As spine care becomes more collaborative, surgeons are looking to strengthen their relationships with non-operative specialists or bring them into their professional practices.
"I firmly believe in the integrated model of spine care," says Richard N.W. Wohns, MD, JD, MBA, founder and president of NeoSpine in the Puget Sound region of Washington. "You cannot operate in a vacuum. The best practices have an integrated model so the spine surgeons put together specialists they collaborate with on a daily basis with a majority of their patients."
The specialists surgeons often collaborate with include pain and rehabilitation specialists, EMG specialists, physical therapists and potentially neuroradiologists.
"My goal as a spine specialist is to evaluate the patient and understand what the origins of their pain might be," says Purnendu Gupta, MD, medical director of the Chicago Spine Center at Weiss Memorial Hospital. "To treat that origin, you really need a team of people who are experts in their field. They aren't always in the same setting, but you can still work together to achieve better patient care."
Here are eight steps to make spine care more collaborative on the local level.
1. Develop a personal and professional relationship with specialists. The flow of information and communication with other specialists is easier when you know them personally as well as professionally. "It's difficult because nobody has time for social relations or seeing colleagues out side of clinic," says Standiford Helm, MD, MBA, a pain management specialist in Laguna Hills, Calif. "However, spine care has changed a lot over the last 20 years, so you have to simply develop those relationships. If you can't connect on a personal level, at least strengthen the professional relationship however possible."
2. Give other specialists feedback in a timely manner. When spine specialists refer patients to you, or ask you questions about their patients, respond to them in a timely fashion. Give them feedback about their process and when these specialists are from the surrounding area, make them feel like they are still part of your professional network.
"Let them know you consider them part of your extended network of spine care professionals," says Andrew Hecht, MD, orthopedic surgeon and Co-director of Spine Surgery and Director of the Spine Center at the Icahn School of Medicine at Mount Sinai in New York City. "You can be very inclusive, regardless of your practice setting. As we train more outstanding people and work together to increase the virtual network of spine care professionals, patients will have a better care experience."
3. Treat other specialists like part of your team. If you don't work alongside other spine specialists in your practice, work to increase your professional network among them by finding the outstanding spine professionals in your community and partnering with them. "Invite these people to your conferences so patient care feels more inclusive," says Dr. Hecht. "If the opportunity arises, invite them to participate in research with you. Make them feel part of your virtual network."
Communication is key to maintain a positive relationship with other spine specialists. "It's wonderful to have a true multidisciplinary spine center, but I think above all communicating with the individual specialists and letting the patient and specialists know what the organized plan is so they have the perception and understand that their care is coordinated really means the world to them," says Dr. Gupta.
4. Use texting and other forms of new media to communicate with other specialists. Take advantage of technology to communicate with other specialists on a quick and constant basis. In some cases, you may be able to text or email instead of calling or writing letters by hand, but make sure these communications are HIPAA compliant. "There are some HIPAA issues associated with texting," says Dr. Helm. "You can fall back on phone messages or email, but everyone knows it's difficult to get physicians on the line because everyone is so busy."
5. Build trust that you'll take care of their patients. It's important for other specialists to recognize when patients might need a spine surgeon's care, or vice versa. Build trust with other spine specialists by sending patients their way and treating the patients they send you appropriately. This becomes easier when the specialists are part of your practice.
"I think it's really important for spine surgeons' practices to include pain specialists so if injections are needed, you aren't farming them out into the community," says Dr. Wohns. "The integration allows for more cohesive, multidisciplinary communication regarding treatment of patients. The electronic health records are shared, so you know how the blocks are done and can see the diagnostic evolution."
6. Arrange calls to discuss mutual patients. When you share multiple patients with another specialist, arrange a time every few weeks to talk about those patients over the phone. "I might speak with a pain management specialist that sees my patients in a certain part of the city to touch base with them on how things are going," says Dr. Gupta. "They tell me what they think is going on and we address any concerns we have about how the patient is responding."
7. Bring specialists together under one roof. If possible, recruit non-operative spine specialists to join your practice, hospital department or center so you're in close physical proximity. This makes working together on cases more efficient and effective.
"It's easier to work collaboratively in a spine center where you are focused solely on spine issues," says Dr. Helm. "It's the only issue you are dealing with and you aren't diverted by the road array of concerns physicians face in the hospital setting. Additionally, when specialists work together and see each other professionally and socially, there is a trust and ease of communication engendered between you."
When patients come to integrated practices, they are more likely to see a specialist regardless of where they are in disease progression. They also have access to diagnostics and other tools to ensure they receive the right type of care. "We create a one-stop shopping for patients," says Dr. Wohns. "Everything we need to take care of the spine patient is right here."
8. Work together on patient protocols. When operative and non-operative specialists work together on treatment pathways and protocols, care becomes more efficient and patients will receive the right treatment quickly. "The relationship between specialists is going to become stronger as the thrust of the implementation of the affordable care act comes into play, particularly as we move into a bundled payment system," says Dr. Helm. "We are going to need this type of collaboration to get the outcomes we want in the most efficient way."
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