How to grow in the era of healthcare reform & payer scrutiny: Spine destination centers

Written by Laura Dyrda | November 19, 2014 | Print  |

Marcy Rogers on spine surgery coverageThe freestanding spine destination center could be one of the next big trends sweeping healthcare providers today. These centers meet the goals of healthcare reform, payer scrutiny, patients and providers by guiding patients throughout their entire episode of care with top-quality outcomes.

Traditional spine care models silo different specialists and rely on primary care providers — many of whom aren't back pain experts — to triage patients to the right specialist. Sometimes they are successful; sometimes the patient receives the wrong care or the right care is delayed unnecessarily. Each specialist in the spine care process has a different office, sometimes across town from one another, and communication is rare.


All these factors lead to uncoordinated patient care; patients are unhappy with their experience, providers are frustrated because their patients aren't happy and the healthcare system absorbs wasted time and money along the way.


However, now more spine specialists are learning to work together and create spine destination centers to grow and prosper in the era of healthcare reform and payer scrutiny.


"It's no longer enough to just be a physician who does spine," says Marcy Rogers, president and CEO of SpineMark, a developer of spine centers of excellence and spine research organizations. "It's no longer enough to be a center of excellence; that definition changed with the advent of healthcare reform. We are looking at a hybrid model that captures the trend of Medicare and other payers moving toward bundled payments as a way to manage costs and provide the right type of care."


Destination centers have all services available onsite, including:


• Multispecialty physicians for conservative, primary, surgical and interventional care
• Physical therapy
• Outpatient surgery
• Pain management
• Diagnostic testing capabilities — imaging, blood, toxicology, hormonal, vitamin D
• Medical spa
• Compounding pharmacy


"Surgeons are using destination spine centers to reclaim the quality of care they want to give to their patients," says Ms. Rogers. "Surgeons are losing their voice in the delivery of care today and they want to create a campus-like culture for like-minded professionals under a single roof to provide care. Or they are strategically identifying locations in their communities where they can develop inpatient co-management agreements to become a single destination center for inpatient and outpatient care."


This model can work with small, medium or large physician groups. An example of a large physician group succeeding with the destination center strategy is The CORE Institute in Phoenix, which developed algorithms and protocols for triaging the patient to specialists. They were also able to improve their efficiency and approach.


"In the past, we took the specialists' opinions for granted without protocol. Now there are protocols from payers, but many weren't developed by physicians. Instead, they were put in place for the insurance companies to evaluate efficiency and necessity of care," says Ms. Rogers. "The CORE Institute has an alliance with Cleveland Clinic, Rothman Institute and OrthoCarolina to present a surgeon-driven solution for data and episodes of care."


Data will serve as the leverage for destination centers in payer negotiations as well as direct-to-patient marketing. The data promotes clinical and price transparency that will become extremely valuable currency in healthcare post-reform. Even small organizations that only have a few physicians can track their data with electronic records and enter it into registries or combine it with strategically aligned partners to create a critical mass.


A multispecialty medical group in Baton Rouge, La., offers a flagship model for sites around the United States in urban environments. A second site and group in Farmington, N.M., is in the planning stages for launching a spine destination center model in a rural area using multispecialty teamwork and data capture.


"It takes a team approach to acceptably manage musculoskeletal spine pain. Providers are accountable for their outcomes and transparent with their work and their team," says Ms. Rogers. "You can put together a group and create the capacity to have a center built on a plot of land and then integrate with local hospitals. The model resonates just as well in that environment as the sophisticated urban environment. The key is understanding the demographics of your community and where strengths, weaknesses and opportunities exist."


Surgeons will always need a relationship with the hospital, but working as an aligned independent group allows physicians to control their own destiny. Co-management arrangements align the clinical governance with hospital managers to align economic incentives and optimize the ancillary services, including radiology, diagnostics, pharmaceuticals and urgent care.


"We are seeing successful development of the small, two-room ASCs with a boutique niche focus where in the past people thought an ASC had to have four to five operating rooms, or more," Ms. Rogers says. "But it doesn't have to be this way."


The physician-operated and -controlled surgery center could also allow physicians to remain independent and feel less of a pinch when reimbursements are cut.


"Five to 10 years down the road, are you going to give up and become a hospital employee or will you succeed on a private practice basis?" asks Ms. Rogers. "If you want to find a way to take back control of your career and provide outpatient services while still maintaining a good relationship with hospitals on the inpatient side, the destination center is a good opportunity. You can think outside of the box to attract cash pay volume and corporate self-insured volume, and work to secure contracts with employer-direct benefit businesses. But the only way a smaller group or solo physician can fit these requirements from a cost and data perspective is alignment."


Ms. Rogers is currently working on the rollout of the flagship model SpineMark Destination Center in Baton Rouge and the conversion of a campus from a single-specialty solo provider into a multispecialty group. This site has an international patient population and a payer mix which will expand its medical tourism to initially 5 percent of the practice. She hopes to build the business to 15 percent to 30 percent medical tourism in three to five years, thus attracting patients from all over the U.S. and abroad.


"We start off slowly, but the destination centers are geared toward meeting the needs of medical tourism, cash pay and private patients who are local, regional, tristate, national and even international in certain locations," she says.


More articles on spine surgery:
Adjacent segment disease: What are the risk factors for more spine surgery?
How spine surgeons are taking charge of ACOs, pay-for-performance and their own data
Tomorrow's world: Where is spine-related biologics headed?

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