"Historically, a lot of spine surgeons nationwide have been very good at clinical intelligence, and we as a field have been getting better at business intelligence," said Jonathan Slotkin, MD, director of spinal surgery at Geisinger Health System Neurosciences Institute and director of spinal cord injury research for Geisinger Health System in a Becker's Spine Review report. "I think over the next five to 10 years we will need to master predictive intelligence and analytics. The challenge used to be a paucity of data. As EMR becomes required, everyone will begin to have access to the same data, or at least good data. The question for the next five to 10 years is what do we want to do with that data — how do we utilize it intelligently."
Individually, the right data could "make" or "break" a practice. Surgeons will still need great skill, expertise and artistry to care for each patient, but gathering data and having more information about outcomes at their fingertips has the potential to really boost their practice.
Protocol for "the right treatment, in the right patient at the right time" can optimize outcomes and reduce healthcare waste. Collecting data on patient demographics, treatment modalities and time of treatment for each patient is an important first step to standardizing treatment protocol at the practice. "We measure the variety and timing of patient treatment paradigms as it happens to see what works best in whom," says Matthew McGirt, MD, practicing spinal neurosurgeon at Carolina Neurosurgery & Spine Associates and is Associate Research Professor at University of North Carolina. "Outcomes are measured as standard of care and reported only by the patients receiving care."
Dr. McGirt's practice has a call center that tracks one year outcomes via phone interviews and invested in mobile health technologies to help automate the process. Patients also have access to a web-based portal allowing connectivity throughout the one-year episode of spine care.
Both the "low-hanging fruit" and more complex longitudinal patient reported outcomes are important to advance the field. Here are 10 benchmarks for a data-driven spine practice:
• Pain scores — recorded before treatment and at various points post-treatment to compare treatment effectiveness
• Disability and function outcomes scores
• Complication rates — this includes infection, wrong-site surgery and other issues that occur during surgical procedures
• Return-to-work status, including whether the patient returns to the same or different level of work post-treatment
• Hospital readmissions within 30 days of discharge, including the reason for readmission—if the patient is readmitted for pain but doesn't present with complications, an update to patient education and expectations of pain after surgery can prevent future readmissions
• Antibiotics and anesthetic administration
• Whether the team followed a surgical checklist and how long each part of the process takes, from pre-op to the OR to post-op and recovery
• Patient satisfaction, both with their outcome and their experience at the hospital/surgery center
• Cost per quality-adjusted life year for operative and non-operative treatment, which builds an economic argument for pursuing one treatment method over another
• Timing of treatment — this includes imaging studies orders, diagnoses, nonoperative treatment, surgical intervention and medication administration
Collecting both quality and cost data will allow spine care providers and other stakeholders to participate in value-based care — including narrow networks, accountable care organizations, bundled payments and other risk-sharing payment models. Beyond the business, data collection can also improve the quality of care and bring surgeons closer to providing the best treatment for their patients on the right timeline every time.
"This level of accountability and transparency of quality helps position our practice group to compete in the emerging value-based healthcare market," says Dr. McGirt. "Practices and hospitals aiming to become regional destination spine care centers will need to report not only their safety of care, but also their effectiveness and durability of their treatments."
More Articles on Spine Surgery:
15 Spine Devices Receive FDA 510(k) Clearance in June
Discogenic Low Back Pain: Is Nonoperative Treatment Really Better? 5 Things to Know
17 Spine Surgeons Receive Leadership Award