One part of my job that I enjoy is meeting with different healthcare organizations and groups. Given the richness and complexity of our industry, it's no surprise that I see a pretty wide range of environments. But a few weeks ago the contrast between two different spine groups was particularly eye-opening.
On the surface, the groups looked pretty similar — both had strong reputations in their communities and highly skilled, experienced surgeons. But in speaking with them about their needs in the realm of care coordination, their responses could not have been more different.
Restricted coordination
The first group was highly resistant to the idea that a care coordinator could or should do anything more than capture patient information and basic data on symptoms before scheduling a consultation. In effect, the surgeons more or less insisted on seeing all referred patients, believing that no tool or algorithm could point patients with appropriate symptoms to physical therapy or a physiatrist.
Before I left the meeting, it came out that their surgical conversion rates were very low — roughly 3%. Surgeons were seeing more than 30 patients for each surgical procedure.
That is extraordinary, and shows just how far down their license many surgeons operate. Though comprehensive data on surgical conversion rates is difficult to come by, and rates vary by procedure, experience teaches that 10-20% is a pretty decent benchmark for spine surgeons.
Unrestricted coordination
A few days later, I visited another surgeon group which had surgical conversion rates closer to 30% — nearly 10 times higher than the first group. The only tangible difference is that the second group embraced intake coordination as an effective means to filter patients at the first point of contact. They were quite comfortable relying on care coordinators who have the training, knowledge and tools to help them direct patients to the best first step on what is likely to be a multi-step care path.
Notably, the surgeons had full confidence that their referrals would be protected — that is, patients originally referred to them would not go elsewhere if future surgery was necessary. They also knew they would be kept in the loop as patients progressed along their care path. These surgeons recognized that everyone is best served when they see only the right patients. After all, there's no prize for seeing the most patients.
Patient-centered coordination
Taking the view of patients, it's easy to see how a lack of care coordination presents real issues. Chief among them is long and unnecessary delays in receiving the care they need, whether it's physical therapy, physiatry or surgery. Beyond the lost time and money associated with unnecessary appointments, such delays in treatment may cause conditions to worsen, leading to higher-risk and higher-cost care in the long run (not to mention more lost work time).
To avoid these situations, surgeons must recognize the value of filtering referred patients, with the objective to get the right patients to the right treatment as quickly and efficiently as possible. Some of the questions necessary to enable such filtering are clinical in nature, but the outcomes or recommendations are not diagnostic in nature.
Fundamentally, filtering or care coordination at intake is about directing patients, not diagnosing them. Using algorithms and criteria surgeons can and should help define, based on available evidence about symptoms and acuity, if a surgical consultation or physical therapy is more likely to be the best next treatment option.
Barriers to coordination — and care
A common barrier to care coordination are physician concerns about giving up control. Surgeons are often skeptical of any process or technology which may be viewed as a threat to their role in diagnosing patients or making clinical decisions. (Perhaps, given their rough experiences with EMRs, some doctors are simply skeptical of any technology.) And they certainly don't want referring doctors to think patients are shuttled away.
This responsibility to referred patients and to the doctors who refer to them is commendable, but the complexity of current systems has created a clear and significant gap between what surgeons individually need to do and what needs to be done for patients. And that gap is a barrier to surgeons operating at the top of their licenses and doing what they do best — performing surgery.
A coordinated system can help address these concerns. With the right technology and data, specialists can have full confidence that their referrals are protected — that patients originally referred to them will come back if and when they need surgical care. Further, doctors can benefit from complete transparency so they know and can see — quickly and easily — how far along previously referred patients are in their treatment plans.
The care coordination community must do a better job of helping spine care providers understand the many ways care coordination adds value. By providing insights and information about particular patients, care coordination can help reduce the time and money wasted on appointments that don't make sense or with caregivers patients don't need to see.
I'm not suggesting that conversion rates are the ultimate end goal or most important metric for surgeons. But they are a significant metric for helping surgeons operate at the top of their license, and for helping patients connect with the right providers for the care they need sooner and more efficiently. Care coordination has the ability to help out on both fronts, with clear benefits for both patients and the doctors — including spine surgeons — who treat them.
Gary M. Winzenread co-founded Cordata Healthcare Innovations in 2014 and serves as its president and chief executive officer. Used by more than 100 hospitals and healthcare organizations around the country, Cordata's technology solutions for specialty care coordination are designed for more effective patient management and improved clinical and business outcomes.
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