Physician collaboration across fields of patient care is necessary as value-based care becomes the measure with which the healthcare field is judged. Maurice Collada, MD, board-certified neurosurgeon and director of the Salem Spine Center, a part of Salem (Ore.) Health, discusses how he and four other surgeons, in collaboration with Salem Hospital, built a program designed to support and perpetuate collaborative patient care in spine treatment. Here are the steps Dr. Collada and his colleagues took to create this unique referral program.
1. Commitment to value-based care. Referrals are a large part of a spine surgeon's case volume. When primary care physicians can no longer manage a patient's spine-related pain, they refer the patient to a spine surgeon. Though this seems simple enough, there are a vast number of individuals involved in the continuum of spine care. Beyond the primary care physicians and spine surgeons, there are physical therapists, pain specialists, imaging centers, physiatrists, and chiropractors.
"There is plenty of literature on spine care, but there hasn't been a high level of continuity or collaboration in any given community," says Dr. Collada. With so many different providers involved, varying standards of care are inevitable. Spine care becomes difficult to navigate, for both patients and physicians.
"Managed care was supposedly all about primary care providers directing patient care, but they didn't have the necessary relationships with the right specialists," says Dr. Collada. "We decided we needed something better in Salem. We had all of the components of spine care, but no true effort toward collaboration existed."
Coordinated care is once again becoming a hot topic in healthcare, but it is a daunting task to accomplish. Dr. Collada began five years ago and along with colleagues, and with the hospital’s full support they decided to tackle the challenge of transitioning from their existing fragmented spine care model towards a more efficient, evidence based, patient centered model that would be well positioned to shift from volume-based reimbursement to value-based reimbursement
2. Appropriate patient direction. In the case of Salem Spine Center, the referral system is designed around the Priority Consult program. Priority Consult is an electronic platform that allows for collaboration, and management through the sharing of patient information. Any potential case that is a candidate for a spine surgeon consultation is viewed by a surgeon, or a physiatrist of Salem Spine Center. The surgeon or the physiatrist then decides the best course of care.
How cases are reviewed and the resulting actions are determined by a set of algorithms created and agreed upon by Dr. Collada and his colleagues. "We review the cases and decide if someone needs to see a neurosurgeon. In this way, we don't waste a patient's time or money," says Dr. Collada. "We started flipping the situation from seeing 75 percent non-surgical patients to seeing 75 percent surgical patients."
3. Transparency with treatment decisions. Once the core group of neurosurgeons had formed the program's foundation, they had to reach out to bring together all of the providers involved in spine care. They built an education program and visited primary care physicians to explain how the referral system worked.
Initially, there was a level of suspicion. Primary care physicians and other providers feared that Salem Spine Center was simply trying to trap large numbers of patients. "Over time, those suspicions have been allayed. There is a give and take. We need to understand the other providers' needs and perspectives. After this is clear, they are more comfortable. It has made them certain that they are sending their patients to the right facility," says Dr. Collada.
From the beginning, the Salem Spine Center surgeons offered a transparent relationship with those that would become involved in the referral program. The algorithms used to create the system were shared with the primary care providers and used to identify the proper timing to decide when patient referrals become the correct choice.
"Primary care providers now feel as if they are a part of the spine care continuum. They always have been, but now we are taking the time to actively engage them," says Dr. Collada.
4. Outcome documentation. Providing supporting evidence is a pillar of value-based care. From the inception of the program, Dr. Collada and his colleagues initiated tracking studies. With the data gathered from these studies, Salem Spine Center has earned recognition as a Center of Excellence. The data offers substantial proof that the program is meaningful for the providers involved and beneficial for patient care.
A year was spent organizing the idea among the neurosurgeons. The first two years of the program involved a slow rise of participation. Only in the past two years has the number of referrals coming to the Salem Spine Center increased dramatically. The center is now coordinating care for more than 200 patients each month. Throughout the program's infancy to its present, outcomes have been documented. These outcomes support and drive the program forward.
5. Prioritized patient care. "First and foremost, a program that is worth doing is worth it because it is designed for better patient care," says Dr. Collada. "We have provided a better service for the patients." Dr. Collada sees provider and patient collaboration as the next step.
"We need to develop a very strong education program for the population at large. We need to talk to patients about their role in spine care and how to avoid being in a spine dilemma," says Dr. Collada. "Our program will continue to grow. Collaboration and dedication will attract the attention of both patients and providers."
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