Ty Thaiyananthan, MD, founder and head neurosurgeon of BASIC Spine in Orange, Calif., discusses the benefits and challenges of building and leading a multispecialty spine practice.
"In our practice, we have both neurospine and orthopedic spine surgeons," says Dr. Thaiyananthan. "We have physical medicine and rehabilitation, anesthesia, pain management, neurology and a pain psychologist. Our practice also includes physical therapy and chiropractic care."
Q: Why did you decide to build a multidisciplinary practice?
Dr. Ty Thaiyananthan: What we originally wanted to do was establish a protocol for patients that followed evidence based medicine. We would employ conservative treatment before directing patients toward interventional and invasive procedures. We discovered we were able to give patients a comprehensive treatment opportunity.
When patients have back pain, they also suffer from psychological issues and addressing those underlying issues is important. Specialists from different areas can discuss patient care and optimize outcomes, which helps patients recover faster. We don't have a monochromatic view of treatment; we aren't always operating. We have to figure out how we can merge these specialists together for the best outcomes.
In addition to having different physicians under one roof, we are also trying to bring in the diagnostic components. This gives us access to the diagnostics we need when we need them instead of referring patients out for CT scans or lab studies to see if their opioid levels are high. We can actually make that determination while they are there. We can make a diagnosis more accurately and faster if everything is under one roof.
Q: What were the biggest challenges you faced when creating a multispecialty spine practice?
TT: It was a challenge to establish protocol and ensure there was good communication between different providers. Our protocol depends on evidence-based guidelines so when a new patient comes in with back pain and they can see our physical therapist, chiropractor or pain specialist who can refer them to an interventional pain physician if that modality doesn’t work. They had to come to a consensus about when to use additional imaging studies and when it would be appropriate to begin surgical evaluation.
It wasn't easy to establish those protocols — it was a dynamic process. You set up the algorithm and see if it's applicable. We have been developing software for our system that actually helps coordinate workflow. What we've looked at is a computer-based algorithm for spine patients. New technology to coordinate that communication in this application has been really something that makes our practice model feasible.
Q: From your perspective, what are some of the biggest benefits of coordinating a multispecialty spine care practice?
TT: There are several benefits, especially for insurance plans because we are able to coordinate care and lower costs for overall care. It's a more efficient system and because of that our costs are cheaper. We've had a few insurance plans designate us as spine and pain providers because we are cost-effective and produce results. As we start to think about accountable care organizations, providing cost-effective care in an efficient manner will become a necessity.
One of the other things we noticed is that most patients will present to their primary care physicians, who wonder whether they need an MRI and which specialist they should see. We hear back from providers that they don’t have to worry about that because when they send their patients to us we direct them to the appropriate place. We take care of the decision-making and diagnostic workups. The primary care physicians refer the patients and we can do the next step. We define the delivery of care from that standpoint and we can eliminate unnecessary tests.
Care is also faster because patients don’t have to go through unnecessary steps that just treat the symptoms instead of help their condition.
Q: For spine surgeons who wish to incorporate this model into their practices, what is the most important element to have in place before becoming a multispecialty center?
TT: The number one element is infrastructure. Without the appropriate infrastructure, it is really hard to coordinate different physicians and providers together. It really helps to have everyone under one roof. Then you have to come up with an algorithm everyone agrees on for a patient that presents at your practice. How do they decide which treatment route the patient will follow?
Finally, the practice must establish a mode of communication that works well to overcome communication hurdles. For us, that has been emails and text messages. We are in the process of installing our software, which gives us the ability to send electronic communication at the point of contact. Most surgeons are really busy, but we want to give real time feedback. It would be similar to a chat dialogue that is open throughout the day.
In the software environment, you should be able to see notes and images at the same time. Email and texts are fine, but there is a better way to achieve access for patient care in real time.
Q: Do you see this multispecialty spine care model spreading across the country?
TT: I think whether by private companies are insurance plans, there will be encouragement for physicians to pursue a model like this. What has been keeping it at bay right now is that there hasn't been a push from medical insurance companies, and the infrastructure hasn't existed until now. Now we have electronic medical records and other communications to help us facilitate patient care.
Dr. G. "Ty" Thaiyananthan is founder of BASIC Spine. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and minimally invasive surgery to treat chronic neck and back pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center. Follow Dr. Ty on Google+.
More Articles on Spine Surgeons:
Meeting Financial & Regulatory Demands of Healthcare Reform: 3 Spine Experts Discuss
12 Spine Surgeon Leaders With New Hospital Programs
6 Trends in Scoliosis Treatment & Correction From Dr. Peter Gabos
Building a Multidisciplinary Spine Practice: Q&A With Dr. Ty Thaiyananthan of BASIC Spine FeaturedWritten by Laura Dyrda | Friday, 30 November 2012 16:07
Last modified on Thursday, 23 May 2013 20:22
© Copyright ASC COMMUNICATIONS 2015. Interested in LINKING to or REPRINTING this content? View our policies here.
Most Read - Spine
- Spine surgery in a value-based world: Dr. Jed Vanichkachorn on spine bundled payments
- Hospital employment vs. independent practice: 5 spine surgeons weigh in
- The endless possibilities in spine biologics, artificial disc & outpatient procedures
- 5 things to know about Medicare charges for cervical spine surgery
- Dr. Todd Gravori praises stem cells for back pain relief
Top 40 Articles from the Past 6 Months
- 12 statistics on neurosurgeon salary in 2015
- North American Spine brings in two new procedures — 5 things to know
- Drs. Larry Lenke, Daniel Riew, Ronald Lehman leaving St. Louis for NYC — 5 things to know
- DePuy Synthes, Stryker, Zimmer, Medtronic lead global orthopedics now — 8 key notes on where they're headed
- Bundled spine surgery for Walmart, Lowe's employees — 6 things to know
- Medtronic is headed for strong 2015 — 8 reasons why
- 20 Spine Surgeon Leadership Awards | 2015
- 25 Spine Device Awards | 2015
- 15 things to know about Zimmer Biomet
- Neurosurgeon named in counterfeit spinal implant lawsuit — 5 things to know
- 10 spine, orthopedic surgeon tech entrepreneurs to know
- A differentiated approach in lateral spine surgery: Oblique lateral interbody fusion (OLIF at L2-L5)
- Top 10 specialties with highest pay — Orthopedists lead the pack
- Zimmer voluntarily recalls knee device
- Safeguards to Prevent Neurologic Complications after Epidural Steroid Injections: Analysis of Evidence and Lack of Applicability of Controversial Policies
- 6 spine physicians ranked #1 on Google
- Dr. Aria Sabit pleads guilty to unnecessary spine surgery, faces 11+ years in prison — 5 things to know
- Northwestern's Feinberg School of Medicine neurological surgery chief Dr. Andrew Parsa dies
- Is the Zimmer-Biomet closed merger finally around the corner? 5 things to know
- Dr. Neal ElAttrache to perform Manny Pacquiao's shoulder surgery: 5 things to know
- Spinal fusion vs. disc replacement: Which costs more? 5 key notes
- Another spine surgeon named in "fake implants" lawsuit — This time in Maryland: 5 key notes
- Medtronic pays 8 physicians $1M+: 5 key notes
- Building an empire: How Dr. Douglas Won created a physician-led health system
- Dr. Sanjay Khurana helps rescue Harrison Ford from crashed air plane
- Zimmer Q1 sales drop 2.3%, Biomet merger still not final — 10 things to know
- How The CORE Institute grew 40% last quarter — IT leads the way
- 55 statistics and issues for neurosurgeons and orthopedic spine surgeons — compensation, global device market and more
- UPMC's Dr. Tanya Hagen dies at age 45
- Is Smith & Nephew's cost-conscious strategy working? 5 key notes
- Hospitals face 4 lawsuits in connection with unnecessary spine surgeries case — 6 things to know
- Johnson & Johnson (J&J) sells Cordis line for $1.9B: What it could mean for DePuy Synthes
- How high-energy spine surgeons start their day — 5 things to know
- Spinal deformity surgery — On the cutting edge with Drs. Isador Lieberman, Suken Shah
- Dr. Ziya Gokaslan to leave Johns Hopkins for Rhode Island Hospital
- Cervical disc replacement Mobi-C vs. spinal fusion: Are there advantages to one? 6 key notes
- Medtronic facing product liability lawsuit over Infuse once more: 9 things to know
- Hospital for Special Surgery names Dr. Frank Schwab spine service chief — 5 things to know
- 5 statistics on orthopedic surgeon net worth
- Patient sues troubled orthopedic surgeon for malpractice — 7 things to know