Spine surgeons and non-surgical spine and back pain specialists traditionally worked in silos, their care reflected through the lens of whichever physician they saw first. In some communities, surgeons and non-surgical specialists have competitive relationships and studies with varying responses fill the literature comparing surgical to non-surgical approaches for different conditions and indications.
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Here are six trends for spine surgeons to know about working with non-surgical specialists.
1. The Patient Protection and Affordable Care Act, with aims to improve quality of care and reduce cost, encourages collaboration between specialists with accountable care organizations and other care-delivery models. Providers participating in these payment models accept more risk for patient outcomes by negotiating a global fee for service. Additional costs for care, such as re-operations within a specified period of time, or complications are not covered within that fee.
"With healthcare reform, all accountable care organizations will be looking for spine centers that emphasize non-surgical treatment options and minimally invasive spine surgery to reduce costs," said James Lynch, MD, FRCSI, FAANS, founder and CEO of SpineNevada, and chairman and director of spine at the Surgical Center of Reno, a member of the Spine Center Network in a Becker's Spine Review report. "National payers always have to search to find the best spine centers in the region [and they will be] attracted to the Prizm model that includes PM&R, spine surgeons, spine therapists, clinical outcome report cards, emphasis on home exercise and non-surgical treatment all under one roof."
2. Third-party payers looking to provide quality services for patients and reduce healthcare cost are also devising new coverage programs that triage care. Some insurance companies, such as HealthPartners in Minnesota, promote programs that encourage back pain patients to see a non-surgical specialist before seeing the surgeon to discuss best treatment options. The new program, launched in 2012, aimed to cut the $28.3 million the company spent on spine surgeries in 2011.
3. Larger institutions with spine centers of excellence that include surgical and non-surgical treatment have "nurse navigators" or clinical coordinator designated to gather initial information about the patient, triage care and follow the patient through treatment. Sometimes the point person will follow the patient up the ladder of treatment, eventually resulting in surgery, while others will ensure the patient returns to functionality and exits the program appropriately. The nurse navigator also pays attention to how long patients stay with each specialist so care isn't stalled if treatment with one specialist isn't effective.
4. Many surgeon practices are faced with increased responsibilities to collect and document a patient's non-surgical treatment to gain pre-authorization for surgery from insurance companies. Traditionally primary care physicians or pain specialists gathered this information, but with new expectations from the insurance companies surgeon practices may find stronger partnerships with these specialists beneficial as they seek clearance for their patients' procedures.
5. Patients are often less satisfied with their treatment if they are sent to several different specialists all across town, and patient satisfaction is a growing part of how physicians are rated in the public eye. Whether online rating sites, insurance company polls or payers taking patient satisfaction into consideration when negotiating reimbursement, physicians are increasingly dependent on patient experience.
Those promoting the multidisciplinary model of spine practices and spine care believe bringing different specialists together improves the experience; reduces the economic burden on patients taking time away from work to seek treatment because they don't have to travel to see their other specialists; and encourages communication and collaboration between healthcare professionals to achieve the best treatment possible.
6. Spine surgeons with non-operative practice partners have easier access to these specialists to discuss treatment and communicate about individual patients. Spine surgeons and non-operative specialists in the same practice can refer patients to each other and develop a personal relationship in addition to a professional relationship.
"I think it's really important for spine surgeons' practices to include pain specialists so if injections are needed, you aren't farming them out into the community," says Richard N.W. Wohns, MD, JD, MBA, founder and president of NeoSpine in the Puget Sound region of Washington, in a Becker's Spine Review report. "The integration allows for more cohesive, multidisciplinary communication regarding treatment of patients. The electronic health records are shared, so you know how the blocks are done and can see the diagnostic evolution."
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