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Structuring a Spine Program

Joe Cantlupe, for HealthLeaders Media, August 15, 2011
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Hospitals are finding that multidisciplinary approaches in spine care, with partnerships among the key disciplines, are leading to more efficiencies and better patient outcomes.

Indeed, under the umbrella of spine care, hospitals are expanding multidisciplinary approaches in inpatient and outpatient care for spinal complications such as herniated disks, sciatica, and related conditions.

From minimally invasive techniques to concentrating on specific illnesses such as osteoporosis, health centers are increasing their varied approaches to meet needs of patients seeking shorter recovery times. The wide area of spine care runs the gamut for conditions including scoliosis, degenerative issues, and fractures.

While spine procedures are continuing to evolve, hospital officials are dealing with an evolving marketplace in implants as insurers are rejecting more expensive surgical procedures, and the complexity of spinal surgeries is undergoing more scrutiny.

Kamal Thapar, MD, medical director of neurosurgery and tertiary care services at the 300-bed Sacred Heart Hospital, in Eau Claire, WI, says pressing financial pressures combined with better ways to serve patients are prompting healthcare leaders to expand multidisciplinary techniques in spine care, a process traditionally used more frequently in other service lines, such as cardiology.

At Sacred Heart, for instance, using multidisciplinary techniques has led to expansion of the service line in spine care and increased surgical procedures with technological advances, Thapar says. Hospitals also are including technological innovations and specialized surgical suites to provide state-of-the-art treatment for spine care.

"The whole issue of spine care is huge," Thapar says. "There are an increasing number of people in their 70s and 80s, living a very intellectually and spiritual life in every other way, except their back pain or other ailments may not allow them to have the quality of life they are seeking."

At least 31 million Americans experience low-back pain at any given time; and half of all working Americans claim to have back pain symptoms each year, according to the American Chiropractic Association. Americans spend at least $50 billion each year on back pain, the association states, with 80% of the population expected to experience a back problem at some time in their lives.

A study published last year in the Journal of the American Medical Association found that the cost of treating spine problems in the United States rose 65% in the past decade to $85.9 billion a year, rivaling the economic burden of cardiology treatment, which is about $89 billion.

Controversies have swirled around spine care, particularly regarding overutilization of surgeries and costs. As a result of those concerns, some hospitals are opting for more conservative approaches, including chiropractic programs in their overall spine care program, says Lee Zohn, DC, DAAPM, CCSP, FICPA, director of the 229-bed Winchester Hospital's chiropractic center in Woburn, MA.

The 680-staffed-bed UCSF Medical Center also has incorporated a multidisciplinary approach combining orthopedic and neuro spine surgeons with radiation oncologists and neuroradiologists in the center's spine care program which has led to improved outcomes and processes to explore nonsurgical and surgical solutions for patients, says Eula Mckinney, MsHA, director of general surgery, orthopedics, pain management, and spine service lines for the UCSF Medical Center in San Francisco. The hospital has streamlined its program for evaluating implant costs to improve efficiencies.

"We have made great strides to increase the collaboration among the various disciplines by having a common goal of working in an integrated fashion," Mckinney says.

The multidisciplinary approach has resulted in marked changes in delivery of spine care, particularly among surgeons.

"There is a different mind-set from what spine surgeons have been so used to; it's been longer in coming. It is slowly gaining traction; it is long overdue," says Douglas Garland, MD, medical director and chair of orthopedics and neurosciences at the 162-bed Long Beach (CA) Memorial Medical Center.

Success Key No. 1: Patient management

The 299-bed Methodist Hospital in Merrillville, IN, does a comprehensive treatment of spinal disorders with a multidisciplinary approach through a collaboration of physicians and other clinicians specializing in neurosurgery, orthopedic surgery, and physical therapy under a program known as Priority Consult. It is a patient management system that hospital officials say has been implemented to improve productivity and the patient experience.

A digital technology program has been drawn up to organize and review each patient's medical history, clinical status, tests, and imaging during the early stage of evaluation for spinal care.

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