Texas Back Institute – Part 2: Who we are today


This article is a portion of a book titled "Challenges, Risks and Opportunities in Today's Spine World " edited by Stephen Hochschuler, MD, Frank Phillips, MD, and Richard Fessler, MD. You can find links to the previous chapters at the end of this article.

Texas Back Institute continues to be one of the largest most successful spine practices in the country. Founded over 40 years ago, we evaluate over 20,000 new patients and perform over 4,000 surgeries, annually. TBI was built on a foundation of research, training, education, innovation and evidence-based medicine. We continue to embrace these concepts through our multi-disciplinary group which includes orthopedic spine surgeons, neurosurgeons, physiatrists, a psychologist and a very strong team of physical therapists located in eleven offices across the Dallas Fort Worth metroplex.

TBI has experienced significant growth over the past 10 years, including the addition of 12 surgeons, 8 new offices, and affiliations with 4 new hospitals. Much of TBI’s growth has been in the area of high acuity spine, including trauma, scoliosis and spine revision. Critical to this growth has been finding new ways to work with others in our communities. Examples of this include co-management arrangements for our concierge practices such as the Scoliosis and Spine Tumor Center and the Center for Disc Replacement. These arrangements not only include a high level of customer service for patients traveling long distances, but they also include continuous research to identify best practices at all levels.

Another example of working with others in the community includes our involvement with large employer groups that are seeking new ways to contain cost while delivering quality care. We have partnered with the DFW Business Group on Health to help educate employees, and to work with employers on unique plan designs. With the continued pressure of increasing costs, it is paramount to the industry to work with our communities to create innovative solutions for efficient quality care.

TBI’s success is dependent on our environment of continuous improvement and education. Our quality programs were initially developed out of our desire to provide a strong fellowship program that delivers capable spine surgeons for the future. Due to our growth, and the addition of surgeons from many different programs from across the country, our education programs have evolved into quality programs for ALL of our surgeons, at all stages of their careers. We have developed a Peer Review Committee to evaluate all complex surgeries and to review trends and outcomes as reported through our spine registry. We have developed a culture of transparency to ensure that we provide the most appropriate and least invasive spine care for any particular instance. Our physicians meet weekly for two hours to participate in our neuroscience lectures, to discuss interesting cases, and to review our cases that have gone well and those that may have not turned out as initially planned. This has created a collegial and collaborative learning environment for everyone which has resulted in a high level of accountability among all the physicians.

Our foundation of research, training, education, innovation and evidence-based medicine is instilled in the culture of TBI. We believe this foundation has a reach beyond our patient base or local market, but can have a profound effect on how spine conditions are evaluated and treated in the future. For example, we are one of the first spine focused groups in the nation to have a biomechanics and gait lab integrated with our private practice. We are studying the characteristics of gait and balance abnormalities associated with spinal pathology and defining those results as objective measures of the benefits of our interventions.

Along with patient care, TBI believes in the philosophy of giving back to our local and international communities. Several of our doctors are dedicated to philanthropic missions in Ethiopia and Uganda which allows our surgeons, fellows and employees to volunteer spine care services to the less fortunate in regions of the world where spine care does not otherwise exist. We also have a community outreach program which is managed and operated by our employees. This program encourages and allows our employees to identify non-profit organizations where TBI can have an impact such as community fund raising runs, packing lunches for school children, collecting coats for the homeless, providing supplies for animal shelters and even building wheelchair ramps for those who are disabled and do not have the means to provide it for themselves. These programs unite our teams and provide an outlet for our employees to get to know each other and build cohesiveness.

Second only to patient care is ensuring our organization is sustainable. With an increase in the complexity of medical economics, with new regulatory hurdles, considering the competition in the market place, and the need for comprehensive IT solutions, as well as, patient demands, it is vital that we continuously challenge “how” we run our business. As an organization we embrace the challenge to find new, more efficient processes in delivering patient care, and better methods of working with the payor community. This is a particularly difficult task for those who are committed to maintaining their autonomy and independence, however we have made substantial improvements in our efforts to achieve these goals..

Our executive team and governing physicians are always exploring options to optimize overhead and streamline operations. This year we are evaluating our software solutions to help improve the efficiency of patient flow as well the accuracy and timeliness of our billing and collections. We have transitioned some of the outsourced services to be in house which in a very short span has already proven to be beneficial to our bottom line. We recently brought our billing services in-house. This has proven to be a positive move for TBI in that our team is more integrated with the rest of the practice since everyone contributes in some way to the revenue cycle. In addition, Sales and Marketing are important components of our organization as we are located in a highly competitive market. Our sales team works tirelessly to build and maintain relationships with other providers. Our marketing team continuously searches for and initiates opportunities to place traditional advertising as well as social media advertising, including video content, and blog posts, along with maintaining our website. We are finding new technological solutions and organizational solutions for many of our processes which are enhancing the patient experience, such as restructuring our care teams to align them in a more patient-centric manner.

TBI exists to provide the best possible spine care in an environment of collaboration, education, research and innovation. This is who we are today, and will still be tomorrow.

Previous chapters:

Challenges, risks and opportunities in today's spine world

Spine care - Balancing cost with innovation

What are big data and predictive analytics

Predictive Analytics and Machine Learning

The HSS Spine Care Model, Part 1

The HSS Spine Care Model, Part 2

The Rothman Model, Part 1

The Rothman Model, Part 2

The History of Texas Back Institute


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