This article is a portion of a book titled "Challenges, Risks and Opportunities in Today's Spine World " edited by Stephen Hochschuler, MD, Frank Phillips, MD, and Richard Fessler, MD. You can find links to the previous chapters at the end of this article.
Prior to the migration of many out-patient spine surgery cases to ambulatory surgery centers, specialty hospitals began to emerge in the late 1990s, early 2000s.
Specialty hospitals are designed to limit their range of services to focus on the needs of specific diagnosis and treatments while leveraging expert care delivery. Specialty hospitals typically choose 3 to 4 service lines and train their care teams to become experts in those service lines. Benefits of a specialty hospital often include specialized and consistent surgical and nursing teams, technology and equipment specific to its service lines and individualized attention for patients. Further, physicians working in the specialty hospitals often serve in governance roles to ensure the hospitals maintain cutting edge services. The combination of these factors ultimately improve the quality outcomes such as length of stay, and reduce complications such as falls and infections. These specialized care teams directly improve patient experience and yield higher physician satisfaction. Patients typically prefer specialty hospitals over a general facility and have the perception that specialty hospitals offer better quality services, resulting in higher patient satisfaction.
After extensive research, Texas Back Institute determined a specialty hospital would be a means to improve our care to patients, increase physician satisfaction, and enable us to more effectively control the cost of care. After considering various models we opted to partner with our community hospital which was part of a large healthcare system in North Texas. Over the years, we have utilized the specialty hospital for many of our surgeries, both in-patient and out-patient. Data plays a significant role in the ability for our practice to maintain a high performance, and we have years of outcome data tracked both in comparison to other hospitals in our system as well as national averages. What we have found at our facility, which is consistent with other similar facilities across the United States, is quite favorable and sustainable.
Of specific interest, are the economics. By repeatedly performing the similar surgical cases with the same resources and teams in place, we have been able to anticipate and manage the costs of delivering care, which allows us to provide greater value to both physicians and payors. A specific example of this advantage is that our hospital and the surgeons from the Center for Disc Replacement lead the industry in offering bundled rates for artificial disc surgery prior to wide-spread insurance coverage. Larger facilities are generally willing to discount charges for cash-pay procedures, but in our specialty hospital, we had a thorough understanding of our costs, which allowed us to work from the cost up rather than the artificial figure of charges down. This enabled us to be competitive with international medical tourism sites, which generally are vastly less expensive than the equivalent US-based facilities. This competitive advantage stems from the fact that most US facilities do not clearly track or understand the costs of delivering a specific episode of care. Now that many of these procedures are done in ambulatory surgery centers which have a better handle on cost, we are starting to see more consistent pricing in an open market system where more and more of the payments are coming directly from the patients. For many elective spinal procedures, I see this as the future as access to new technology becomes more restricted by insurance carriers.
Previous chapters:
Challenges, risks and opportunities in today's spine world
Spine care - Balancing cost with innovation
What are big data and predictive analytics
Predictive Analytics and Machine Learning
The HSS Spine Care Model, Part 1
The HSS Spine Care Model, Part 2
The History of Texas Back Institute
Private practice vs. hospital employee: Where we are today and why
Episodes of care and bundled payments
Episodes of care and bundled payments, a sustainable approach