7 Ways for Spine Surgeons to Stay Ahead in Competitive Markets FeaturedWritten by Laura Miller | April 27, 2012
Here are seven ways spine surgeons can succeed in competitive markets.
1. Emphasize the points of clinical differentiation from competitors. The days of being a general neurosurgeon who performs both cranial and spine surgery are numbered as more fellowship-trained specialists enter the field, says Khawar Siddique, MD, a fellowship-trained spine surgeon with Beverly Hills Spine Surgery in California. This is especially true for surgeons practicing in a competitive urban environment. You have to set yourself apart as an expert in spine, and offer better care than other spine-focused physicians in your market.
Additional points of differentiation could include:
• Concierge services
• Responsive and caring staff members
• Rapid turnaround to patient questions
• Newer technology
Payors such as Blue Cross, Blue Shield, United and Medicare calculate reimbursement based on the procedure performed, and not always on the quality of care. However, surgeons should seek better reimbursement if they can prove their quality is better. One of the ways to differentiate your practice from others is showing your surgical skills are more advanced.
"Emphasize the differentiation, such as different surgical skills if you do minimally invasive procedures, or the fact that you don't have residents or trainees performing the procedures," says Dr. Siddique. "It's important to train surgeons, but the outcome could be different if a surgeon with 10 years of practice performs the procedure as opposed to a second-year resident. One way we are different is that we don't have any residents. We are trying to show the patients that they'll get better care from us and that's why we charge more than other surgeons."
You can also persuade payors by proving your mortality and morbidity rates are better than the national averages, but you must maintain those rates. "You can't just increase prices and do the same procedures as before," says Dr. Siddique. "We emphasize quality over quantity. In our practice, we do fewer surgeries per year but charge more because we can achieve better patient outcomes and experiences."
2. Develop additional ancillary service lines at your practice. Dennis Crandall, MD, president and CEO of Sonoran Spine Center in Phoenix, and his partners are exploring ancillary services as a new way to bring revenue into the group. Sonoran Spine Center currently includes an in-house X-ray and physical therapy.
"Most practices have an X-ray, but since we do a lot of spinal deformity cases we have a machine that allows us to shoot 18x36 inch long spine films," Dr. Crandall says. "That's something that can't be done at just any outpatient radiology center, so we brought it in-house."
When it was time to bring in physical therapy, Dr. Crandall was initially skeptical of its profitability because overseeing the collection of $10-$20 copays can be onerous; the office staff spend time tracking down these small payments, which may not amount to much value. However, soon after incorporating those services the profitability became clear.
"It really has been a good, revenue positive decision to add physical therapy," he says. "We have tight control on the therapists and how the therapy is delivered. Our communication between the physicians' and therapists' offices is fantastic, which makes working together with a patient so much easier."
Now, when Dr. Crandall recommends therapy for the patient, he can call a therapist into the office to the office during the patients' visit to discuss their treatment plan. This boutique level of care projects a positive image of the practice with highly integrated care.
3. Make it easy for patients to come through the door. Sonoran Spine Center is a patient-driven practice, which means the surgeons depend upon a high volume of cases to keep the practice running. Since there are specialists in several different spine-related areas, the group can accept most patients coming their way; however, they must also focus on quality to encourage those referrals.
"We want to see everyone who walks through the door," says Dr. Crandall. "We need to have sufficient quality providers to meet our need for volume. Our care must be consistent with our patients' and referring physicians' quality expectations. We have to be able to take on surgical and non surgical cases, work-related issues, tertiary or simple cases."
Currently, the practice has four spine surgeons ranging in expertise from adult and pediatric scoliosis and other major deformity correction to caring for patients with degenerative and traumatic conditions. Additional medical specialists include a pain management physician, five physician assistants and one research nurse. In the future, Dr. Crandall hopes to add additional pain management specialists, tumor and spinal trauma surgeons to further extend coverage at the practice.
"We want to develop niche areas in spine we don't have covered right now," says Dr. Crandall. "It's hard for us to meet the needs we have right now and go after new business considering how busy we already are. However, this is an opportunity for the future and we are thinking about how to take advantage of it."
4. Train in new and minimally invasive techniques. When spine surgeons decide to incorporate minimally invasive spine surgery into their practice, Walter Eckman, MD, founder of Aurora Spine Center in Tupelu, Miss., says they must be committed to the transition. It takes a lot of time and effort focused away from the regular practice to become proficient in the minimally invasive technique. "I have people visit my practice to see my technique and I can help them learn the procedure," says Dr. Eckman. "If surgeons want more outcomes data, we are amenable to providing that for them as well. I started performing minimally invasive surgery early and have built a good reputation for my work."
However, he cautions surgeons to make sure there is data supporting the efficacy of any technique they learn. "There are so many procedures coming out which people consider 'minimally invasive' but won't be around in five years because the long-term outcomes won't be good," he says. "They might have good outcomes temporarily, but then they'll fall apart. You don't want to jump into performing a procedure just because it's minimally invasive; you want to do a procedure that has good long-term benefits."
5. Focus on creating a positive culture inside and outside of the practice. Success for your business in a competitive market depends upon differentiating you product from others on the shelf. The same rings true for orthopedic practices. When launching their practice, the original Rothman partners were keenly aware of this concept. "In order to be a sustained leader in our market, we had to differentiate ourselves," says Alexander Vaccaro, MD, PhD, a spine surgeon and one of the founding partners of Rothman Institute. "Instead of just being the best surgeons clinically, we had three additional criteria our partners strove to meet: we had to be clinically productive, a good citizen and active in academic work."
Maintaining clinical productivity meant the surgeons were seeing an appropriate patient volume and optimizing their time; being a good citizen meant respecting all employees, being a team player and contributing to the positive culture at the practice; having a focus on academics meant the surgeons were also required to research and write papers, deliver lectures at professional meetings and participate in community events such as sitting on the sidelines at youth sporting activities.
"You can't just be a productive orthopedic surgeon because everyone does that, and their practices can still fail," says Dr. Vaccaro. "If you give back to the community and participate academically, that's different."
6. Become involved with community events. Since it is important for a spine center to have patients and make a profit, external marketing is necessary. One method is to gain exposure for the practicing physicians.
"Consider what organizations or societies in your community physicians should be involved with. Organizations like the chamber of commerce or non-profits," says Stephen Hochschuler, MD, founder of Texas Back Institute in Plano. "Look into areas of children education, sports and disadvantaged individuals. You have to keep your eye on everything."
Physicians that become involved with community groups may not only meet potential patients but also other physicians who could drive patient volume through referrals. Relationships are integral for acquiring patient referrals and driving patient volume whether those relationships are community or medical based.
7. Use marketing tools to brand your practice. Surgeons must market their private practices to drive patient volume and promote brand recognition. Dr. Siddique says it's important for practices to have a moniker that reflects their commitment to high level care, which is why his group decided to practice under the name "Beverly Hills Spine Surgery."
"Beverly Hills denotes a quality of care," says Dr. Siddique. "The name of your corporation should tell patients about the level of care you provide; such as Premier Spine Surgeons, Inc."
Focus on any aspects that make your group special in your marketing efforts. For example, if your group includes all fellowship-trained spine surgeons, tout your expertise to show you are a quality organization.
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