6 Techniques for Building a Successful Spine Practice

Practice Management

Operating and maintaining profitability at a spine practice presents many challenges to the spine surgeons who run them. Thomas Schuler, MD, a spine surgeon, founded the Virginia Spine Institute in 1992 and has dedicated the practice to providing top surgical and nonsurgical solutions to spinal conditions and injuries. Dr. Schuler discusses six ways to build and expand a successful spine practice.

1. Take a multidisciplinary approach to building the practice.
In addition to bringing spine surgeons to your practice, hire family practice physicians, anesthesiologists, physiatrists and physician assistants to diversify the range of services at the practice. "No one specialty has all the answers on how to best handle a situation," says Dr. Schuler. "Having the different specialists integrated in the practice together and meeting weekly, we can ensure the best care is offered to each individual patient." Dr. Schuler is the spinal specialist for the Washington Redskins and says that if one of the players needs medical attention, the problem can be diagnosed and the player can begin pain management and rehabilitation the same day. "It's our ability to immediately perform comprehensive treatment of our patients that makes us so successful," he says.

It's also easier to keep track of the patient if all of their care occurs in the same place. "If you are referring to an outside practice for these services, patients can sometimes become lost in loop holes and physicians might hold onto a patient longer than they should," says Dr. Schuler. "When everyone works together in a coordinated care system, it enables the proper care to be given by the most appropriate doctor. By being integrated under one roof in the same facility, we can ensure that patients get what they need and are not captured inappropriately in any one specialty." This collaborative approach is both time and cost efficient because the different specialists don't spend time with inappropriate patients. If a patient comes in to see a surgeon when he or she really needs pain management, the surgeon can take the patient to a rehabilitation specialist the same day. Also essential is that the different specialists can collaborate to produce the most synergistic treatment for each patient.

2. Only hire the most qualified specialists.
The Virginia Spine Institute only hires specialists who are board certified and fellowship trained, aiming to create a practice of only elite experts in each field. However, finding fellowship-trained specialists in some areas, such as physician assistants (PA), can be challenging. Dr. Schuler overcame this challenge by creating a PA residency and fellowship program in spinal surgery at the Virginia Spine Institute. The program trains PAs in spinal healthcare so they are able to diagnose and evaluate spinal problems as well as understand the appropriate pain management indications and techniques. "Our success is also dependent on the fact that our specialists are all at the top of their game," says Dr. Schuler. "We are very strict at who we have working here. Everyone has to have the same culture: excellence in operative and non-operative care. Most surgeons don’t truly practice non-operative care. Our surgeons’ emphasis on excellence in both non-operative care and operative care is what sets us apart."

Dr. Schuler also advises practice physicians and CEOs to take as much time as they need to find the right surgeons for their practice. He recently added a new partner to the Virginia Spine Institute after interviewing 25 surgeons over a three-year period. The process was so extensive because Dr. Schuler wanted to make sure the new surgeon’s core values were consistent with the organizational culture. "You can't just add bodies," says Dr. Schuler. "You have to add physicians that embrace your culture."

3. Hold weekly teaching conferences to bring all specialists together.
All specialists at the Virginia Spine Institute gather for weekly meetings to discuss cases, which keeps all the specialists on the same page. The meetings also serve as a time to educate the different specialists about what their colleagues do in the practice to make sure everyone speaks the same language. "Everybody understands who does what and they work together to provide the best experience for the patient," says Dr. Schuler. "That's something we have done which has taken our organization to the next level." Specialists are also cross-trained in different areas to promote advanced understanding of the different services at the practice.

4. Incorporate employees from all levels in strategy meetings.
At the quarterly strategy meetings, the Virginia Spine Institute gathers employees from all levels of the organization to discuss what the current initiatives from each department and how they can improve. "These meetings build ownership by the employees of the organization," says Dr. Schuler. If your philosophy is to be more inclusive rather than exclusive it has a direct effect on participation and buy in with changes and improvements to processes and procedures.

In the strategy meetings, the participants discuss a diverse range of topics, including the perceptions or misperceptions of patients at the practice and issues among employees. At one meeting, the Practice Administrator decided to revamp the organization's healthcare benefits because employees were unhappy with that aspect of their compensation. Changes in the way information is disseminated to patients, the process for checking patients in and out of the clinic and how employees are educated at the clinic occurred as a result of these meetings.

5. Maintain dedication to education.
"We encourage employees to undergo advanced training and education for higher level careers in healthcare. Many of our medical assistants have gone on to become physician assistants or medical doctors because the education they received at Virginia Spine Institute revealed career opportunities," states Dr. Schuler. Many new employees train to become medical assistants, or achieve a higher level of understanding of their jobs. Educational advancement is encouraged even if it means the employee leaves the organization to take another job. The network of people connected to the practice expands, which is good for business. "Encouraging people to take advanced education improves our teamwork and makes us local and national leaders," says Dr. Schuler.

6. 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. Dr. Schuler 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.

Learn more about the Virginia Spine Institute on their award-winning website: http://www.spinemd.com/

Read other coverage on maintaining profitability at spine practices:

- 6 Ways for Orthopedic and Spine Surgery Centers to Stay Profitable in 2011


- 5 Points About Successful Anesthesia For Orthopedic and Spine Surgery


- 5 Techniques to Make Spine Profitable at Your Orthopedic Practice

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