Ty Thaiyananthan, MD, founder and head neurosurgeon of BASIC Spine in Orange, Calif., discusses the benefits and challenges of building and leading a multispecialty spine practice. "In our practice, we have both neurospine and orthopedic spine surgeons," says Dr. Thaiyananthan. "We have physical medicine and rehabilitation, anesthesia, pain management, neurology and a pain psychologist. Our practice also includes physical therapy and chiropractic care."
Q: Why did you decide to build a multidisciplinary practice?
Dr. Ty Thaiyananthan: What we originally wanted to do was establish a protocol for patients that followed evidence based medicine. We would employ conservative treatment before directing patients toward interventional and invasive procedures. We discovered we were able to give patients a comprehensive treatment opportunity.
When patients have back pain, they also suffer from psychological issues and addressing those underlying issues is important. Specialists from different areas can discuss patient care and optimize outcomes, which helps patients recover faster. We don't have a monochromatic view of treatment; we aren't always operating. We have to figure out how we can merge these specialists together for the best outcomes.
In addition to having different physicians under one roof, we are also trying to bring in the diagnostic components. This gives us access to the diagnostics we need when we need them instead of referring patients out for CT scans or lab studies to see if their opioid levels are high. We can actually make that determination while they are there. We can make a diagnosis more accurately and faster if everything is under one roof.
Q: What were the biggest challenges you faced when creating a multispecialty spine practice?
TT: It was a challenge to establish protocol and ensure there was good communication between different providers. Our protocol depends on evidence-based guidelines so when a new patient comes in with back pain and they can see our physical therapist, chiropractor or pain specialist who can refer them to an interventional pain physician if that modality doesn’t work. They had to come to a consensus about when to use additional imaging studies and when it would be appropriate to begin surgical evaluation.
It wasn't easy to establish those protocols — it was a dynamic process. You set up the algorithm and see if it's applicable. We have been developing software for our system that actually helps coordinate workflow. What we've looked at is a computer-based algorithm for spine patients. New technology to coordinate that communication in this application has been really something that makes our practice model feasible.
Q: From your perspective, what are some of the biggest benefits of coordinating a multispecialty spine care practice?
TT: There are several benefits, especially for insurance plans because we are able to coordinate care and lower costs for overall care. It's a more efficient system and because of that our costs are cheaper. We've had a few insurance plans designate us as spine and pain providers because we are cost-effective and produce results. As we start to think about accountable care organizations, providing cost-effective care in an efficient manner will become a necessity.
One of the other things we noticed is that most patients will present to their primary care physicians, who wonder whether they need an MRI and which specialist they should see. We hear back from providers that they don’t have to worry about that because when they send their patients to us we direct them to the appropriate place. We take care of the decision-making and diagnostic workups. The primary care physicians refer the patients and we can do the next step. We define the delivery of care from that standpoint and we can eliminate unnecessary tests.
Care is also faster because patients don’t have to go through unnecessary steps that just treat the symptoms instead of help their condition.
Q: For spine surgeons who wish to incorporate this model into their practices, what is the most important element to have in place before becoming a multispecialty center?
TT: The number one element is infrastructure. Without the appropriate infrastructure, it is really hard to coordinate different physicians and providers together. It really helps to have everyone under one roof. Then you have to come up with an algorithm everyone agrees on for a patient that presents at your practice. How do they decide which treatment route the patient will follow?
Finally, the practice must establish a mode of communication that works well to overcome communication hurdles. For us, that has been emails and text messages. We are in the process of installing our software, which gives us the ability to send electronic communication at the point of contact. Most surgeons are really busy, but we want to give real time feedback. It would be similar to a chat dialogue that is open throughout the day.
In the software environment, you should be able to see notes and images at the same time. Email and texts are fine, but there is a better way to achieve access for patient care in real time.
Q: Do you see this multispecialty spine care model spreading across the country?
TT: I think whether by private companies are insurance plans, there will be encouragement for physicians to pursue a model like this. What has been keeping it at bay right now is that there hasn't been a push from medical insurance companies, and the infrastructure hasn't existed until now. Now we have electronic medical records and other communications to help us facilitate patient care.
Dr. G. "Ty" Thaiyananthan is founder of BASIC Spine. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and minimally invasive surgery to treat chronic neck and back pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center.
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