Developing Successful Spine Centers of Excellence and Managing Quality

In the simplest of terms, it is a challenging time to develop a successful spine center, and the challenge is growing. Hospitals and physicians are under greater scrutiny by the government, payors, consumers and the media because of reports about overutilization, illegal and unethical referral schemes, questionable relationships with device manufacturers, fraud and other accusations that suggest providers are making compromises to put more money in their pockets at the expense of patients' quality care.

Unfortunately, the field of spine is often perceived as a hammer, with patients looking like nails who need to be hammered, to receive a procedure or series of procedures whether they need it or not. Further complicating matters for the field of spine is the perception that this specialty lacks data, evidence-based protocols and quality metrics that support the provision of care or treatment.

Marcy RogersThere is a serious perception problem focused on overutilization, and it is a significant reason why developing a new spine center or operating a successful one is difficult. Perception is always a greater problem to handle than reality. Currently, scrutiny at the government, payor and now the consumer level has greatly increased due to reports of poor decisions made by some individual practitioners or entities that have significantly tarnished the reputation of an entire specialty.

The issues are exacerbated by referring providers being confused as to when, to whom and under what circumstances should patients be referred to a spine center or a team of specialists. More importantly, how does one measure the benefits of conservative care? Who should be the gatekeeper managing the process: chiropractors, physiatrists, general orthopedists, neurologists with interventional pain specialty training, neurosurgeons, orthopedic spine surgeons or primary care physicians? The bottom line: There are no rules, and each hospital and its community is a culture in and of themselves, so "one size does not fit all."

Good time for spine

The good news is it is not all doom and gloom for the field of spine. In fact, demand for spine care is increasing, and, in our experience, there's probably no better time to develop and operate a spine center. There are millions of people around the world suffering from spinal pain, and until they receive help, they will continue to be consumers of these services, even if they have to go outside of this country to get the most state-of-the-art care.

But how do you attract these consumers in your community, in the United States and even patients from abroad to come to your spine center? How do you combat the negative impressions of spine care? How do you create a spine center model that captures the appropriate kinds of physicians you want to work with; has specific checks and balances that provide a mechanism for avoiding overutilization, improper procedures and duplication of services; and carries with it a perception and reality that you are collaborative and dedicated to excellence? We believe the first step is utilizing a measurable, focused operating management protocol as a quality metric collection tool.

It should be noted that your current process for documentation of your quality of care may not be sufficient. It is crucial to make a commitment to transparent, measurable accountability, and to adhere to and be governed by the establishment of an operating management protocol that includes the following factors at a minimum:

  • Establishment of spine center policies and procedures
  • Identification of appropriate patient, consumer and market needs
  • Applicable federal and state regulatory requirements
  • Establishment of plans as a means for continuous quality improvement
  • Establishment of a mechanism to facilitate planning, controlling, monitoring, training and correcting activities with respect to the center's policies and its spine protocol requirements and governance
  • Development of a business plan
  • Monitoring of technological advancements and adaptability to change

Renewed focus on quality

For some organizations, these changes likely represent a dramatic cultural shift, but the goal of transforming your organization in such a manner is to develop the ability to perform continuous, organization-wide quality improvement, as well as measure all of your processes on a daily, monthly and yearly basis, and benchmark them both internally and externally.

These efforts will improve the quality of care provided, which should be reason enough to make changes to one's operations. They will also paint a clear, honest representation of your operations; a transparent look at how you care for patients, what you are doing to improve that care and how well you are reducing the cost of that care. These are the efforts payors, the government and consumers want and expect to see from the best healthcare institutions, and are what defines a center of excellence.

What are some of the areas that should be measured? We've talked about the importance of tracking patient outcomes for many years, which led to the pay-for-performance initiative in the 1990s. Today, outcomes are still important, but now it's about looking at all of the components of care that influence outcomes throughout the entire system of care. It is important to address questions such as the following: Did the patient have the feeling of being supported and treated well throughout their stay? How is this measured? How are negative reports handled? Was the entire experience efficient; was it user friendly? To view a sample report card we have used at SpineMark as an example, click here.

Now let's address the operational aspect of the process. Here it is important to look at several areas, including the following: Was is it easy or difficult for the patient to receive their lab work or find radiology? How did the staff treat the patient? Was there a long wait to see a physician or have a procedure? What was the response to any potential errors or complications? If a patient is sent to the hospital or seen on an outpatient basis for a procedure, was the right part of the body operated on? Was the patient provided the right medication? Were there any complications associated with the medication?

Traditional benchmark key indicators should continue to be tracked and measured, such as length of stay, case costing and patient satisfaction. However, don't stop at the broad category of the benchmark; within each of these categories, there can be 100 more subsets of data that can be collected and measured, depending on interests or where improvement is required.

These are just a few examples of questions and areas of focus that tie directly into the quality metrics that should be measured. It's not just a process of looking at the incident in patient care; rather, it's a system that supports the diagnosis all the way through the procedure, discharge and recovery outside of the institution. It's the process of examining every experience of a patient, as it relates to the care provided and how they felt about their experience throughout the system. By turning the measurement of every component into quality metrics, you can improve a potentially less-than-perfect experience into a better process.

Glass is half full

This is not a time to put our heads in the sand and ignore the opportunity to improve our processes. This is the time to take responsibility for what we do, why we do it, how we do it and making the process transparent so it leaves no room for misrepresentation.

We need to be proactive, not reactive. A spine center protocol should provide the identification of minimum spine-related training and competency requirements for its staff and those providing services. Contractors working on behalf of the spine center should have similar competency requirements. If we support quality initiatives, we will grow our market in an appropriate way.

This is going to be the way of the future. Presently, about 70 percent of referrals for a spine center come from a medical provider. This is likely to change. As more organizations — and even payors — form accountable care organizations or other coordinated care models, spine centers are likely to lose access to their traditional patient bases, while medical tourism and directed employer contracts represent significant opportunities for incremental new business and referrals.

Protecting and growing the market in the future will be tied to maintaining quality measures and building relationships with primary care, internal medicine and family practice physicians in a structured way, all while developing the ability to demonstrate to the government and payors that you are assuming total responsibility for the care you provide.

With this type of program focused on quantifying metrics, recanting our successful outcomes about patients and their outcomes utilizing defendable statistics and data, the process of shifting the public's perception about the field of spine can be begin. We will be in a position to say, "Here is what we did, here is why we did it and here is why we were successful."

While I began this article by stating it is a challenging time for spine centers, it is also a time of tremendous opportunity. By focusing on transparency, data, accountability and maintaining compliance with global initiatives on quality patient care, hospitals will not only meet, but also exceed, current guidelines developed by third-party payors for designation of their network criteria and will achieve a well-earned recognition of operating a spine center of excellence.

Marcy T. Rogers, MEd, is president and CEO of SpineMark Corp. SpineMark partners with medical professionals, hospitals and industry manufacturers to provide a turnkey solution to the diagnosis and treatment of spinal disorders. Its objective is to create a global network of multidisciplinary "spine centers of excellence" for quality, innovative care, constantly advanced by research and branded by transparency, accountability and alignment of key stakeholders as partners. www.SpineMark.com

More Articles on Spine Centers of Excellence:

4 Best Practices for Staffing Hospital-Based Spine Programs
3 Best Practices for Technologies and Facilities at Hospital-Based Spine Programs
New Survey Helps Spine Centers Benchmark Services

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