Developing a spine center of excellence in today’s turbulent health care environment is no easy task. The value-based care revolution has empowered patients, insurance companies and government agencies, all of which pressure care providers in different, and sometimes confounding, ways.
The field of spine surgery has its own unique challenges, reported Becker’s Hospital Review. Due to rising rates of overutilization in the specialty and negative media attention, some believe spine surgery centers try to force patients into undergoing overly extreme or unnecessary treatments. Additionally, many patients who undergo spine surgery aren’t happy with the results. In a patient satisfaction survey conducted by Spine Universe, nearly 50 percent of respondents said they were not satisfied with their surgical outcome. Almost half said they experienced post-operative complications.
Care providers looking to build spine centers of excellence will face a number of challenges. However, thorough planning and strict adherence to some key best practices can make these organizational strains easier to bear and enable you to provide superlative patient care.
Consider your space
According to Bob Reznik, president of Prizm Development, a company that specializes in spine center development, care providers looking to develop centers of excellence should take advantage of low interest rates and purchase the structures they plan to use. Taking ownership of your building will allow you to control its interior. Building layout is especially important, as it not only impacts the overall efficacy of spine centers, but also affects patient confidence.
“You want the back pain sufferer to say that this spine center is unlike any other,” Reznik told Becker’s Spine Review. “Most clinics hide physical therapy in the back or in the basement of the spine center. [Prizm Development] puts the rehab area up front and center so it is the first thing the patient sees when they walk through the door.”
Reznik also advises care providers to look for smaller spaces rather than larger complexes.
“The days of surgical mills are over. Payers and medical directors are trying to eliminate unnecessary spine surgeries,” he said. “I have found that large 25,000-square-foot spine centers are not as successful as smaller spine centers of 15,000 to 20,000 square feet.”
Additionally, complex procedures that once required many square feet of surgical space have become minimally invasive and can be performed in smaller areas.
Take a multidisciplinary approach
A spine center of excellence takes a multidisciplinary approach to care. It incorporates orthopedic surgeons, physiatrists and physical therapists into a complex care network that offers a host of services. Such networks not only facilitate complete instances of care but also cut back on over-utilization.
“We try to have all our patients see the physiatrist first, and then spine surgeons are at the top of the ladder as the last specialists in line to see the patient,” Dr. Jason Brodkey, a neurosurgeon at Ann Arbor Spine Center in Ypsilanti, Michigan, said in an interview with Becker’s Spine Review. “Ultimately, you will have a happier patient and lower costs for insurance companies by performing surgery as a last resort.”
Multidisciplinary centers also cater to seniors more effectively, as they can provide the transitional care that many older individuals require.
Market your center
A fledgling spine center of excellence must immediately confront specialty-specific perception problems. Care providers can address these issues with effective marketing, reported Becker’s Spine Review. Spine surgery patients are normally searching for one thing: comfort. Your branding should engage individuals in this demographic and offer a theoretical solution to their pain points. However, don’t make any promises. Spine centers of excellence connect with prospective patients but offer personalized, realistic care plans.
“You can’t cure anybody’s back. We aren’t dealing with broken bones that can be fixed. It is a chronic degenerative process,” Dr. Neel Anand, clinical professor of surgery at Cedars-Sinai Medical Center in Los Angeles, said in an interview with Becker’s Spine Review. “We can control it but not cure it. But patients come in thinking their backs will be fixed. So spine surgeons need to manage their expectations.”
You must also reach out to the community at large. Sponsor public spine education programs, offer informational seminars and, perhaps most importantly, maintain engaging social media channels. According to Pew Research Center, 65 percent of all adults use social media. Usage among adults 65 and older has tripled since 2010. Today, social media accounts are the entry point for many patients seeking out spine surgery. Centers should follow a few basic social media best practices, reported Becker’s Spine Review. Create useful, appealing content, facilitate two-way communication with users and know your boundaries.
Patients empowered by the value-based care movement won’t simply trust spine centers to provide them with the best possible care – they want outcome data. Spine centers of excellence must carefully track care outcomes and faithfully record the results.
“It is important to talk transparency,” Marcy Rogers, CEO of SpineMark, told Becker’s Spine Review. “Be very much out in the open with metrics, and even make things like policy and procedure available, as well as continuous quality improvement plans.”
Additionally, you should institute internal quality thresholds and use outcome data to measure your adherence. Be judicious about the data you decide to record. Many patients want metrics on post-operative outcomes, such as the percentage of patients who receive physical therapy, take prescriptions for lingering pain or required hospitalization.
Health care companies are normally interested in much of the same data. Unfortunately, many payers categorize situations in which patients seek spine surgery as care failures. As a result, they rarely do business with centers that perform a large number of actual surgeries. True spine centers of excellence record high numbers of successful, non-surgical care outcomes.
Focus on the patients
For most involved in the health care industry, providing patient-centered care is the primary objective. However, many providers lose sight of this goal amid the logistic and regulatory concerns that come with establishing and operating an accredited health care facility such as a spine center of excellence. To combat this possible oversight, you should weave patient-centered policy into the essential fabric of your developing spine center of excellence.
You must first compile a detailed patient protocol that addresses severe, life-threatening conditions so that clinical staff can quickly react to patients in need of emergency care. Your burgeoning spine center should also develop physical therapy and educational programs that emphasize exercise and movement. Effective exercise regimens, more so than prescription-based pain management plans, are key for patients looking to achieve long-term recovery.
Additionally, carve out a role for a clinical coordinator or nurse navigator. These individuals guide patients throughout their entire instance of care and follow up with them once they have returned home. Navigators also facilitate communication between disparate departments within your spine center and occasionally act as patient advocates in the face of the mercurial and sometimes cold, modern health care system.
“The most logical person to do that would be the registered nurse who has experience in spine and is familiar with emergent symptoms, and would look at the schedule to see how many visits the patient has with the specialist over six months,” Reznik said in an interview with Becker’s Spine Review. “They would question why the patient is coming back so often when they haven’t seen the surgeon for complementary expertise.”
A true spine center of excellence empowers employees and patients through value-based processes and treatment schemes, and enable these parties to contribute to the ultimate goal: providing quality spinal care.