Accountable Spine Care: Behind the Michigan Spine Surgery Improvement Collaborative


Stephen BartolThe Michigan Spine Surgery Improvement Collaborative was launched in September 2013 as a collaborative between Henry Ford Health System, eight Michigan hospitals, Blue Cross Blue Shield of Michigan and Blue Care Network to gather data that will help improve outcomes for spine surgery patients.

The goals of the collaborative are to:


•    Improve patient outcomes
•    Reduce complications
•    Reduce costs and episodes of care
•    Minimize repeat surgery rates


"This is a large and impressive effort," says Muwaffak M. Abdulhak, MD, a neurological spine surgeon at Henry Ford Health System in Detroit. "Henry Ford has a history of orthopedic spine and neurosurgeons working together in a very collegial partnership. The BCBSM is involved as a facilitator and supporter, and they don't have access to the data or the ability to influence it. However, they have an interest in decreasing complications and improving outcomes, and we're working with them to meet those goals."


BCBSM and Blue Care Network provided funding for the project, designed to develop best practices that promote quality in spine care, and the project's directors hope to continue adding hospitals across the state in the future. Funding is available for surgeons who collect data for both orthopedic and neurological spine surgery in the state.


"There have been multiple attempts in the past to make this happen," says Dr. Abdulhak. "Intuitively, patients are interested in the best outcomes, physicians and insurers also have a stake in the project. Previous attempts failed because there was no funding or organization. However, the unique thing about this collaborative is it starts with the surgeons themselves. Instead of telling surgeons what should be measured, we decide the most important outcomes measures and take control of the project from there."


The surgeons decide which quality measures are tracked and own their personal information. "The data is not something reported by someone else and told to them," says Stephen W. Bartol, MD, an orthopedic spine surgeon at Henry Ford Health System. "The surgeon owns the data and has active input into using that data to target quality improvement initiatives. Instead of using quality data to punish doctors, the distinction here is that the data actually targets quality improvement."


The project is also unique because of the breadth of surgeons who will input information about their patients. Surgeons have different strengths and weaknesses, but put together in the registry patients will draw upon a huge collection of data to improve their care.


"There are hundreds of spine surgeons and each one of us has a blind spot," says Dr. Abdulhak. "If we can put ourselves together and find the best practices from all our experiences, we can get the best outcome. This is a process of learning and teaching, and we all have something to teach and learn."


The data gathering efforts are still in their first stages, but the program directors have high hopes. "We are pretty young and we are full of energy, but we're still in the learning phase," says Dr. Bartol. "We went through a year-long process to set up this data registry and we want to make sure our five essential components are adhered to."


The five components are:


•    Good quality measures
•    Physicians owning the data
•    Data that targets quality improvement
•    Funding for data extraction
•    Active engagement from orthopedic and neurospine surgeons


"I have observed over my career that surgeons are extremely competitive and they want to be at the head of the pack," says Dr. Bartol. "They want access to their data and they want to see how it compares to everyone else. One of the anticipated impacts of having a good registry is that the surgeon will naturally gravitate toward a better practice and try to improve on their deficiencies. We are bringing surgeons together to make sure everyone feels safe in the process — we don't want anyone to feel like they are personally attacked or scrutinized by anyone else. That element of safety combined with the desire to improve things is what will make this initiative work."


The data could also prove handy for insurance company approvals. Surgeons across the country are battling with insurance companies for coverage, even for routine procedures, and if the Collaborative can prove a treatment works and is cost-effective, insurance companies could get onboard.


"We have to show we are doing the right thing, eliminating waste wherever possible, and that we are getting effective outcomes," says Dr. Bartol. "The Collaborative gives us access to big data and allows us to answer those questions."


The database went online in January, with 10 hospitals and 50 surgeons enrolled. All members are actively entering their data and they'll meet in June to discuss their findings. A key topic at their next meeting is rolling out the next phase of the database and which centers they will recruit to join their efforts.


"While it's too early to see results, we are seeing good quality data collected on the whole episode of care," says Dr. Bartol. "Data is collected on patient demographics, medical history, treatment provided and patient outcomes. We do postoperative outcomes and follow-up as well. One of the differences in our registry is the immediate focus on the actual treatment provided to the patient and the outcome; most registries are a little sparse on the outcomes data, but we are set up to do that."


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