Multiple Sclerosis Centers of Excellence
A National System to Treat Multiple Sclerosis and Other Neuroimmunological Disorders
What is the MSCoE System of Care?
MSCoE serves Veterans with MS and other neuroimmunological disorders via neuroimmunology-trained providers located in a network of Regional Specialty Programs (RSP) across the VA health care system. Each Veteran Integrated Service Network (VISN) contains at least one certified MS RSP. RSP clinics directly serve Veterans with MS and neuroimmunological disorders within their facility catchment areas and provide management support to general neurologists and primary care serving Veterans in non-RSP facilities within their VISN.
Which Veterans are appropriate for MSCoE RSP referrals?
For Veterans served at non-RSP designated facilities, the RSP subspecialists may provide face-to-face, video, or e-consults to support local neurologists and primary care physicians in providing neuro-immunological care. Neuroimmunological conditions include MS, neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein spectrum disorders (MOGAD), autoimmune encephalitis, and drug-induced demyelinating diseases, among others. Topics for support may include diagnosis, second opinion, disease-modifying treatment, symptomatic management, prognosis, family counselling, and so on.
Who will respond to MSCoE RSP Consult Requests?
MSCoE RSP subspecialist providers lead multidisciplinary teams capable of diagnosis, treatment, and management of MS and other neuroimmunological disorders. The team member appropriate to the consult question will respond to the consult request.
How do I access the MSCoE System of Care?
Veterans with MS and other neuroimmunological disorders first establish care with the nearest facility-level neurology/national tele-neurology.
Facilities not designated as RSPs establish Inter-Facility Consult (IFC) agreements with the closest RSP in the VISN.
General neurology places IFCs to the RSP for face-to-face visits, video visits, and/or e-consults. If unsure of the appropriate modality, start with an e-consult.What should I include in the IFC Request?
The IFC request must include the relevant records necessary to complete the consultations including labs, radiology images and reports, and prior evaluations for the issues. It is the responsibility of the requesting provider to ensure this background information is accessible in JLV/Carestream/Vista, etc. prior to placing the IFC.
What should I expect from an IFC Request?
RSP consultants work with the requesting providers to establish the optimal individualized management strategy for the Veterans. This may include requiring initial face-to-face visits, ongoing supportive management on fixed or as-needed bases, and/or escalations of the consultations to other MSCoE System providers (first) or to non- VA sub-specialists.
What if the Veteran currently receives neurologic care outside the MSCoE System of Care?
For Veterans with MS and other neuroimmunological disorders currently receiving neurological care via Community Care, primary care, and/or VA general neurology, providers should periodically place IFCs to their VISN-level RSPs for determination of the optimal treatment strategy. For instance, superior care may result from partnerships between RSP subspecialists and primary care physicians rather than care received from general neurology via Community Care. Because defining optimal care changes over time depending on treatments, physical needs, and other factors, periodic (e.g. 3-5 years) neuroimmunology consultation by RSPs is suggested.
Veterans served by the VA National Tele-Neurology programs receive neuroimmunological subspecialty support through that program’s internal referral process.
What if the Veteran requests non-VA care?
Veterans requesting non-VA care for their MS or other neuroimmunological disorders who have not yet been evaluated by VA neurology should be redirected to the MS System of Care. Namely, by first establishing with general neurology at the nearest available facility and subsequently the MS RSP for review and determination of optimal neuroimmunological care.
Note that there are some restrictions on where a Veteran can receive neurology care outside of the VA. Some providers or networks will not accept VA Community Care reimbursement. In addition, Community Care neurology is often provided by general neurologists who cannot provide the specialized care available from RSP providers.
Questions about accessing the MSCoE System of Care can be directed to MSCentersofExcellence@va.gov.
