Bryan Oh, MD, a neurosurgeon with a special interest in spine surgery at BASIC Spine in Orange, Calif., discusses the important elements of a successful spine practice business models in the future.
1. Treat the whole patient. There are a variety of treatments for patients with back pain and spinal disorders, including both surgical and non-surgical care. In the future, spine practices and surgeons will be responsible for coordinating care for the whole patient, not just performing surgery.
"There are a lot of treatment modalities out there and we want to get the patient's care done in the most efficient and effective way possible," says Dr. Oh. "We like to capture treatment modalities that a specific spine or pain patient needs, including chiropractic care, physical therapy, injections, pain psychology, acupuncture and pain management before considering surgery."
BASIC Spine has brought these medical specialists under one tax ID number to offer these services at one location. "There are big practices out there that have been successful with this," he says. "There has to be a change in the mindset of the surgeons. Very few people come to my practice wanting surgery, and if they do I'm wary of those patients. Surgeons have to understand the mindset of treating the whole patient and adapt to it."
2. Coordinate care among specialists. If all the specialists are under one roof, it's easier to coordinate care for patients. This model also promotes the continuity of care for the patient and ensures patients receive the same message about their care.
"If you are a single surgeon and you refer your patient out to physical therapy, the therapist might say they know 10 pain management physicians and refer the patient somewhere else," says Dr. Oh. "It takes a long time to track down patient referrals and interferes with the continuity of care. In this instance, you would lose the patient from your practice."
Instead, grow with the practice and make sure you have non-operative specialists who are able to bring patients in along with your surgeon to capture necessary new patient volume.
3. Understand what other specialists do. Become familiar with how the non-operative specialists at your practice treat patients and develop an understanding for how their treatments work. Learn to speak the language of these specialists and you can relate to them, and patients, better.
"If you are recommending chiropractic care or acupuncture to your patients, you have to understand what they are doing," says Dr. Oh. "This is a change in paradigm. It takes a lot of time to develop this program and organize it properly, but if you have the right practitioners, it's something that can — and has — to work in your group."
4. Seek payor partnerships and accountable care organizations. In the future, spine groups providing the continuum of care will be attractive to big payors, self-insured individuals and Accountable Care Organizations looking for high quality, low cost solutions to back pain. Plan a single rate for the spectrum of care and different players in the market will be interested in your services.
"Spine groups could start a spine ACO by themselves," says Dr. Oh. "This is what we are doing for the future. We have a group of stellar programs that help us out, and this is revolutionary in terms of the type of care we are able to deliver to our patients."
BASIC Spine has developed an electronic medical record tying all providers together so they can communicate under the same umbrella. The program also allows communication between providers and patients to develop a cohesive message and treatment plan.
5. Implement EMR for data tracking. Beyond communication, providers at BASIC Spine use their EMR for data tracking to prove positive patient outcomes. Leverage those numbers during insurance contract negotiations in addition to marketing efforts for the group.
"Do you have the status that you claim?" says Dr. Oh. "Do the numbers show that your quality is as high as you say it is? Based on certain statistics — such as improved pain scores and functionality — you can attract patients and insurance rates, and you'll be a win for the ACO. If you don't track your data, you'll lose the shirt off your back."
6. Outsource business management. Obtain the services of a managing or marketing company to fulfill the business functions and help surgeons implement technology and processes into the practice.
"If you are two surgeons like we have in our group, it's impossible to complete all the business tasks while running a full practice," says Dr. Oh. "You want your practice to grow as a business so patients will tell their friends and family to go there."
A management group can help you bring non-operative and ancillary services into the practice so you capture the revenue from those services without compromising your clinical time.
Bryan Oh MD is board certified in neurosurgeon 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+.
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