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Chicago Back Pain Center Aims to Avoid Surgery

Cheryl Clark, for HealthLeaders Media, July 16, 2010

With bundled payments on the horizon and more seniors and others with back pain complaints, Chicago's Swedish Covenant Hospital has invested $2.5 million in a center to treat just this kind of complaint—in a comprehensive kind of way.

The 334-bed hospital recruited three neurosurgeons and support staff to help patients exhaust every course of possible care before considering surgery, says Daniel Laich, DO, one of the center's new neurosurgeons.

"I'm one of the rare neurosurgeons who spends time talking about nutrition with our patients. I tell them, 'You're changing. Your hormones are changing. Perhaps you want to get on a vitamin supplement plan that's useful.' "

Osteopathic and chiropractic techniques as well as massage, physical therapy, pain management and acupuncture specialists with Swedish are all part of the offering and only if these non-invasive strategies fail will the doctors turn to invasive ones, Laich says. "We're really a group that's open to alternative measures." Even if patients need surgery, the least invasive will be tried first.

Although the center has its own space, it is well integrated into the rest of the Swedish Covenant campus and the Galter LifeCenter, the hospital's fitness center that was the first in the country operated by a hospital for the public, says Mark Newton, Swedish CEO.

Newton says the concept of having a back pain center is in line with models resembling accountable care organizations, ones that allows providers to manage the patient's entire episode of care in one place. Also, it allows patients in Swedish Covenant's neighborhoods, nine miles northwest of downtown Chicago, to avoid trips to major teaching hospitals in the city.

At Swedish Covenant, a back pain staff member will "navigate the care for that patient, and make all the arrangements," Newton says.

"If you arrive and are in serious pain, you can be diagnosed and get a plan of care all in the same visit and with an MRI the same day. Care is expedited and patients don't have to be hunting and pecking. The fundamentals are based on a model that allows us to manage that episode of care," Newton said.

One unusual aspect of the center is that the surgeons are on salary, and while they are paid for their operations, they are also paid if they don't operate, Laich says. "We'll know when surgery must be the end result, but we hope to stay far short of that, with mainstays of behavior modification, changes in diet and (getting patients to) take responsibility for their own health."

"We get paid to guide the care that we feel is more medically and fiscally appropriate," Laich says.

Also underway at the center will be a number of clinical trials of devices and surgical strategies that are being used in Europe.

CEO Newton says he decided to go forward with the project when research "told me is that there's a significant, 20% increase expected in the next five to seven years in people with back issues, and not all of them will necessarily require surgical intervention."

He modeled the center after the Texas Back Institute in the Dallas/Fort Worth area and the Barrow Neurological Institute in Phoenix.

His biggest challenge: Finding a group of physicians who share this philosophy: treating the patient with conservative strategies at first, and who wanted to work in a partnership with the hospital as employees.

The center is only two weeks old, but four weeks of surgery are already booked, Newton says.

"And yes," he says without hesitation. "It will definitely be profitable, because profitability comes from having a full program."

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