A patient with chronic back pain who lands in the wrong office at the wrong moment can walk out scheduled for a surgery they never needed. Designing that failure mode out of the system is the premise behind the spine program Jed Vanichkachorn, MD, now oversees.
Dr. Vanichkachorn is a physician and medical director of orthopedics and spine for Richmond, Va.-based Bon Secours Mercy Health, which launched the Bon Secours Spine Institute across the region June 29.
The program pulls orthopedic and neurosurgery spine surgeons, physical medicine and rehabilitation, pain management and rehabilitation services into a single coordinated model, with nurse navigators steering patients toward the right level of care.
“If you show up at the wrong place at the wrong time, at a surgeon’s office at the wrong time, you may get a surgery that you don’t need,” Dr. Vanichkachorn told Becker’s.
The candor carries weight coming from him. He performs roughly 400 spine operations a year, close to half of them minimally invasive, and was the first spine surgeon in Richmond trained to operate with the Mazor robotic guidance system, recently completing his 100th robotic-assisted case.
His argument is not against surgery; it is against surgery the patient did not need and the pathway failed to catch.
A system patients entered at random
For years, he said, patients entered Bon Secours’ spine services almost at random, depending on whether they arrived through a primary care physician, the emergency department, an urgent care or, increasingly, an online portal that lets them book their own appointments. Each entry point carried its own odds of landing in front of the right specialist. He was candid that the system has its own stake in fixing that, capturing those patients early and keeping them within Bon Secours over the long term.
The nurse navigation model is built to close the gaps. A dedicated navigator reviews each patient’s history, symptoms and prior treatment before routing them, working, in his words, in the background to sort patients by acuity.
The goal is to catch two failure modes at once: patients who wait too long for care, and patients who cycle through the system without progress.
“You don’t have patients that are constantly jumping into or out of the system and getting duplicate care without really any progress in their symptoms,” he said.
The navigators lean on AI to manage the volume. Algorithms help them “delineate when they triage to the right provider, whether it’s a surgeon, whether it’s a PA, whether it’s an interventionist or PT,” Dr. Vanichkachorn said.
Bon Secours also runs an AI-based navigator on its website that directs patients to the appropriate provider by symptom, across orthopedics rather than spine alone.
The hardest part wasn’t the technology
The operational lift is substantial. Patients enter through four main hospitals, multiple outpatient spine clinics, more than eight urgent care sites, and the patient portal, all feeding a shared EMR build meant to capture and route them across the region. The hardest part, he said, was not the technology. It was the culture.
“Getting everybody to get on board with being collaborative across the system, no matter where they work, has been one of the challenges,” he said.
To show the model is changing outcomes rather than relabeling business as usual, Bon Secours tracks hard numbers, chiefly the time from a patient’s first contact to evaluation and the share of patients who ultimately proceed to surgery. Both, Dr. Vanichkachorn said, are trending down as the pathways take hold.
“We’re also trying to develop a metric that allows us to provide this type of care to patients,” he said, so the program can “deliver something other than just a title of multidisciplinary care model without any real meat behind it.”
What to get right first
For health system leaders weighing their own spine service-line redesign, his advice is to build the clinical infrastructure before the org chart.
“You have to develop the clinical pathways and triage system that form the foundation of a spine center without walls,” he said. The metrics, he added, have to be chosen up front rather than bolted on later.
“You really have to put those two pieces together first, and then you can build all the operational stuff around it,” he said.
Other service lines across the system are beginning to study the same approach, Dr. Vanichkachorn said, an early sign the spine model may become a template inside Bon Secours.
In a specialty where surgical volume has traditionally driven revenue, the number Dr. Vanichkachorn points to as proof of progress is a shrinking surgery rate. His bet is that getting patients to the right care sooner, even when it is not an operation, serves the two goals Bon Secours built the institute to meet: better outcomes for patients, and a system that keeps them for the long term.
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