Ty Thaiyananthan, MD, founder of BASIC Spine in Newport Beach, Calif., discusses key metrics for spine surgeons today and where the industry is headed in the future.
1. Patient outcomes. Traditionally surgeons look at metrics for patient outcomes with scales like SF-12 or SF-36 and the Oswestry scale. There are 12 to 36 questions patients answer about their pain and disability, and usually outcomes are measured with the Visual Analogue Scale as well.
"These have been really good tools, but this is evolving into a bigger practice view," says Dr. Ty. "Insurance companies, patients and hospitals are trying to use these outcomes to validate whether a particular surgeon or group is delivering spine care with good results. They are also trying to quantify costs and patient satisfaction. The traditional scores we had are good for measuring pre- and postoperative pain, but I think with some of the changes in healthcare, we need to expand our scale."
Now, outcomes tracking will include patient satisfaction surveys and overall costs to gauge the effectiveness of treatment.
2. Cost of care. Surgeons haven't traditionally tracked cost of care, but more emphasis is placed on maximizing resources in today's healthcare environment. New payment models, such as accountable care organizations, are demanding cost-effectiveness as part of their goal in overall quality of care.
"There are large grants from the government to develop technologies and performance rank to come up with a numeric scale or another way to measure everything that is needed for the ACO," says Dr. Ty. "Hospitals have used outcomes measures from Press Ganey scores to measure internal data for clinical quality and now insurance companies are requesting relevant data for the cost of care."
Organizations are looking at how to bring providers together and decide on a numeric value for patient outcomes and the cost of care.
3. Patient satisfaction. Along with clinical quality and cost, payers are now demanding patient satisfaction scores. Patients must be satisfied with the overall experience — how your practice staff treats them, time spent with the surgeon and accessibility of treatment — in addition to clinical outcomes.
"We have to be able to justify the cost of care with patient satisfaction and clinical outcomes," says Dr. Ty. "The only way to do that is collect your own data. Find the necessary tools — there is software available to track patient satisfaction — and collect information from your patients. It takes a lot of foundation and work to really quantify your services. With ACOs in healthcare and ObamaCare mandating that we track these perimeters, it's going to be happening in the future."
Electronic medical records will be critical for collecting all data at the practice.
4. DRG costs. Physicians should start thinking about DRG costs at their facility and comparing them with others in the community. Consider why there is a difference and how the difference will impact your practice in the community.
"Traditionally this data has been private to the hospital, but now we're seeing an environment where providers have to put all the chips on the table and crunch the numbers," says Dr. Ty. "We have seen an exposure of what hospitals make on a procedure and how much they give physicians. Patients have access to that data and can make decisions based on that knowledge."
One of the major roadblocks to controlling costs and collecting data is the mal-alignment between providers and payers. Hospitals, physicians and medical insurance companies often have different goals in patient care and it's hard to realize success as a result.
"It's difficult to validate the data and compare it across the board," says Dr. Ty. "One hospital may be less expensive, but it has worse outcomes than another hospital that is more expensive. How do you effectively interpret that data within the changing healthcare system?"
Neurosurgeon Ty Thaiyananthan is a the founder of BASIC Spine. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and advanced devices to treat chronic neck and back pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center.
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, youtube, twitter, and google+.
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