Becker's Spine Review

Improving Spine Practice Profits 5. Instill a patient-focused culture for the whole staff.  At the multidisciplinary environment of Weill Cornell Brain and Spine Center, physicians come together to create a patient-centric care model. The physicians hold regular conferences to discuss patients and frequently see patients together. Dr. Hansraj and his team carefully track the day-to-day time schedule. The practice employs internal "runners" that prepare each patient before meeting with Dr. Hansraj. He meets with the runners at the end of each day to discuss how well timing was managed that day and what could be done better the next. "My whole team works together. We constantly listen to each member for where we can improve," says Dr. Hansraj. Dr. Won also stresses a patient-centric culture at his practice. "All staff members that come into contact with a patient need to keep in mind that he or she deserves A+ service. Patients expect that of a physician's office now. We should meet those expectations," says Dr. Won. "You need to develop a culture of excellent patient care from the top down." Train new hires to provide the best possible patient care and experience. Every element of your practice from medical assistants to the billing department should be geared towards patientcentric care. 6. Always look for ways to improve. For Dr. Härtl, a patient-centered method of practice is a never-ending process. "Technology is always changing and giving us new options," he says. Within the past few years Dr. Härtl and his colleagues gained the ability to electronically transfer image files between one another. As a spine center with a large number of international pa- Driving Value in Spine Care: Outpatient Spine Surgery (continued from page 1) • anterior cervical discectomies with fusions (one-, two-, and three-level) The new era of healthcare reform allows opportunities for small, market-responsive outpatient spine surgery centers to capture segments of the market by providing high-quality care in a narrowly defined, specific area. Outpatient spine centers are essentially boutiques that deliver world-class care in a highly focused niche — what Harvard Business Professor Regina Herzlinger calls "focused factories" in her book, Market Driven Healthcare. Canada's Shouldice Hospital for hernia surgery in Canada was the original focused factory. The Shouldice model proved that when a limited number of procedures are done in high volume by the same providers and staff, the outcomes are better, costs are lower and patients are more satisfied. 37 tients, this saves a great deal of time and allows surgeons to focus on patients instead of struggling to obtain their records. Though files can be in different formats at different institutes, Dr. Härtl says the Weill Cornell Brain and Spine Institute is now endeavoring to immediately enter a patients files into the center's system following initial contact. Dr. Won also acknowledges that this business model can be time consuming and calls for additional resources, but he suggests looking at it as an investment. Satisfied patients are the best marketing plan a practice can have. They will have a positive experience to share with their referring physicians and the people they know. The advantage of a patient-centric business model is simple: "Satisfying patient need is the number one benefit," Dr. Härtl says. n • cervical disc arthroplasties (one- and two level) Outpatient spine surgery allows the spine surgeon to maintain tight control of cost and quality, responding to the needs of not only the surgeon and the patient, but also insurance companies. The cost for outpatient spine surgery is 50 percent to 70 percent lower than for the same procedure performed in a hospital. MIS spine procedures are 30 percent to 60 percent less costly than traditional surgery. Besides the lower cost, MIS also offers the significant advantages of shorter recovery times and decreased rates of recurrence. In this era of cost containment, particularly given the demands of all patients, including increasing numbers of babyboomers, for healthy spines, outpatient and MIS spine surgery will continue to increase in frequency.  Baby boomers want more immediate results, a quicker return to an active lifestyle and work, and tend to prefer to stay out of the hospital, if possible. Presently, the spinal procedures frequently performed in an outpatient setting include the following: Dr. Richard Wohns • cervical foraminotomies and posterior dis cectomies • lumbar microdiscectomies • lumbar laminoforaminotomies • lumbar laminectomies •  IS lumbar fusions including XLIFs, M TLIFs, and interspinous process fusions Cervical arthroplasties or total disc replacements (TDR) are an excellent example of a fairly new and very successful addition to the world of outpatient spine surgery. Based on the proven safety, cost effectiveness, clinical outcomes and patient satisfaction with anterior cervical discectomy and fusion (ACDF), it was a natural next step to perform outpatient arthroplasties. Arthroplasties offer quicker recovery than ACDF, preserve motion of the neck and lessen the chance of developing adjacent disc degeneration that might require further surgery. The five-year disc replacement data compared with fusion  demonstrated that patients who underwent TDR had a 97.1 percent probability of no secondary procedures, compared with 85.5 percent for ACDF patients who did not experience a reoperation due to implant breakage or device failure. In addition, 2.9 percent of TDR patients had reoperations within five years of the initial surgery, compared with 14.5 percent of ACDF patients. I have recently reported a consecutive series of 132 outpatient cervical arthroplasties, from 2009 through April 2013, with 92 percent improved symptoms, an average operative time of 60 minutes for one level and 80 minutes for two levels, and an average time to discharge of three hours. There was no significant morbidity and no mortality. There were no transfers to a hospital, no postoperative ER visits, and no late hospitalizations. The cost for outpatient cervical arthroplasty is lower than the cost for ACDF, and is less than 50 percent of the cost of the same procedure in a hospital. Outpatient spine surgery will become increasingly more prevalent as new and enabling technologies continue to evolve, insurance companies and the government drive more healthcare to the outpatient setting for economic reasons, and patients become more educated about spine surgery options that meet their lifestyle expectations. For additional information on outpatient spine surgery, contact the author at rwohns@neospine. net. n

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