Unless a private neurology practice has the capability to interface very closely with your radiology expert or division, meaning if you’ve got a radiologist in the community, you have to be able to coordinate and communicate very quickly, back and forth, because the results of that follow-up MRI are imperative to make sure that our patient who’s receiving treatment is not suffering any ARIA as a consequence of the treatment...
Unless a private neurology practice has the capability to interface very closely with your radiology expert or division, meaning if you’ve got a radiologist in the community, you have to be able to coordinate and communicate very quickly, back and forth, because the results of that follow-up MRI are imperative to make sure that our patient who’s receiving treatment is not suffering any ARIA as a consequence of the treatment. So it’s close coordination because the infusion center can’t move forward unless we’ve got that negative report on the chart. So major barrier in smaller groups is the absence of this close, quick coordination between clinical and radiology. And then all of that information has to then transmit to infusion. Now, if your infusion is in-house, great. But if you’re referring one of your patients to an outside infusion center, you have to make sure that your clinical and your radiology findings are quickly transmitted to the infusion center so that they know whether they can proceed. And then you’ve got to be in close back and forth communication with your infusion center so that they give you real-time feedback as to patients’ tolerability to the treatment or questions regarding treatment. So all of this, again, is a close, mindful, integrated coordination between clinical, radiology imaging, infusion, and also laboratory is always important because, obviously, before a patient can even commence treatment, you want to make sure that you have your APOE status because it’s the APOE status that informs us about our risk of ARIA-E or ARIA-H in all of our patients. So before patients can proceed, that data has to make its way onto the chart. I should also mention that patients have to enter into a registry in order to receive reimbursement from carriers such as Medicare. And in our group, it’s the infusion team that puts that data into the national registry so that those patients can be covered from insurance carriers like Medicare. Private insurances don’t typically require entry into a registration, but by and large, that registry exists for Medicare beneficiaries, and someone in the group has to enter things like mini-mental status, functional assessment, APOE status, presence of anticoagulants, etc. So, close coordination between the group being radiology, clinical, laboratory, and then the registry. So, again, all of this has to be integrated. So that’s a huge set of hurdles that have to be overcome in the primary care setting in order for, I should say, the primary neurology setting, in order for the patients to proceed down the treatment journey.
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