Here are five beneficial partnerships for spine surgeons.
1. Work on cases with neurosurgeons. When patients have access to more specialists in a coordinated effort, their care becomes instantly better. Spine surgeons and neurosurgeons partnering regularly on cases are able to provide patients with increased care options and expertise.
"The patients have the benefit of two different specialists consulting on their pathology," says Alexander Vaccaro, MD, PhD, vice chairman of the department of orthopedics at Thomas Jefferson University Hospital and senior partner at Rothman Institute in Philadelphia. "When surgeons can work with someone they respect, the surgery runs more smoothly."
Dr. Vaccaro partners with a neurosurgeon on some of the more complex cases associated with opening the dura. There are also times when neurosurgeons require his assistance, such as when patients with scoliosis deformity require a specific type of detethering procedure. He also works alongside neurosurgeons for patients with spinal cord injuries so patients benefit from expertise in both areas. Orthopedic spine surgeons and neurosurgeons at Thomas Jefferson Hospital rotate as the primary specialist with spinal cord injury patients every week so both are able to work with each patient and share emergency room responsibilities.
"This partnership really helps patient care, and it saves patients the time and agony of going from the orthopedic surgeon's office across town to the neurosurgeon's office because both specialists aren't at the same hospital," says Nick Shamie, MD, associate professor of orthopedic surgery at David Geffen School of Medicine at UCLA.
Dr. Sharan has a special interest in spinal oncology cases, where complex decompressions and fusions are required. He often works with neurosurgeons to decide upon the proper method to resect the tumor. "Having someone else to work with helps in planning the procedure and executing that plan in the operating room," he says. "I think it's important to understand treating spinal disorders requires a multidisciplinary effort to treat patients."
2. Align with local hospitals and health systems. Spine surgeons and specialists around the country are concerned about how they will fit into new payment models, such as bundled payments or accountable care organizations. This will be a special challenge for private practice spine surgeons who provide care at multiple hospitals across several health systems.
"The spinal community continues to develop patient outcome measurement tools to objectively track our treatment strategies," says Anthony Rinella, MD, a spine surgeon with Illinois Spine & Scoliosis Center in Homer Glen and co-founder of SpineHope. "We are always looking to improve evidence-based analysis and recommendations in spinal surgery."
Andrew's Sports Medicine and Orthopaedic Center has partnered with a local hospital and in the process of exploring ACO options.
"Over the next few years, we'll be developing quality outcomes measures as part of an ACO," says Andrew Cordover, MD, a spine surgeon with Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala. "In the spine realm, I think it will be more challenging than other specialties to produce the outcomes measures because it's certainly not as clear cut as measuring survival rates for cancer or heart disease. There are some new instruments out there now and we are always looking to develop and improve upon the tools that we have to develop evidence based medicine in spine surgery."
3. Connect with other providers for ancillary services. There may be the opportunity in the future to enter into a joint venture with the hospital on new ancillary services, such as an ambulatory surgery center or physical therapy services.
"If your group has a large volume of outpatient cases already, you can approach the hospital to see if they would like to work with you on an ASC joint venture," says Michael Webb, MD, a neurosurgeon with NeuroTexas Institute in Austin. "This is predicated on you having the volume to make the ASC work in the first place. The key is to approach the hospital with a sense of your ability to meet their needs."
While its important to accommodate for the hospital's needs where necessary, keep your own interests in mind as well. Find out where you can leverage your strength and don't be afraid to walk away from the deal if the hospital isn't willing to compromise.
"The more cohesive your group is, and the more flexible you are to move cases to other places, the more ability you will have in making these arrangements," says Dr. Webb. "You are always going to lose some control over your practice when you negotiate with hospitals, but the key is to negotiate to get something back. You shouldn't have to give anything up without receiving something in return."
4. Form an IPA with other orthopedics and spine practices. Just as hospitals are consolidating into health systems, physician practices are now becoming part of larger physician organizations and health systems. OA Centers for Orthopaedics is a founding member of the only specialty independent physician association in their region, which includes 15 different specialties.
"Our intention with the IPA is to be able to plug in and join an ACO in any community,” says John Wipfler, CEO of OA Centers for Orthopaedics. "We can provide 'one-stop shopping' for a coordinated set of specialty services. We are the solution to specialty medical care. That has created a lot of interest and I think holds significant promise as a model."
Providers all need to use data to show how using lower site of service can save the system and payors a lot of money. Moving cases from a tertiary care hospital to a community hospital is a significant savings for payers, be they insurers, government, self insured businesses or patients. It generates even more savings to move cases from hospitals to ambulatory settings.
5. Strengthen your relationship with big local businesses. As large hospitals have in the past, some physician practices and surgery centers are now seeking partnerships with large businesses to provide care. ASCs can remove third party payors from the equation by inking deals with local companies to provide medical care for a set cost, which must be lower than they are able to achieve elsewhere.
"We are reaching out directly to large employer groups going around the third party payors, and we plan to continue with that strategy," says Keith Smith, MD, co-founder and managing partner of the Surgery Center of Oklahoma in Oklahoma City. "We are able to carve out their care. More companies are interested in these carve out arrangements where they deal with us directly. The insurance companies aren't always acting in the best interest of large employers and we have basically redirected the patients to us, instead of the expensive hospitals where insurance companies want to funnel them."
OA Centers for Orthopaedics has also reached out to local businesses seeking partnerships, but change is sometimes hard to come by. "We are finding an interesting problem because even though these businesses have talked for years about driving costs down, they are hesitant to make necessary changes," says Mr. Wipfler. "As an example, they have been slow to step up and modifying their benefit structure to create incentives for employees to use preferred providers like ASC's. It is happening but at a slow pace. As reform efforts accelerate we anticipate a faster pace of engagement from employers. Creating incentives to move surgery from hospital settings to ASCs is such an easy way to create significant savings without compromising quality."
"The patients have the benefit of two different specialists consulting on their pathology," says Alexander Vaccaro, MD, PhD, vice chairman of the department of orthopedics at Thomas Jefferson University Hospital and senior partner at Rothman Institute in Philadelphia. "When surgeons can work with someone they respect, the surgery runs more smoothly."
Dr. Vaccaro partners with a neurosurgeon on some of the more complex cases associated with opening the dura. There are also times when neurosurgeons require his assistance, such as when patients with scoliosis deformity require a specific type of detethering procedure. He also works alongside neurosurgeons for patients with spinal cord injuries so patients benefit from expertise in both areas. Orthopedic spine surgeons and neurosurgeons at Thomas Jefferson Hospital rotate as the primary specialist with spinal cord injury patients every week so both are able to work with each patient and share emergency room responsibilities.
"This partnership really helps patient care, and it saves patients the time and agony of going from the orthopedic surgeon's office across town to the neurosurgeon's office because both specialists aren't at the same hospital," says Nick Shamie, MD, associate professor of orthopedic surgery at David Geffen School of Medicine at UCLA.
Dr. Sharan has a special interest in spinal oncology cases, where complex decompressions and fusions are required. He often works with neurosurgeons to decide upon the proper method to resect the tumor. "Having someone else to work with helps in planning the procedure and executing that plan in the operating room," he says. "I think it's important to understand treating spinal disorders requires a multidisciplinary effort to treat patients."
2. Align with local hospitals and health systems. Spine surgeons and specialists around the country are concerned about how they will fit into new payment models, such as bundled payments or accountable care organizations. This will be a special challenge for private practice spine surgeons who provide care at multiple hospitals across several health systems.
"The spinal community continues to develop patient outcome measurement tools to objectively track our treatment strategies," says Anthony Rinella, MD, a spine surgeon with Illinois Spine & Scoliosis Center in Homer Glen and co-founder of SpineHope. "We are always looking to improve evidence-based analysis and recommendations in spinal surgery."
Andrew's Sports Medicine and Orthopaedic Center has partnered with a local hospital and in the process of exploring ACO options.
"Over the next few years, we'll be developing quality outcomes measures as part of an ACO," says Andrew Cordover, MD, a spine surgeon with Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala. "In the spine realm, I think it will be more challenging than other specialties to produce the outcomes measures because it's certainly not as clear cut as measuring survival rates for cancer or heart disease. There are some new instruments out there now and we are always looking to develop and improve upon the tools that we have to develop evidence based medicine in spine surgery."
3. Connect with other providers for ancillary services. There may be the opportunity in the future to enter into a joint venture with the hospital on new ancillary services, such as an ambulatory surgery center or physical therapy services.
"If your group has a large volume of outpatient cases already, you can approach the hospital to see if they would like to work with you on an ASC joint venture," says Michael Webb, MD, a neurosurgeon with NeuroTexas Institute in Austin. "This is predicated on you having the volume to make the ASC work in the first place. The key is to approach the hospital with a sense of your ability to meet their needs."
While its important to accommodate for the hospital's needs where necessary, keep your own interests in mind as well. Find out where you can leverage your strength and don't be afraid to walk away from the deal if the hospital isn't willing to compromise.
"The more cohesive your group is, and the more flexible you are to move cases to other places, the more ability you will have in making these arrangements," says Dr. Webb. "You are always going to lose some control over your practice when you negotiate with hospitals, but the key is to negotiate to get something back. You shouldn't have to give anything up without receiving something in return."
4. Form an IPA with other orthopedics and spine practices. Just as hospitals are consolidating into health systems, physician practices are now becoming part of larger physician organizations and health systems. OA Centers for Orthopaedics is a founding member of the only specialty independent physician association in their region, which includes 15 different specialties.
"Our intention with the IPA is to be able to plug in and join an ACO in any community,” says John Wipfler, CEO of OA Centers for Orthopaedics. "We can provide 'one-stop shopping' for a coordinated set of specialty services. We are the solution to specialty medical care. That has created a lot of interest and I think holds significant promise as a model."
Providers all need to use data to show how using lower site of service can save the system and payors a lot of money. Moving cases from a tertiary care hospital to a community hospital is a significant savings for payers, be they insurers, government, self insured businesses or patients. It generates even more savings to move cases from hospitals to ambulatory settings.
5. Strengthen your relationship with big local businesses. As large hospitals have in the past, some physician practices and surgery centers are now seeking partnerships with large businesses to provide care. ASCs can remove third party payors from the equation by inking deals with local companies to provide medical care for a set cost, which must be lower than they are able to achieve elsewhere.
"We are reaching out directly to large employer groups going around the third party payors, and we plan to continue with that strategy," says Keith Smith, MD, co-founder and managing partner of the Surgery Center of Oklahoma in Oklahoma City. "We are able to carve out their care. More companies are interested in these carve out arrangements where they deal with us directly. The insurance companies aren't always acting in the best interest of large employers and we have basically redirected the patients to us, instead of the expensive hospitals where insurance companies want to funnel them."
OA Centers for Orthopaedics has also reached out to local businesses seeking partnerships, but change is sometimes hard to come by. "We are finding an interesting problem because even though these businesses have talked for years about driving costs down, they are hesitant to make necessary changes," says Mr. Wipfler. "As an example, they have been slow to step up and modifying their benefit structure to create incentives for employees to use preferred providers like ASC's. It is happening but at a slow pace. As reform efforts accelerate we anticipate a faster pace of engagement from employers. Creating incentives to move surgery from hospital settings to ASCs is such an easy way to create significant savings without compromising quality."