How spine surgeons fit into population health — 3 key ways practices are changing


Population health is the newest buzz word among healthcare professionals. In its broadest terms, population health can be defined as an approach to healthcare that improves an entire population; in spine health, that population is often people with chronic back pain.

There are estimates that more than 100 million Americans suffer from chronic back pain, according to the Institutes of Medicine, which costs the country $600 billion per year in treatments and lost productivity. Now healthcare professionals, and in particular spine specialists, are looking for ways to shrink this population and lower the overall associated costs.


"As our population expands, the strain on healthcare increases not only from a financial standpoint but the availability of healthcare professionals to handle the increased load," says Charles Theofilos, MD, founder of The Spine Center in Palm Beach, Fla. He also developed SpinePack, an all-natural nutritional supplement specifically formulated to promote a healthy back and spine. "There will be a shift towards P.A.-directed patient care to help lessen the load on physicians. Furthermore, with our increasingly aging population, the strain on Medicare increases and eventually affects the services available for this patient population."


People with back pain follow a similar trajectory that can lead to many problems down the road; they experience back pain, but don't see a specialist until it becomes unbearable. At that point, physical therapy and lifestyle changes may not be enough, so the patient has either interventional treatment like steroid injections or pharmacological treatment like steroids. While these methods can mask the pain long enough for patients to attempt rehabilitation without surgery, it may not fix the problem for everyone.


With persistent back pain, patients are less active and may not be able to work. They become depressed and sometimes addicted to their pain medications. These patients are more difficult to operate on if surgery is necessary, and are less likely to achieve good outcomes.


In many respects, the best way to treat this population is prevention.


"Spine care should be focused on preventative care instead of wanting to treat the damage that has already occurred," says Dr. Theofilos. "Core strengthening is essential to help protect the spine as well as lifestyle changes including lifting techniques and proper posture. This is very similar to cardiac care. Instead of waiting for bypass surgery to treat blocked arteries, the focus should be on preventative care with diet and exercise."


In addition to diet and exercise, prevention also includes balance conditioning and proper posture. There are products available, including AlignMed, that help people with bad posture maintain good posture to prevent back pain and further issues in the future.


"Proper posture is key, and the beauty of AlignMed is that it forces you to stand properly," says Stephen Hochschuler, MD, co-founder of Texas Back Institute in Plano. "I also advise a proper ergonomic chair. Your spine is in balance. Years ago, all we cared about was dealing with the patient's pain and doing fusions to get the spine straight. Now the hot word in spine is alignment."


The focus on population health in spine surgery is a paradigm shift for most surgeons. Here are a few ways the surgeon's practice is changing as a result:


1. Surgeons are ordering their own physical therapy plan. Dr. Hochschuler learned from sports medicine physicians that ordering physical therapy doesn't always mean the therapist knows how to optimize individual patients. He makes sure all his patients undergo aerobic conditioning, core strength and balance training.


2. Focus on educate for proper posture. The traditional posture points are sitting and standing, but surgeons are now adding a few new messages into the mix:


• Not looking down at phones; instead, holding them eye-level
• Making sure computer screens are raised to eye-level when sitting or standing
• Proper biomechanics in sports, especially golf swings


3. More time is spent on education in different media. Television ads and magazine pamphlets can spread the word about back pain prevention in the local communities. When people see surgeons becoming the face of prevention, they'll remember that surgeon if back pain does arise, or recommend that surgeon to friends and family with back pain. Lectures at health clubs are an easy way to spread the word about prevention, and surgeons can write articles for websites circulating beyond their community.


"Spine surgeons should broaden their practice toward earlier patient care rather than just wait for surgical referrals," says Dr. Theofilos. "Getting involved with community education, physical therapy programs, as well as other support groups, will allow people to become educated earlier on preventative spine care."


One of the challenges for spine surgeons in this paradigm shift toward population health is the time it takes to provide education. Whether it's describing prevention methods to each patient at visits or writing blog posts for a weekly update, education is time-consuming and often unbillable.


"Many times we as physicians are investing in the community by spending our own funds to develop educational lecture series," says Dr. Theofilos. "If we spend time educating patients in the office or lecturing on preventative measures, we'll help patients in the long run."


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