Medical care is more coordinated today than ever, and spine specialists are beginning to form groups and organizations that will provide comprehensive treatment for back pain patients. The Spine Center Network, developed by Prizm Development, Inc., two years ago, is a national network of credentialed Spine Centers of Excellence for payors and consumers to choose truly multidisciplinary spine care settings. Currently, there are 18 spine centers across the United States, including Ann Arbor Spine Center in Ypsilanti, Mich., where Jason Brodkey, MD, practices."I think with time consumers are going to become more weary of the care they receive because as information becomes more available people are going to come in to the office educated about their options," says Dr. Brodkey, who is board certified in neurological surgery and pain medicine, and underwent a fellowship in spine surgery. "People are going to travel for their spine care and try to find the best possible place to care for them. Over time, I think people are going to look for places that can cover all of their spine needs at one center."
Dr. Brodkey discusses trends in the spine field and how his practice has adapted to meet patient needs and pioneer a truly multidisciplinary spine center.
Q: What steps did your group take to achieve success with a multispecialty spine center?
Dr. Jason Brodkey: We started trying to mesh neurosurgical and orthopedic spine surgeons together a long time ago, and that has its challenges. Both specialists are trained differently and have different opinions based on their disciplines. However, the collaboration also has advantages because we are able to learn from each other.
We also decided to add physiatrists to our practice, which was easier. Over the years we had referred patients out to the physiatrists, so we were familiar with which patients would benefit from that approach. However, our first hurdle came when convincing the first physiatrist to join our group. It was daunting being a single physiatrist with a group of six surgeons, but once the first one came the rest followed easily.
Q: How were you able to make sure you were bringing the right physiatrists onboard who could work with the surgeons and fit into the group's culture?
JB: We really interviewed a lot of people to make sure we were partnering with someone who was right for us. It was also an economic challenge because when you are a group it requires capital and outlying expense to bring in a new physician partner. It was a financial investment, but we are in it for patient care. Even though our incomes were impacted — it took money out of our pockets to do it — the package that our patients got was better.
Q: What has changed in the spine space since you began your practice? What are the benefits of a truly multidisciplinary group?
JB: The mindset for multidisciplinary spine care should shift the focus away from surgery and injections to climbing up the ladder of care. Hopefully this will drive down costs. Over time you will see groups merging different specialists together to achieve a multidisciplinary center. We started out merging orthopedic and neurosurgical spine surgeons and now we also have physiatry and physical therapy.
We try to have all our patients see the physiatrist first, and then spine surgeons are at the top of the ladder as the last specialists in line to see the patient. Ultimately, you will have a happier patient and lower costs for insurance companies by performing surgery as a last resort. I think the economics are right and the focus is right to make multidisciplinary spine centers become more prevalent going forward.
Q: As spine centers become more comprehensive, how can providers make sure their patients are seeing the right specialists and receiving high-quality care?
JB: As a member of the Spine Center Network, we track outcomes and I think that will become important because if you don't know outcomes data, then you won't know whether patients are receiving the treatment they need. We have an independent person call patients and collect outcomes data to see how many people were sent to physical therapy or pain management injections, and how many were able to go back to work or experienced pain reduction.
Once you have this information, you can create a report card. This helps us because we can see the trends in our center and make sure we're falling within the norms for what should happen in the spine world. If there is too much surgery, we will think about changing our filter.
Q: What are your goals for the future? Where should spine groups focus to achieve success with a multidisciplinary practice model?
JB: Our goal is to make sure we have a very satisfied and happy group of patients. We need to have an easy access point for patients and an appropriate pathway for spine care. Patients must be able to reach us and go through a smooth process so they meet with the right physician at the right time.
I want us to be leaders in the spine field and evolve in a way that moves forward with both our skill and technology. The technologies are merging and changing in the same way spine care is, and now we are focused on providing cost-effective spine care. We continue to track and report outcomes and I want to make us a desirable center that is able to care for patients.
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