With the industry’s focus on value-based care, musculoskeletal service line leaders responsible for transforming processes and programs must be responsive both to payment reform and to the increasing expectations of healthcare consumers for ease and convenience. Everyone’s sights are set on delivering better outcomes, greater patient satisfaction, and lower costs.
The 2018 Musculoskeletal Leadership Summit brings orthopedic and spine thought leaders together to share best practices and lessons learned, presenting a unique opportunity to provide orthopedic and spine program excellence without the need to reinvent the wheel.
In Part Three of our series, we spoke with Dr. Jeff Masciopinto, Chairman, Department of Neurosurgery and Director of the Spine Program at SSM Health, about his top strategies for patient-centered care.
I’ve been in practice since 1998. I have a spine focus to my practice, having done a fellowship in complex spine surgery at UCLA. I started my career in Denver in a single-specialty group, and then moved to Madison to a multi-speciality clinic of 400 doctors.
We’ve always had a patient-centered focus in our spine center. And we have a unique situation where I practice, with about 40% of our business being from an HMO that we own. There’s always been a focus on value, but as our group has consolidated regionally, we’ve finally had the communication tools to allow us to manage things throughout the patient’s experience with their back pain problems.
As you know, the 2018 Musculoskeletal Leadership Summit presents an opportunity for service line leaders to connect and participate with surgeons and other clinicians. Why is this type of collaboration important for clinical transformation?
I think to a great extent we all operate in our own little village, and we don’t necessarily know what innovations others may be doing on a small scale or even sometimes on a large scale. Having people in a room to share ideas with, even if you pick up one or two concepts you hadn’t previously considered – there can be tremendous value in that. It’s an opportunity to share both successes and failures in grading programs – in our case, sharing the ups and downs of the spine program, where we’ve experimented with different concepts and personalized to the point where we feel like we’re moving forward.
Our mission statement is to have the patient be in the right place for treatment, at the right time in their disease process. We’ve really focused on that, and that in and of itself creates value. Instead of patients calling their physician and saying, “I’ve had back pain for two weeks,” and immediately having an MRI scheduled and a consultation with the spine surgeon, we’ve developed a practice pattern that allows for directing that patient—based on their symptoms and the duration of their symptoms—for treatment at the right time and in the right place.
Can you tell us a bit about your speaking topic, “Evolution of a Spine Program”? Why is this topic important to you personally?
During my talk, I’ll lead with some of the hiccups we faced early on in our spine center, and where things fell apart, just as some examples. I want to emphasize how much the data really helps with change management. And when we finally started to acquire data that was meaningful and demonstrated where there were some real points of value lost, that’s when we were really able to pivot and get everyone on board as far as primary care—other spine providers as well as surgeons—and start moving forward. The patients also really like to have the pathway. Those who have gone through the pathway have almost uniformly felt like it was a positive part of their experience.
I think sharing these experiences will allow others to have insight into what has been successful and what has not been, and this will help those outside of the spine world get a few ideas for ways to be more efficient as they move forward in their programs. And I hope to learn some things as well from the obvious skill sets and talent that will be in the room.
Can you share some examples of the work you’ve done to improve experience, outcomes and value in the spine program at SSM Health?
Our pivot point was when we started to engage our primary care leadership in our program design. Previously—and this is going back 10 years or so—sometimes the things that we did would be looked at from our primary care physicians as a way for us to get more cases or have more efficiencies in our clinic, and not to provide full service to them as providers. But once we engaged with primary care, and at same time refined our triage process, then started to educate upfront about why we’re doing things the way we are, that really helped.
We’re fortunate to have studied our process for a year; we looked at all patients referred for spine consults to our group, and we analyzed the duration of symptoms, whether or not they’d had high cost imaging, and what sort of treatment they had to the point of consultation. We were able to see that almost half of the patients that were being referred and had MRIs were less than six weeks into their pain symptoms.
With that data in hand, we were able to go back to our primary care leadership and have them disseminate best practice. That really resonated with our primary care providers and changed the way they were making referrals and treating patients with acute back pain.
It also gives a glimpse into our future, our next step, which involves creating a uniform patient pathway from the first phone call of a back pain problem. Our center is fortunate to have active engagement from our physical therapy leadership, our pain management leadership, as well as the managers throughout – and again primary care is represented. We have the people in the room who will be the ones establishing pathways at different points in time. That’s our trajectory, that’s where we want to go next. Again, coming back to the idea that we want the patient to be treated by the right team at right time in their problem.
What about the Summit are you most looking forward to?
Unfortunately, I can’t be there on Thursday because I already had a prior engagement scheduled. But I’m hoping to see what others are doing and I’m really hoping to have a nice dialogue, as opposed to just giving a talk, to see what others think.
We’re also now a couple years into our surgical care pathway through Wellbe. We are one of the first spine groups with that process in place, which we’ve refined along the way. We learned a lot about how we communicate with the patients, and it’s allowed us to eliminate things like last minute cancellations to a great degree. It’s also been the first time we’ve had access to some broad patient outcomes based on scoring, as well as overall patient satisfaction with the patient surgical experience.
I don’t think there are a lot of surgical spine pathways out there, so I suspect there will be some interest in that. And for those who are using some type of pathway for their other orthopedic surgical procedures, they might be interested in how spine compares favorably or has variation to total joint, for instance, as a pathway. There are some nuances with spine care that are a little different than total joint.