Marin General Hospital (MGH) in Greenbrae, Calif., recently began a new collaboration with the University of California, San Francisco Department of Neurosurgery and the orthopedic spine surgeons at the Mt. Tam Spine Center, led by Dr. Robert Byers and Dr. Brian Su. The collaboration has resulted in the launch of the Marin General Hospital Spine & Brain Institute, an effort focused on bringing multidisciplinary specialists together to provide a wide range of patient treatments, including elective spine and brain surgery.
"With the UCSF Department of Neurosurgery now performing procedures at Marin General Hospital, we're developing a stronger relationship between the two facilities and Marin patients can now go to their local hospital for elective neurosurgery care," says Tarun Arora, MD, a UCSF neurosurgeon who is involved in the Institute. "It's a little bit of give and take on each side. There's competition between us, but we can provide better care if we all work together. We clearly see the benefits of close collaboration for our patients, for our hospitals and for our practices."
Here are six points about the collaboration that have helped create the Marin General Hospital Spine & Brain Institute.
1. How the collaboration began. Marin General Hospital leadership thought the Marin community would benefit from having elective brain surgery and expanded spine surgery services available locally. Prior to the partnership, patients requiring elective brain travelled to San Francisco due to lack of a local alternative. It was important for MGH to offer these elective procedures to their community so that surgery and follow up treatment could be more easily accessed. "We wanted to team up so we could build a comprehensive center," says Dr. Arora.
The Mt. Tam Spine Center, a well established practice in Marin which provides complex spine care to the community, also welcomed the collaborative effort with the UCSF Department of Neurosurgery, to expand spinal care. "We felt we could do more together than apart," says Brian Su, MD. "The basis of the collaboration is the rising tide; that by expanding spine services to include orthopedics and neurosurgery all those involved, patients and providers alike, will be better off."
Under the agreement, the groups work together at the Marin General Hospital Spine & Brain Institute to provide patient care, but remain financially separate.
2. Financial separation. Under the terms of the agreement between UCSF and MGH, the hospital and the Mt. Tam Spine Center remain financially separate and do not share income. "The hospital provides the bulk of the marketing budget for the Spine & Brain Institute, which includes advertising in newspapers and magazines as well as promoting to other physicians through literature and symposiums," says Dr. Su. "We've been meeting with the marketing team at Marin General Hospital. They see that if we can treat more of the local elective spine and brain surgery cases in our area, it will be a good thing for the community."
When a patient calls for a physician referral through the Spine & Brain Institute, physicians are assigned to them on a rotating basis (unless the patient specifically asks for one surgeon over another). "There's equity in assigning patients that way," says Dr. Arora. "Marin General Hospital doesn't favor one physician or physician group over another.”
If patients need rehabilitation services associated with the Mt. Tam Spine Center, MGH does not receive compensation for the services.
3. Regular meetings between the groups. Every two weeks, the groups hold a multidisciplinary spine conference where surgeons, physical medicine specialists, physical therapists, radiologists and other specialists come together to discuss and offer insight on particularly difficult cases. Through these discussions, the team is able to learn from each other about the best modes of treatment, says Dr. Arora.
4. Neurosurgeons and spine surgeons teaming up. Orthopedic spine surgeons are able to easily team up with neurosurgeons because there is significant overlap in what they each do, says Dr. Arora. "We're developing a multi-disciplinary Spine & Brain Institute," he says. "Having two specialists collaborating on a case in the operating room broadens the range of available expertise."
"The majority of spine surgery in the United States is done by orthopedic spine surgeons," says Dr. Su. "While neurosurgeons also perform spine surgery, they have unique subspecialty training in intradural work such as dealing with spinal tumors. The collaboration between orthopedic surgeons and neurosurgeons is a very powerful thing."
Dr. Su was recruited to the Mt. Tam Spine Center a year and a half ago to advance its services in complex cervical spine surgery. As a result of his addition, the Spine Center has been able to increase the complexity of procedures as well as reduce the time of surgery. The addition of Dr. Arora, his expertise in neurosurgery, and the development of the Marin Spine and Brain Institute will further this concept with the end result being less time under anesthesia, less blood loss, and a faster recovery.
5. Creating a one-stop-shop for treatment. The three groups are collaborating to bring both inpatient and outpatient services to Marin General Hospital. "We're working together to expand the Spine and Brain Institute. UCSF provides neurosurgery, MGH has neurologists, physiatrists, rehabilitation specialists and other experts, and of course Mt. Tam has outpatient services and experienced spine surgeons," says Dr. Arora, "Each disease has multiple specialists that treat it from different angles, but they're all complementary. Bringing everybody together enhances the care we deliver."
Dr. Su says that due to their conservative approach towards spine care, more than 90 percent of the patients coming into the practice are treated non-operatively. This means having physiatrists available onsite is critical. "The management of chronic spine pathology, which is not treatable surgically, should be done by physiatrists, not spine surgeons," says Dr. Su.
The close relationship between specialists makes it easier for the patient to navigate as they go through the treatment process. "It is much less confusing for patients to have a single point of access to the specialists they need," says Dr. Arora.
6. Working with the ancillary support team. Dr. Su says the hospital's ancillary support team, including the nursing care and postoperative care professionals, need to work together to provide the best environment for spine surgery. "It's challenging to bring together the resources to do complex cervical spine surgery," he says. "MGH has really stepped up to the plate and delivered on that front. Having Marin General Hospital available to me is a real advantage. I feel privileged to be there and have the support of outstanding internists, general surgeons, etc." The hospital also is located less than one quarter of a mile away from the Mt. Tam Spine Center, which makes it easy for the surgeons to travel between the two locations.
Learn more about Marin General Hospital.
Learn more about Mt.Tam Spine Center.
"With the UCSF Department of Neurosurgery now performing procedures at Marin General Hospital, we're developing a stronger relationship between the two facilities and Marin patients can now go to their local hospital for elective neurosurgery care," says Tarun Arora, MD, a UCSF neurosurgeon who is involved in the Institute. "It's a little bit of give and take on each side. There's competition between us, but we can provide better care if we all work together. We clearly see the benefits of close collaboration for our patients, for our hospitals and for our practices."
Here are six points about the collaboration that have helped create the Marin General Hospital Spine & Brain Institute.
1. How the collaboration began. Marin General Hospital leadership thought the Marin community would benefit from having elective brain surgery and expanded spine surgery services available locally. Prior to the partnership, patients requiring elective brain travelled to San Francisco due to lack of a local alternative. It was important for MGH to offer these elective procedures to their community so that surgery and follow up treatment could be more easily accessed. "We wanted to team up so we could build a comprehensive center," says Dr. Arora.
The Mt. Tam Spine Center, a well established practice in Marin which provides complex spine care to the community, also welcomed the collaborative effort with the UCSF Department of Neurosurgery, to expand spinal care. "We felt we could do more together than apart," says Brian Su, MD. "The basis of the collaboration is the rising tide; that by expanding spine services to include orthopedics and neurosurgery all those involved, patients and providers alike, will be better off."
Under the agreement, the groups work together at the Marin General Hospital Spine & Brain Institute to provide patient care, but remain financially separate.
2. Financial separation. Under the terms of the agreement between UCSF and MGH, the hospital and the Mt. Tam Spine Center remain financially separate and do not share income. "The hospital provides the bulk of the marketing budget for the Spine & Brain Institute, which includes advertising in newspapers and magazines as well as promoting to other physicians through literature and symposiums," says Dr. Su. "We've been meeting with the marketing team at Marin General Hospital. They see that if we can treat more of the local elective spine and brain surgery cases in our area, it will be a good thing for the community."
When a patient calls for a physician referral through the Spine & Brain Institute, physicians are assigned to them on a rotating basis (unless the patient specifically asks for one surgeon over another). "There's equity in assigning patients that way," says Dr. Arora. "Marin General Hospital doesn't favor one physician or physician group over another.”
If patients need rehabilitation services associated with the Mt. Tam Spine Center, MGH does not receive compensation for the services.
3. Regular meetings between the groups. Every two weeks, the groups hold a multidisciplinary spine conference where surgeons, physical medicine specialists, physical therapists, radiologists and other specialists come together to discuss and offer insight on particularly difficult cases. Through these discussions, the team is able to learn from each other about the best modes of treatment, says Dr. Arora.
4. Neurosurgeons and spine surgeons teaming up. Orthopedic spine surgeons are able to easily team up with neurosurgeons because there is significant overlap in what they each do, says Dr. Arora. "We're developing a multi-disciplinary Spine & Brain Institute," he says. "Having two specialists collaborating on a case in the operating room broadens the range of available expertise."
"The majority of spine surgery in the United States is done by orthopedic spine surgeons," says Dr. Su. "While neurosurgeons also perform spine surgery, they have unique subspecialty training in intradural work such as dealing with spinal tumors. The collaboration between orthopedic surgeons and neurosurgeons is a very powerful thing."
Dr. Su was recruited to the Mt. Tam Spine Center a year and a half ago to advance its services in complex cervical spine surgery. As a result of his addition, the Spine Center has been able to increase the complexity of procedures as well as reduce the time of surgery. The addition of Dr. Arora, his expertise in neurosurgery, and the development of the Marin Spine and Brain Institute will further this concept with the end result being less time under anesthesia, less blood loss, and a faster recovery.
5. Creating a one-stop-shop for treatment. The three groups are collaborating to bring both inpatient and outpatient services to Marin General Hospital. "We're working together to expand the Spine and Brain Institute. UCSF provides neurosurgery, MGH has neurologists, physiatrists, rehabilitation specialists and other experts, and of course Mt. Tam has outpatient services and experienced spine surgeons," says Dr. Arora, "Each disease has multiple specialists that treat it from different angles, but they're all complementary. Bringing everybody together enhances the care we deliver."
Dr. Su says that due to their conservative approach towards spine care, more than 90 percent of the patients coming into the practice are treated non-operatively. This means having physiatrists available onsite is critical. "The management of chronic spine pathology, which is not treatable surgically, should be done by physiatrists, not spine surgeons," says Dr. Su.
The close relationship between specialists makes it easier for the patient to navigate as they go through the treatment process. "It is much less confusing for patients to have a single point of access to the specialists they need," says Dr. Arora.
6. Working with the ancillary support team. Dr. Su says the hospital's ancillary support team, including the nursing care and postoperative care professionals, need to work together to provide the best environment for spine surgery. "It's challenging to bring together the resources to do complex cervical spine surgery," he says. "MGH has really stepped up to the plate and delivered on that front. Having Marin General Hospital available to me is a real advantage. I feel privileged to be there and have the support of outstanding internists, general surgeons, etc." The hospital also is located less than one quarter of a mile away from the Mt. Tam Spine Center, which makes it easy for the surgeons to travel between the two locations.
Learn more about Marin General Hospital.
Learn more about Mt.Tam Spine Center.