There are a lot of changes in healthcare today, but what really makes a difference in spine care? Some surgeons and facilities are putting lots of resources into gathering data, changing treatment protocols and testing new processes for patient care. Time will tell whether these strategies pay off.
"Protocols will change when effective treatment is reasonably priced and validated by the results," says Anthony Yeung, MD, founder of Desert Institute for Spine Care in Phoenix. "Results can also be predictable if diagnostic and therapeutic injections by the surgeons are able to identify the pain generator."
There are several specialists who treat back pain, and in some regions a serious turf battle wages on about appropriate patient care between operative and non-operative spine surgeons and specialists.
"It is difficult with so many subspecialists evolving and promoting their techniques to address pain, with each subspecialty protecting their turf, but multispecialty practices or practices that support each other in a congenial environment will thrive," says Dr. Yeung. "Patients are grateful to physicians who are given a referral to a competing physician who is able to help."
Keeping patients happy is important because they'll return for repeat visits if you earn their loyalty, or at least recommend you to a friend. But it isn't always easy to refer a patient away.
"Although we all feel the altruistic need to do what is best for our patient, it will require changes in the reimbursement environment forcing surgeons to make good progress with their treatment methods and look at more conservative or less invasive options first rather than the ultimate 'definitive' treatment based on the imaging abnormality," says Dr. Yeung.
So how can surgeons become leaders during a time of great change?
There are several ways to show expertise and foresight for success, even during turbulent times:
• Take patients to the safest surgical setting possible
• Compile a group of specialists who complement each other
• Become involved in clinical trials for new technologies
• Offer patients several different treatment options
• Participate in spine organizations through podium presentations, posters, workshops and symposiums
"The leaders are those who have demonstrated success in their delivery model and are involved in their spine organizations," says Dr. Yeung. "They should be recognized by their peers as a leader and receive referrals from their competitors for procedures where they have established a good reputation as an expert. They will be able to subject themselves to peer scrutiny."
While maintaining a strong clinical practice and participating in organizations builds the surgeon's reputation, they are also now responsible for providing high quality care in a low cost setting. Ambulatory surgery centers have long been considered the high quality, low cost care setting but up until recently most spine surgeries were performed as open procedures requiring several days to recover in the hospital.
"Affiliation with an ASC will create opportunities for a surgeon, but the surgeon or ASC will have to be able to deliver on their promises and be aware of safe surgical practices in patients with little comorbidities," says Dr. Yeung. "Taking surgical care to an ambulatory center and away from hospitals is the first step surgeons can take to reduce the cost of surgical care."
The ASC also offers surgeons another option to become less dependent on local hospitals and narrow networks designed to capture insurance payers. Proving your care in outpatient centers — whether through data collection, clinical studies or other means — will be even more important in the future.
"Leaders will keep informed but just as important will have to be 'performers' and be able to accomplish what they adopt and promote, not just talk about it," says Dr. Yeung. "Just being on the lecture circuit and a podium speaker at spine meetings is desired, but not enough."