8 Core Concepts for Cutting-Edge Comprehensive Spine Practices Today

"Spine is definitely a service line that is growing," says Brian Bizub, CEO of Palm Beach Orthopaedic Institute in Southeast Florida. "People are living longer and are more mobile so they are having back pain. In the past, people weren't as active in sports during their later years, and that's causing great problems as well. Spine care needs to be a comprehensive program these days to treat patients and return them to activity."

Here are eight key concepts that made Palm Beach Orthopaedic Institute successful.

1. Gather data for treatment protocol. Mr. Bizub's practice is examining ways to develop a more comprehensive program for their patients to offer conservative care as well as minimally invasive interventions before relying on fusion as a last resort. "We have started collecting as much data as we can to identify trends in specific treatments," he says. "Tracking ICD-9 codes allow us to identify specifics about the patients we treat and then we'll coordinate our program accordingly."

2. Bring multidisciplinary specialists onboard. The practice currently includes pain management specialists, physiatrists and surgeons. Patients are triaged to the appropriate specialist and work through their treatment. "We are trying to collect more data as well to see how we handle patient flow and find more opportunities to serve our patients," says Mr. Bizub. "Postoperatively we are always looking at our outcome rates and mobility versus immobility to determine the best course for the specific patient based on their demographics."

3. Reach out to the community with educational programs. The practice is located in Western Florida where there are a lot of orange farmers as well as retired people traveling to and from the community during the winter months. Practice physicians have begun to boost their reputation by doing a lecture series about how to move properly to avoid back pain.

"I'm looking from the administrative side about how we can educate the population," says Mr. Bizub. "It's about being in the community and supporting the people here. We'll say, 'I'm here if you need me, but here's how not to come and see me.' I think education is key for outcomes as well as collecting data to better serve our patients."

4. Develop an efficient patient navigation program. A strong internal program allows the physicians and staff to move patients through the practice efficiently.

"We've created a navigational program where patients call in to schedule a visit because they have low back pain, and we put them into the low back pain protocol program," says Mr. Bizub. "They are able to talk to the nurse and our nurse determines whether they have acute or chronic pain and makes sure they are put on the right pathway. If it's a sports injury, they'll see the sports medicine specialist. If they have chronic pain, we make sure they've had an MRI and epidural treatment before they are considered a surgical candidate. We also measure factors such as weight and BMI to take them into consideration for their treatment."

5. Schedule appointments as soon as possible. Seeing patients quickly after they call to schedule an appointment is another trademark of the practice. When a patient with acute pain calls, they are scheduled within 24 hours to 48 hours for a visit. A chronic pain patient is questioned thoroughly to ensure the physicians don't recommend repeat services and determine whether they can help the patient.

"Seeing a pain physician when you need a laminectomy or fusion isn't worthwhile," says Mr. Bizub. "It's more beneficial to put the patient into a pathway that works for them."

6. Consider implant costs. In addition to managing the patients clinically, the practice physicians partner with local hospitals and surgery centers to ensure they are providing an efficient and cost-effective service for their patients.

"We have a product committee that holds meetings to determine whether new products are beneficial or not," says Mr. Bizub. "The vendors come in and tell us how their products are beneficial to the patient and we negotiate the price. We want to make sure reimbursement will cover the cost of care. At ASCs we want to provide high quality care, but make sure we aren't just using medication and implants because they are new in the marketplace."

7. Construct an ambulatory surgery center. Cases performed at the outpatient surgery center often cost less and are more efficient for the patient, but the patient must return home within 23 hours. New pain management techniques numb the patient's pain through the peak hours — the first few days — and allow the patients to become more mobile and recover quickly.

"It's a very competitive world — there is a big split between hospital-employed surgeons and private practice surgeons," says Mr. Bizub. "We are trying to support an environment that gives private practice surgeons autonomy, but there are also standards in place to make sure the practice runs smoothly. We are trying to entice high-level, fellowship-trained surgeons to our practice. There is a lot of research done prior to even interviewing a new potential partner. We talk to their references, but also the people they worked with at their last hospital and the implant representatives to make sure they are high quality surgeons. We want to make sure the surgeons can do what they love to do and will buy into our protocol so our program can be successful."

8. Make new surgeons partners quickly. When a new surgeon comes onboard, Mr. Bizub and the physician partners engage them quickly to become a shareholder in the organization rather than an employee. This gives further incentive for the physician to become involved in the practice's success.

More Articles on Spine Surgery:
Spine Surgery in ASCs: 6 Burning Questions About Future Feasibility
New Initiatives in Spine & Pain Management: What Works Best
Understanding the Impact of MIS Surgery: 8 Key Concepts