  2. Integrate neurology and neurosurgery outpatient clinics and schedules, fusing relevant subspecialties into a Neurological Institute structure. Combine overlapping neurology and neurosurgery clinics - epilepsy, movement disorders/DBS, neuro-oncology, stroke/neurovascular, and spine injury/back pain. Combined clinics will be introduced annually, at 1/year through year 5. Additional NP support in specialty clinics.
  3. Institution of neurohospitalist program at SMH, with 3 neurohospitalists to rotate on inpatient and outpatient services (1:2 ratio). Additional clinical recruits in MS, pediatric neurology, critical care, and Alzheimer's. All self-funded in 4-5 years.
  4. Establishment of neurology and neurosurgery ICU, and achieve operational integration with joint interdepartmental training and co-coverage.
  5. Achieve net increase in size and geographic draw of referral base, accruing to both expanded catchment area and aggressive outreach, as well as coordinated neuro-ICU, neuro-neurosurgery specialty clinics and new treatment programs.
  6. Establish case and outcomes database, as both a research adjunct and metric for improvement in both USN&WR and DOH surveys. Integrate neurology and neurosurgery databases.
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URMC Neurology 5 year goals: Education and training

  1. Reinvigoration of morning report Establishment of an academically-oriented, multi- attending morning report at SMH. Achieve joint SMH-HH morning report structure. RGH participation via video conferencing.
  2. Improved grand rounds structure, with both academic clinicians and basic researchers. Once a month joint with neurosurgery, once bimonthly with experimental therapeutics. Endowed funding commitment, to permit attraction of nationally recognized speakers.
  3. Expansion of residency to 6 residents/year; aggressive retention of best UR students intending to match in neurology, neurosurgery, neuropathology; 2 of 6 MD-PhDs/year within 5 years. Keep the best after training.
  4. Broaden fellowship programs Add second stroke fellow in year 1. Institution of new fellowships in:
    • neuroimmunology (by year 3)
    • neurocritical care (year 4)
    • neuro-oncology (year 5)
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URMC Neurology 5 year goals: Research

  1. Recruit new academic clinicians or disease-focused basic researchers in:
    • Neuro-oncology
    • Neuroimmunology/virology:
    • Neurogenetics
    • Neurodegenerative disease: biology and repair
    • Stroke: protection and repair

    All to be assigned to existing relevant clinical divisions, with concurrent Center or basic science appointments and space. All congruent with ISP slots in neuromedicine and/or stem cell programs, and IDP slots in neuromedicine or cancer biology.
  2. Establishment of independently-defined research centers of excellence in:
    • MS
    • Parkinson's
    • Alzheimer's
    • Neuro-oncology.

      Apply for NMSS Research Center status (within 2 years), Udall Center grant for Parkinson’s (3 years); ADRC status for Alzheimer’s Disease (4 years); SPORE grant for primary CNS tumors (5 years). Achieve each within 2 years of initial application.
  3. Integration of new translational efforts with CTCC, expanding the existing trials infrastructure to include biological therapeutics - cells and viruses, antibodies and proteins. Establish internal competence in FDA GLP compliance and IND preparation.
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URMC Neurology 5 year goals: Financial & Administrative

  1. Increased centralization of department administration, to permit department-wide financial analysis and real-time reports, pre- and post-award research administration on an optional basis for smaller division and lone investigators, and assistance with RSRB and UCAR compliance mandates.
    Establish transparent and departmentally-accessible metrics of case volume, complexity and practice revenues, including RVU-based billings. This will entail a doubling of the administrative support infrastructure within the first 3 years.
  2. Establish incentive structure for clinical productivity, including hospital service providers, based on diminishing tax scale for incremental billings.
  3. Development within year 1 of business plans, leading to hospital service lines, for :
    • multiple sclerosis
    • Alzheimer's
    • epilepsy
    • stroke/critical care
    • neuro-oncology
    • pediatric neurology

      Coordinate programmatic reimbursement strategies for each service line with neurosurgery and radiology. Sustainable, positive return on investment for each within 4 years.
  4. Departmental self-sufficiency by end of year 4, though still including hospital contributions via service-line recoveries. All divisions self-sufficient by 5 years, through mix of patient revenues, grants and awards, and biotech/pharma funding.
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URMC Neurology 5 year goals: Reputational

  1. Regional and national clinical reputation Increase local Western/Central NY and Southern tier marketing, highlighting neuro ICU and stroke program, other major specialty programs.
  2. Academic reputation Improve publication quality level, impact factor and frequency. Intensive faculty mentorship at both divisional and departmental levels to achieve both improved publication and grant success.
  3. Overall Aggressive effort to restore neurology to national prominence, marketed on basis of new and unique treatment programs. Aim for top 50 USN&WR in 3 years, top 30 within 5 years.
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Neurology: New resources

  1. New recruitments via Strategic Plan: 10 total:
    • ISPs (basic scientists): 4
    • IDPs (clinician-scientists): 6
  2. Hospital supported positions: Partial support of 7-12 academic clinicians and 2-3 NPs in Peds, AD, MS, MD, stroke and critical care, depending upon field and degree of support; all subject to hospital approval of new division business plans. 3 hospitalists for general neurology service and clinics a priority.
  3. New positions in central administration
    • 3 for central research admin: manager, pre- and post-awards management & compliance
    • 2 financial analysts, at least 1 an accountant; 1 outcomes database coordinator
    • 1 patent/licensing liaison with tech transfer, CTSI for FDA GLP and IND
  4. Salaries for residency, clerkship and clinical administrative direction, the 2d year course and 3d year clerkship directors, and for quality assurance compliance. This will permit redirection of extant departmental funds to new initiatives, e.g., expanded grand rounds.
  5. Space - acquisition and renovation for new administrators, offices for new clinicians (URMC 5th floor). CTN/CVB/CNDD space for new labs.
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