Bryan Oh, MD, a neurosurgeon with a special interest in spine surgery at BASIC Spine in Orange, Calif., talks about how spine surgeons can build a healthy relationship with hospitals and where these relationships may be heading in the future.
Q: How can spine surgeons build a strong relationship with hospital leaders?
Dr. Bryan Oh: First and foremost, spine surgery that is done without excessive instrumentation costs is a huge moneymaker for the hospitals. The question is what spine surgeons can do when they have interest in surgery centers. When they have interest in ASCs, there's tension there; however if you go to a hospital and say you have spine cases at Medicare, commercial payor or workers' compensation rates, I think every hospital will want your business.
Q: What initiatives can spine surgeons bring to the hospital?
BO: The surgeons can educate the whole team at the hospital about quality of care and how to become a spine center of excellence. The whole concept is that their entire experience should be outstanding. It's not just bringing the patient into the hospitals; everyone has to know what they are doing and make sure the patient has a good experience. Surgeons have to realize that it's really important to build that experience, and we have been doing it at a fairly small hospital successfully.
Q: Where should spine surgeons focus to build a better experience for the patient?
BO: They should focus on everything from how friendly the nursing staff is to the quality of the food; you have to think about this as a situation where the patient has the best experience possible. That's in addition to having a quality outcome from surgery. If you meet with hospital administration ahead of time and talk about developing a center of excellence, they can work together.
All hospitals track outcomes and quality metrics, so work with them to figure out how to get better outcomes and higher quality. Additionally, there should be specific nurses who are trained and experienced with orthopedic and spine patients. Those nurses are able to recognize complications early on and they know there are certain things the patient should do, such as physical therapy, to have a better outcome.
You can talk to the hospital about these initiatives, but the surgeon has to take command of these ideas to improve the experience for his patients.
Q: How does investing in an outpatient surgery center impact this relationship?
BO: Clearly, hospitals would prefer surgeons bring cases to their setting, so it's challenging to maintain a good relationship. We've had a business of workers' compensation patients and that paid the hospitals well, but with our ability to perform these procedures at an outpatient facility will mean the hospital sees a significant loss. Insurance carriers are moving to situations where they want good care to be delivered at a small price and outpatient surgery centers are cheaper than hospitals.
Q: Can surgeons and hospitals partner on outpatient surgery centers?
BO: There are a few options for partnerships and some are doing joint ventures with hospitals. On the surface it looks like a win-win because hospitals will continue to get the facility fee for procedures that are going to the outpatient side and surgeons are building a referral source. However, distributions from the surgery center can be tricky. Both the hospital and physicians want to claim as much as possible, so there are challenges balancing the relationship.
Doctor Bryan Oh is board certified in Neurological Surgery and received his medical training at Stanford University with a residency in neurosurgery and fellowship in spine surgery at the University of Southern California.
Dr. Oh was a faculty member at the University of Texas at Houston Medical School and was Director of Neurotrauma for the busiest Level One Trauma Center in the United States.
He is a reviewer for the journals Neurosurgery and World Neurosurgery as well as a member of several prestigious societies, including the Congress of Neurological Surgeons and the American Association of Neurological Surgeons. Please follow him on facebook, twitter, and google+.