Ty Thaiyananthan, MD, founder of BASIC Spine in Newport Beach, Calif., and Bryan Oh, MD, a neurosurgeon with a special interest in spine surgery at BASIC Spine, are joined by practice manager Casey Crawford to discuss the biggest challenges and opportunities for independent spine groups in the evolving healthcare market.
Q What is the biggest issue facing independent spine groups today?
Dr. Ty Thaiyananthan: The first problem most practices face is how to generate volume and get patients in the door. That was the first thing we addressed with our group; how to reach the appropriate markets. We have relied on the web and gone as far as hiring individuals to help maintain our referral relationship and improve our communication with referring physicians.
We've created surveys asking people to rank us on different qualities, such as accessibility and patient experience. We also gather feedback from referral sources to make sure we are addressing their concerns and making improvements.
Q: How are you able to ensure a positive patient experience?
TT: When patients come into the clinic, we work with them to make sure they are directed to the right physician. We see a lot of patients with low back pain, and usually they are seen by a physical therapist first; however some truly are surgical candidates. We have developed a system where patients are appropriately routed to the right specialist based on symptoms, imaging studies and past treatment.
An intake questionnaire is part of our electronic medical records that identifies nonoperative treatment they've had in the past. Our practice includes several pain specialists to cover different needs our patients have. This system helps us deliver the appropriate type of care, and patients don't have to go through a referral ring to several different specialists.
Once patients are routed to the appropriate channel, we make sure patients get the appropriate treatment on time. It doesn't take long to get authorizations for treatment; we've relied on technological components to help with that.
Q: What technology do you use to improve this process?
TT: We have an intraoperative project management software to coordinate tests that need to be done to ensure we have the right people in the right place. The software assigns a task we need to collect patient information and alerts us of the due date so we can gather the information before the patient's visit and minimize wait times. We've incorporated that software into the EMR.
We also identified a workflow algorithm to really quantify the way we clinically evaluate patients. We are trying to integrate that into our software as well to cut down on work and repetition. Patients get the care they need faster with less expenditure and surgeons aren't wasting their time with patients who don't need their expertise. The outcomes are better because we are able to treat patients appropriately. We developed our EMR around these ideas.
Q: What was the advantage to designing the EMR yourself?
Casey: One of the advantages of building the EMR from the ground up was that it enables surgeons to increase their efficiency. EMRs are trying to be everything to everyone and asking providers to tailor their practice to the software afterwards, with a few minor customizations. We wanted to eliminate that to provide better care and not get bogged down by a cumbersome system. It's better for patients and the practice in the long run.
Q: How has this improved technology and process impacted patient care?
TT: Once patients have treatment, we want to find out if that treatment really helps, and whether they need another step to care. Part of that is doing another patient intake screening, primarily for us to see Oswestry and VAS scores. Patients give us quantifiable feedback to show what we do is working. If it fails, they are sent to interventional pain specialists or physical therapy to treat residual pain.
We are able to capture some of the data that is unique to back pain practices and incorporate our best practices into EMR. We can also collect data from the patients about what they've tried and compare their results to data that has been published before determining the best treatment pathway. We are able to more efficiently treat patients — we've actually cut time down by half — and still deliver the same amount of patient face time because we are spending less time on documentation.
We designed our EMR to present algorithms and templates with drop down menus so we have minimal typing and dictation. That has sped things up, improved data mining for analysis and outcomes collection. We can also mine the data for how long we are spending with each patient, how long it takes patients to check in, and see where there are efficiency issues we could improve on.
Q: Can practices actually realize a cost savings from these process changes?
Dr. Bryan Oh: One of the things we are trying to track right now is the quantifiable cost savings compared to a traditional practice. It's important to show these comparisons to insurance providers. We are developing our clinic into its own accountable care organization in a microenvironment. It's a continuously evolving process to streamline the referrals. There are certain diagnostic tools, like imaging, labs and neuro-activity to bring into the clinic to make sure patients have access to these modalities in a timely fashion. Additionally, these services result in ancillary revenue for the practice, which increases profitability.
Ty Thaiyananthan MD is a neurosurgeon and 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 minimally invasive surgery 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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