Staff shortages, insurers compound spine surgeons' patient experience challenges

Alan Condon -  

From hiring the right staff in a challenging labor market to the advantages of technology and the importance of getting to know one's patients, seven spine surgeons from independent practices and health systems across the country discuss how they aim to improve the patient experience at their practices.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: Cervical disc replacement has really taken off in recent years, and long-term data continues to impress. What advancements would you like to see in the design and functionality of artificial discs?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Aug. 24.

Editor's note: Responses were lightly edited for clarity and length.

Question: What are the biggest challenges your practice faces when it comes to the patient experience? How are you addressing those challenges?

Adam Kanter, MD. Hoag Memorial Hospital Presbyterian (Newport Beach, Calif.): One of the greatest challenges in medicine these days as it relates to the patient experience is good old-fashioned sincere "face time." So much of our visit is now consumed by EMR paperwork, patient outcome surveys, satisfaction questionnaires, ratings, reviews, etc. Both the patient and physician have double the paperwork to complete in half the time. It is an ill-fated modern reality that has hindered our ability to get to genuinely know our patients, yet we are asked to provide a personalized treatment plan based on their individual needs and expectations. It's quite the conundrum. As physicians, we need to balance the administrative challenges of running a contemporary spine practice with our earnest desire to get to know our patients as people, so we can help empower them to make the best decisions for their own physical and psychological well-being. 

Jeremy Smith, MD. Hoag Orthopedic Institute (Newport Beach, Calif.): In a post-pandemic high-inflation era, we are experiencing multiple obstacles that interfere with quality of care. Staff shortages continue to play a significant role in hindering the patient experience. These shortages are happening in the clinic, ASC and hospital and have significantly impacted workflow and efficiency. Delays in care for diagnostic studies, procedures and surgery have been more commonplace. Therefore, maintaining high-level quality of care and ensuring excellent outcomes has become more difficult. Existing staff have been stressed to their limits to accommodate these shortages and many of the newer staff have less experience and need time to be trained. We are working closely with administration to ensure that our veteran staff are compensated appropriately and don't become burned out. The search for new staff continues to be aggressive and training has been ongoing. 

Of equal importance to the staffing challenge is working with commercial insurance. Working with most carriers continues to be more difficult, adding more stress to the patient experience. Getting any diagnostic study, procedure or surgery authorized has become more challenging each year. I find myself or my staff having to do a "peer-to-peer" discussion for nearly every order, often with a medical provider outside our field. The time I spend on the phone managing these situations has doubled over the past year. In addition, getting paid for a surgery that has been preauthorized has also been a challenge in many cases. I feel this experience continues to worsen, and I worry about the near future. In all other professional realms, the actions of insurance companies would be considered illegal and would not be tolerated. We as physicians need to take a better stand for our patients and for ourselves. 

Michael Goldsmith, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): The patient experience is about more than interactions with clinicians; it includes scheduling appointments, wait time in the office, interactions with the front desk and more. In order to keep our patients happy, we must continue to evaluate and improve our processes, whether it's purchasing the correct system to improve scheduling and patient flow or hiring the right people to fill each role. As a private practice, we are in a unique position to control these decisions. We are committed to addressing these challenges and finding new ways to enhance the patient experience.

At my practice, we have implemented online booking with the capability for patients to interact and communicate with our office and physicians through our portal. This has drastically reduced our call volumes and allowed us to keep hold times to a minimum. To improve waiting times in the office, our EMR system tracks patient flow and allows us to audit our systems, so we can identify our needs to hire and schedule appropriately. Our front desk interactions with our patients are critically important for the patient experience and overall satisfaction of the visit. Technology has allowed us to improve many aspects of our business, but when it comes to the hiring process, we pride ourselves on hiring compassionate and kind people in all roles, including at the front desk.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: By far, the most difficult thing in terms of patient experience is making sure the clinic runs on time. During my fellowship, my director was a stickler for keeping the clinic running on time. He wanted to know the reasons we were running late if we were more than five or 10 minutes behind. Stay on time ideally, and if you are running late, acknowledge it with the patient and thank them for their patience. They will appreciate it more and realize you are giving them the same generous amount of time as the preceding patients.

The​ definition of patient experience can be encapsulated as "the sum of all interactions and communications that a patient has with the health system." That broad definition can be broken down into these four drivers of patient engagement: perceptions, culture, interactions and the continuum of care.

Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The biggest challenges surrounding the patient experience and value-based care are most cumbersome — in the delivery of care — especially affecting hospital-based employees and cultural paradigms. My contention is this has become another partial deterrent to patient care delivery when the overarching theme of care is redefined to satisfaction. 

Best practices are expectations by patients and providers alike, yet those expectations, perceptions and outcomes have been transformed into another social media heaver and its nebulous metric system that rarely favors the positive. 

Post-pandemic curtailments and nationwide staffing issues are the newest of hurdles that most patients will face and certainly cause more consternation in this already unnavigable process.

Brian Fiani, DO. Weill Cornell Medicine/NewYork-Presbyterian Hospital (New York City): The most difficult challenge that spine practices face today is patient satisfaction, also known as a positive patient experience. The two most important factors for a positive patient experience is a sense of confidence in the spine surgeon and a feeling that the spine surgeon genuinely cares. 

In order to develop patient confidence, the patient must have an understanding of the expertise and qualifications that make that surgeon capable of addressing the patient's needs. How I am addressing that challenge is by making sure the patient understands my training, my understanding of their pathology and what surgical or nonsurgical method of treatment I recommend and the reasons why. We must remember that patients gain confidence in us when we explain our rationale. 

Secondly, the patient experience is largely related to if the patient feels the surgeon cares about them as a person. I address this challenge by developing a rapport with the patient, by being compassionate and empathetic, and addressing their concerns and questions as they arise. The reason some surgeons have a difficult time with this is because they feel they do not have enough time to spend with the patient. It is far less about how much time as much as how that time is used. For example, taking five minutes to show the patient their MRI and explain the findings is far more useful than taking five minutes to explain to them what pathology they have without a visual representation. 

Chester Donnally, MD. Texas Spine Consultants (Addison): The obvious is patients don't want to show up 20 minutes early for their appointment and not see the physician until an hour after that. Not to pass the blame for my own shortcomings on to the insurance companies, because they will always be the bad guys, but part of the reason is the patients have so much insurance required information to fill out in terms of their own demographics and patient intake forms. I think it highlights another form where telemedicine has been really helpful for me. The patient has a link I send them when I'm about ready and they might sit in this virtual waiting room for 10 seconds or a couple minutes. They don't have to park or drive in; they could even still be at work or spend time with the family. It's faster overall and patients like it so much more. It also allows me to see more patients and decrease the wait time for others in the office. I really hope we don't walk back our telemedicine abilities and policies.

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