Orlando (Fla.) Health launched the Orlando Health Spine Center in the Tampa Bay, Fla., area Sept. 1. The center brings neurosurgery, orthopedic spine surgery, pain management and nonoperative care into one program. For neurosurgeon Clayton Bauer, MD, that kind of model is no longer optional.
“I don’t just think that it’s something that’s going to be likely to happen,” Dr. Bauer told Becker’s. “I think it’s something that has to happen.”
The goal, he said, is to get each patient to the right provider at the right time, rather than leaving them to bounce between specialists before finding the care they need.
Building the program
Orlando Health has been in the region for a couple of years and brought with it a spine center model already in use in Orlando, Dr. Bauer said. The Tampa Bay-area program has been in development for more than a year.
Its providers are now all Orlando Health employees, but they came from different places. Some practiced with Land O’ Lakes-based Florida Medical Clinic, which Orlando Health acquired, and others were recruited from private groups.
Dr. Bauer was one of them. He had been in private practice in the area, and the spine center was one of the reasons he joined Orlando Health. Before signing on, he traveled with a group of providers to see the Orlando program firsthand.
‘Patient-specific care’
Dr. Bauer said the program aims to prevent a familiar scenario: A patient shows up to a specialist only to hear they should be seeing someone else.
Instead, imaging, physical therapy, surgeons and nonoperative providers work together so patients are properly diagnosed and routed from the start. That leads to better-optimized patients, more accurate diagnoses and better outcomes, he said.
“The best surgery is the surgery that benefits the patient, and sometimes that is no surgery,” Dr. Bauer said.
He described comprehensive care as patient-specific care. Depending on the case, that could mean physical therapy, injections with interventional pain management, diagnostic tests such as EMG or nerve conduction studies, or surgery ranging from minimally invasive procedures to large deformity corrections.
The idea, he said, is a one-stop shop where a patient can “be seen, be evaluated, be appropriately diagnosed, and be given a treatment plan that is specific to them.”
A walk-in option for spine care
One of the program’s less common features is a walk-in clinic for patients with sudden pain or a flare-up of a chronic condition.
Without it, Dr. Bauer said, same-day spine care would often mean a trip to the emergency department. At the walk-in clinic, patients can be evaluated that day, receive medication or a physical therapy referral and be routed to the right specialty clinic.
What sets it apart, he said, is that the walk-in provider belongs to the same program as the surgeons, pain management physicians and physical therapists who may treat the patient later.
“You really have this continuity of care that you wouldn’t otherwise have just going into an emergency room,” Dr. Bauer said.
What changes for surgeons
The model also changes who lands in a surgeon’s clinic. By the time a patient reaches Dr. Bauer, they have often already tried pain management and physical therapy and are ready for a conversation about surgery.
That is better for patients, too, he said. Someone with a first bout of back pain who is sent straight to a spine surgeon may find the experience frightening when a little medication or physical therapy would do.
A larger group also can let surgeons focus on what they do best. Dr. Bauer said he performs cranial-cervical work that some orthopedic colleagues may not, while some of them perform procedures such as sacroiliac joint fusions that he may not.
The program also breaks down a common divide. Spine surgeons are usually siloed into orthopedic practices or neurosurgery practices, but at the spine center, neurosurgeons and orthopedic spine surgeons sometimes operate on cases together.
“It’s very cool to have a practice where you can have the influence and the benefits of both of those surgery groups,” Dr. Bauer said, adding that patients have given positive feedback on having both specialties involved in their care.
Standing up the program has had its challenges. Dr. Bauer said the up-front work involves deciding which providers handle which conditions and building a call center that routes patients to the right clinic with the right workup already done.
Effect on outcomes
Dr. Bauer said demand will make the model a necessity. Primary care physicians juggling thousands of patients often default to referring back pain to a spine surgeon, even when that is not whom the patient needs.
Continuity of care will also matter more as outcome metrics grow and insurers add requirements patients must meet before surgery, he said. A coordinated group can make sure each step is completed.
Ultimately, Dr. Bauer said, the model is about outcomes. Spine surgery historically has not always had strong results, and he sees a shift toward proving that treatment improves patients’ quality of life, not just how their imaging looks.
“That’s really what is going to change within spine,” he said. “Truly focusing on making sure that you’re providing a service to the patient that is truly going to be helpful.”
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