Return on Investment

Irene Litvan, M.D., moved to Louisville from Bethesda, Md., at the end of 2002 to become the Raymond Lee Lebby endowed professor in Parkinson's disease research at the University of Louisville, a position funded by private donations to UofL and matched by the state's Bucks for Brains program.

When she arrived, she was the only movement disorders specialist at UofL, practicing in a city in which patients often had to wait as long as a year to see a neurologist specializing in Parkinson's and related disorders.

Less than five years later, Litvan has assembled a first-rate team of researchers and clinicians that successfully competed to lead a multi-center, $3.4 million National Institutes of Health-sponsored study of Progressive Supranuclear Palsy, a rare movement disorder.

With three full-time neurologists on staff, waiting times for patients are now shorter and more reasonable. And this summer, the National Parkinson's Foundation designated UofL's Division of Movement Disorders as a Parkinson's Center of Excellence.

"This is a great example of faculty who, after being recruited to Louisville with the help of Bucks for Brains, build programs that not only bring prestige to the university but also make a difference in the lives of patients and families," says UofL President James Ramsey.

Litvan prefers to compare her role to that of a catalyst.

"I have a vision, but the vision couldn't be achieved without a tremendous amount of work from others and the amazing support we've received from the Louisville community," she says.

Nevertheless, those involved in the effort to create a world-class movement disorders program in Louisville are quick to point out the tremendous return on the gift to UofL -- made in honor of Raymond Lebby by his sister -- and on Kentucky's investment through the Research Challenge Trust Fund, more commonly known as Bucks for Brains.

"The obvious measurement for return on investment is research funding, and last year's $3.4 million NIH grant means a more than 100 percent return on the dollars invested in recruiting her to Louisville," says Larry N. Cook, M.D., executive vice president for health affairs at UofL.

At the same time, Cook points out that the economic impact of NIH research grants is not limited to the dollars they bring to the community. Future treatments that may be developed from this kind of research and the prestige that the grants bring to UofL also are tangible outcomes.

"Overall dollar-for-dollar measurements leave out the majority of the real impact that people like Dr. Litvan have on the community," he says. "The NIH study she is leading is the first in the field, and UofL is heading up a group of very prestigious institutions such as Harvard, Emory and the Mayo Clinic. We need to look at these factors when we think about the return on investment for Bucks for Brains."

Joanne Berryman, senior vice president of Jewish Hospital & St. Mary's HealthCare, which owns the Frazier Rehab Institute, agrees.

"Dr. Litvan and the Division of Movement Disorders is a valuable asset to the people of this community and region," she says. "For Parkinson's disease patients in Kentucky and Southern Indiana, this means that dedicated professionals, as well as a nationally designated center, are easily within their reach, allowing for positive outcomes in dealing with their disease."

Frazier Rehab is one of the area's leading providers of physical therapy for patients with movement disorders and works closely with the UofL program.

John Swartz, president of the board of the Parkinson's Support Center of Kentuckiana (PSCK), says the impact of UofL's program on patients' quality of life is quite large.

"The Center of Excellence is important to the more than 4,000 Parkinson's patients in Louisville because it means that they can get the very best care available anywhere without having to travel," he notes.

"Frazier Rehab's facility is fantastic. The partnership between UofL and Frazier is committed to building a staff of caregivers and multidisciplinary experts, which means that patients can be seen by a physician or therapist in a reasonable amount of time. Access to this expertise is critical for quality of life not just for patients but for their loved ones and caregivers."

Swartz says that better and more convenient care allows Parkinson's patients to work longer into the course of their disease, to avoid episodes that require hospitalization and to enjoy a more productive and higher quality of life than might otherwise be possible.

"It really does make a difference," says Kerri Remmel, M.D., Ph.D., interim chair of the Department of Neurology at UofL.

"Movement disorders can be hard to diagnose and treat. Our faculty are truly experts in caring for these patients, and we are proud to have them here at UofL."

PSCK has pledged $650,000 to the Movement Disorders Program, which has officially been granted status as a division of the Department of Neurology. Of that figure, $150,000 will be used to hire and train doctors in the advanced diagnosis and treatment of movement disorders and to add an additional nurse-practitioner to the staff. The remaining $500,000 will be matched with $500,000 from Bucks for Brains to endow a fund that will provide ongoing support for research.

"We have made progress," Litvan says, "but we still need more staff to meet the needs of more than 50,000 patients with movement disorders in the Louisville metro area."

That's why this public-private partnership is so significant, Swartz says.

"The match from Bucks for Brains said to our group that UofL and the state of Kentucky are serious about making progress to fight movement disorders. Without the ability to recruit outstanding professionals like Dr. Litvan, this kind of progress would be much longer in coming, to the detriment of patients."

The national Center of Excellence designation also recognizes the Division of Movement Disorders' efforts in the area of outreach. Litvan notes that this occurs in three ways.

First, the division is working to boost education about movement disorders among health-care professionals by holding seminars on diagnosis and case management.

Second, the program is reaching out to patients, caregivers and the community by focusing on awareness of current treatments. For example, staff and patients of the division are volunteering to tell their stories to community groups at public seminars.

Third, the center is looking at ways to increase access to care for the medically underserved. The division currently is applying for grants to provide care to populations outside Louisville through telemedicine and other mechanisms, she says.

Litvan downplays her own role, saying that a lot of the credit belongs to the people who make up the division. With more than 12 staff members, including a team of specialized allied health professionals, it's really the investment in human resources that allows the division to provide state-of-the-art care to patients with movement disorders, she says.

"In the final analysis, our best return on investment comes in what we do for the patients."