Instead, spine centers should focus on developing a multidisciplinary program of collaborative physicians that directly addresses patient experience and includes more conservative care options. These programs not only meet the needs of patients, physicians, payors and the community but also build market share and add value in hospital services such as surgery, radiology, pain medicine and physical therapy. Plus, they offer two unique benefits for the hospitals and physicians who participate in them: Hospitals gain control over referrals for services while creating strong loyalty from affiliated providers.
10 steps to a more successful spine center
There are 10 basic steps that leading institutions utilize to gain control over their spine program and develop a successful, multidisciplinary spine center.
1. Change the paradigm. Behind the scenes, a collaborative multidisciplinary spine team needs to be created. Physicians and providers who today may practice independently from each other must begin to believe that the spine center service line program is theirs; they need to feel vested in it. Hospital administration must support this paradigm shift.
2. Set up a clinical operations committee. This committee takes ownership on how to achieve access, triage, navigation, quality, marketing and research goals. Participation standards are required so that everyone is clear about roles and commitments. Once the spine center starts operations, the committee becomes an operational and quality committee to support management’s efforts. A transparent management dashboard is required.
Committee members should include spine providers, administration, the program director, marketing and possibly key department managers. All members must agree to the care pathway which integrates care plans for pain, mobility and return to work/life skills.
3. Improve access. One of the easiest ways to change the patient’s experience is to dramatically reduce the time to appointment. Goals might include same day for MRI. They may include same or next day to initiate physical therapy. A typical goal is often two days for a physician appointment when the patient’s condition is determined to be urgent. Meeting these goals requires a deep dive into every participating provider’s office system and participating hospital departments.
4. Initiate a triage process. The triage goal is to get the new patient to the right provider at the right time. A physician needs to review their symptoms and make two decisions; first, which provider should see the patient first? Then second, does the description of symptoms suggest an urgent (two days), emergent (seven days) or routine (next available but not to exceed 30 days) appointment request?
Triage is the beginning point where the patient starts his or her care. Once triage is completed the patient is now in the spine center care pathway.
Additionally, triage must protect each provider’s direct referrals.
5. Patient navigation. Patient navigation serves two goals. The first is to drive home the program’s difference to the patient. The patient now has a personal resource as well as help with appointments and access to all spine center providers and services. This is the game-changing way of altering the patient’s experience because it eliminates the fragmentation within the market.
The second is to control the referral for downstream services. Participating providers must coordinate with the patient navigator for all diagnostic testing and treatment services. The patient navigation service makes this coordination of care easier for the patient and the office practice. The office practice staff no longer needs to make these appointments or obtain these authorizations. Spine center patients have all this performed by the spine center as part of the patient navigation services.
This model is virtual and does not require that all the providers be in one group, or that the hospital build a new medical office building to locate its spine center. Success with these programming elements does not require either of these. However, you may find that as the spine center providers gain experience working as a team they will feel compelled to be together in one building (while keeping their practices separate). Many find this to be a valuable consolidation initiative in year three or four of the program. Include outpatient hospital services such as outpatient surgery, MRI, pain procedure rooms and physical therapy in this plan for a consolidated one-stop spine center.
6. Track quality. Spine center quality includes metrics that hospitals track for accreditation such as surgical infection rates. Quality also includes tracking service quality, outcomes such as patient quality of life, financial metrics and performance metrics. Ideally, it is recommended to include a two year outcome tracking algorithm for both conservative and surgical patients.
7. Market the value. Spine center marketing is about community education. Therefore the first step is to educate the inside community. Start with the hospital’s management team, and then take a simple value message about the spine center program to every hospital employee. Everyone needs to know the programs community value proposition. The message is then expanded to the medical staff, then out to the community’s providers. A dedicated marketing liaison is required to make this effective.
Marketing also includes websites, brochures, newsletters and other information messaging models used by the hospital to promote service initiatives. Again, the goal here is to keep the value message simple and consistent.
8. Team case conferences. Once patients begin receiving care, some patients will fail the care pathway. These patients’ should be presented as part of a team case conference. This is an effort for the group but the rewards are valuable to achieve a quasi-academic model desired by this business model. Team case conferences work to break down the communication struggles between providers who work independently. Making this a critical performance metric for the program’s medical director positions the organization for long term positive outcomes.
9. Set research goals. Once the operations begin to mature, one upgrade is to introduce clinical research in spine. Surgeons should identify appropriate research goals for your market. Make it easy to work with your facility’s institutional review board or contract out IRB services to an organization like Western IRB. It is recommended to work with the surgeons to set up the research workflows or contract with a contract research organization that specializes in spine research.
10. Transparent adaptation and evolution. As you move forward, use the clinical operations committee to maintain a transparent management model. Providers who collaborate with you by using data and facts will work with the administrative team to ensure both your clinical and business objectives.
Using spine centers to drive hospital revenue
A large percentage of spine center revenue can be raised in the hospital while up to 95 percent of the patient care takes place outside the hospital. A successful program will build new patient volume with patients who receive care in hospital services such as radiology, physical therapy, outpatient surgery and inpatient surgery. Examples of typical patient flows are as follows.
| Professional services |
Estimated patients receiving services |
Volume example |
Example of average hospital collections per procedure |
Example hospital revenue |
| New patients starting conservative care | 100% | 1,200 | $ 0 | |
| Referrals for PT | 30 – 50% | 360 | $90 | $172,800 |
| Referrals for MRI | 20 – 40% | 240 | $750 | $180,000 |
| Referrals for interventional pain medicine | 10 – 20% | 120 | $1,500 | $180,000 |
| Referrals for surgery | 5 – 10% | 60 | $25,000 | $1,500,000 |
| Potential revenue example | $2,032,800 |
This article was written to educate the reader on the various value propositions available through the development of spine centers. A multi-disciplinary spine center increases market share and aligns providers and community-benefit goals for every hospital that develops this model. Is it time to move your initiative higher in your planning and budgeting before someone else locks up your market?
Learn more about Grant Healthcare Group.
