1. Reassign staff responsibilities to maximize productivity. We reviewed front office job duties in both our physical therapy department and our clinic, says Penny Forbes, administrator of Sierra Regional Spine Institute in Reno. We noticed the support staff in PT had several hours during the day that were “down time” hours. This position requires the employee to be present throughout the day to handle calls, scheduling and billing, but this employee is efficient and was often left with little to do for various periods throughout the day.
In contrast, on the clinic side our front office supervisor often runs out of time because her duties include editing dictation, daily scanning, helping with phones, check out and supervising five other staff members. She also covers each member of the staff when one is out on vacation or sick leave. During this coverage period the dictation and scanning duties are often delayed.
So we assigned the daily scanning to the PT front office staff member to fill her down time, and freed up the clinic supervisor who could then continue to cover not only in the front office but we were able to extend her reach to the x-ray desk and even to the clinic. We have thus enabled our employees to multi-task at a greater level without hiring additional staff.
2. Provide minimally invasive spine care for all ages. Many spine practices either focus on treating pediatric or older adult patients, rarely treating patients in between. However, Atiq Durrani, MD, founder of the Center for Advanced Spine Technologies, says spine practices should have surgeons available to treat patients of all ages to complete the continuum of care. “We have created an environment where we treat patients from one year old to 99 years old as a continuum of care,” he says. “Families come in and they never have to leave the practice for any member to be treated.” Additionally, the surgeons can treat the same pediatric patient all the way through adulthood.
Using the minimally invasive procedures has helped promote this type of continuum of care because the spine surgeons are able to perform procedures on patients who were not good candidates for open surgery. Scoliosis surgery, for example, can be performed using three small incisions, and children can return to school in two weeks. Pending a successful recovery, these children can also return to sporting activities within a few months. Older scoliosis patients who weren’t physically good candidates for surgery now couple this minimally invasive surgery with the insertion of screws and rods. After surgery, the patients don’t need to spend time in the intensive care unit and are able to return to normal activity.
3. Form a good relationship with referring physicians. Too often surgeons become overly focused on procedures and forget to be friendly toward their referral sources, according to Paul Slosar, MD, an orthopedic spine surgeon with SpineCare Medical Group in San Francisco. He avoids this pitfall by remembering the importance of a letter. Since he sees patients who often travel more than 100 miles to visit his practice, Dr. Slosar doesn’t always know their primary physicians. In those cases, he writes them a letter and introduces himself, sharing information about his practice and sometimes including booklets or literature. He also reaches out to them — himself. “A lot of times, surgeons delegate responsibility for everything,” he says. If Dr. Slosar does know a physician, a simple note, phone call or e-mail thanking them for the referral maintains a connection that results in additional referrals.
4. Do not let insurance companies “own” your practice. The Virginia Spine Institute physicians do not have contracts with any insurance companies. They elected to do so as this allows us to present the patient with the best and most appropriate treatment options. The patient can then select what is in their best interest. By not being encumbered by a contractual agreement with the insurance company, we can provide the patient with what they need and not be limited to what the insurance company dictates.
The Virginia Spine Institute bills the insurance companies for the patients and is compensated as an out of network provider. The exception is Medicare and TRICARE for which the institute is still an in network provider. Thomas Schuler, MD, a spine surgeon, founder of the Virginia Spine Institute, states that, “Virginia Spine Institute remains in these two networks specifically to assist the elderly and military.” The Virginia Spine Institute hires patient coordinators and insurance liaisons to help patients navigate out-of-network care. Insurance companies can make it difficult for patients to receive out-of-network care and the experts guide the patient through the steps he or she needs to take. “We work to create a system that helps the patients understand and be more successful in navigating the very confusing out-of-network experience,” says Dr. Schuler.
5. Cater to new patient acquisition channels. Practices should find a niche of patients to serve within their community and heavily pursue those cases, whether they are the Medicare population or workers’ compensation patients, says Jimmy St. Louis, Chief Corporate Operations Officer of Laser Spine Institute. Laser Spine Institute regularly works with new partners who can facilitate surgeries to the company’s practice. Laser Spine Institute is a good fit for patients who injure their back and spine on the job because minimally invasive surgery returns patients to their normal activity and job quicker than traditional open surgery. Mr. St. Louis says collaborating with the workers’ compensation population and the personal injury is beneficial because these patients pursue more surgery integrated with conservative treatment.
6. Do your own injections. Spine surgeons who do not currently perform their own pain injections and instead refer them out should learn how to perform these procedures themselves. Kenneth Pettine, MD, co-founder of Loveland, Colo.-based Rocky Mountain Associates in Orthopedic Medicine, suggests spine surgeons undergo training in this area and then begin first with lumbar spine injections. “A spine surgeon with a busy practice could generate another $100,000-$200,000 per year by performing these procedures,” says Dr. Pettine.
