At Southlake-based Spine Team Texas, most patients never see a spine surgeon. Neil Patel, MD, considers that a sign the model is working.
More than two decades ago, the practice was built around an idea that was unusual for a surgical specialty: Spine care should not revolve around surgeons. Operative and nonoperative physicians should work together across the continuum, with surgery reserved for the patients who ultimately need it.
Today, Spine Team Texas has 27 physicians across 11 locations in the Dallas-Fort Worth area. Five are surgeons. The other 22 are nonoperative spine physicians.
“We’re kind of flipped upside down compared to a lot of other practices,” Dr. Patel, an orthopedic spine surgeon and president and chairman of the board at Spine Team Texas, told Becker’s.
More than 90% of the practice’s patients never make it to a surgeon, he said. As spine organizations confront fragmented care, payer hurdles and pressure to become more precise about which patients need which interventions, Dr. Patel believes the model Spine Team Texas has spent 22 years building offers an increasingly relevant lesson.
Sometimes the most important part of a spine practice is everything that happens before the surgeon enters the picture.
A spine practice turned upside down
Spine Team Texas was founded in 2004 with two surgeons and two nonoperative spine physicians.
Founder David Rothbart, MD, a neurosurgeon, envisioned a practice in which surgeons and nonsurgeons worked together rather than occupying separate lanes. The organization has expanded significantly since then, but its physician mix still reflects that original philosophy.
“We essentially intake patients, and we take them through the entire care continuum of spine care,” Dr. Patel said.
That changes where patients enter the system. Unless symptoms or imaging indicate an urgent need for surgical evaluation, patients typically do not start with a surgeon. Instead, nonoperative physicians can evaluate them and oversee conservative treatment before determining whether a surgical consultation is necessary.
That sequencing, Dr. Patel said, can shape the care that follows.
“If you start with a spine surgeon, you have a hammer. Everything looks like a nail,” he said.
By the time patients reach one of the practice’s surgeons, many have already undergone nonoperative management. That gives Dr. Patel greater confidence in what he recommends next and provides a record of conservative treatment when dealing with payers, he said.
“90-plus percent of our patients never get to see me, which is great,” Dr. Patel said. “They don’t need to.”
The patient shouldn’t have to navigate spine care
The model is also designed around a problem Dr. Patel sees throughout healthcare: fragmentation.
Patients with back or neck pain may move among different physicians and services as they try to determine what is causing their symptoms and what to do next. Too often, Dr. Patel said, the burden of navigating that process falls on the patient.
“We’re expecting patients to become their own care navigators while they’re in pain,” he said. “They shouldn’t have to worry about that.”
Spine Team Texas instead tries to coordinate that journey within the practice. Physicians discuss cases routinely, and the organization holds a weekly spine conference where clinicians bring complex cases to colleagues across disciplines.
That collaboration has also shaped how Dr. Patel practices.
“There are a lot of things the nonoperative physicians can do that I can’t, and they’ve taught me a lot about managing patients,” he said.
But putting multiple specialties under one organization is not enough to make them function as a team.
Dr. Patel said that starts with culture. “It starts with a culture of collaboration, a culture of checking your ego at the door,” he said. “Everyone has value.”
What gets harder with growth
Maintaining that culture has become more difficult as Spine Team Texas has expanded. When the organization was smaller, physicians could gather physically for its weekly spine conference. With a larger footprint, those meetings now happen virtually.
“Growth is not easy,” Dr. Patel said. The organization has developed hubs where multiple specialties practice under one roof, along with smaller locations. Technology helps connect physicians across the network, while clinicians who have spent 10, 15 or even 20 years with Spine Team Texas help newer physicians understand how the organization operates.
For Dr. Patel, preserving that culture matters as much as adding locations.
“We can grow, but it has to be smart, intentional growth, not just growth for growth’s sake,” he said.
That philosophy reflects something he emphasizes internally as the organization expands. “We’re different for a reason,” he said.
The next spine organization will have to do more with less
Dr. Patel believes the next generation of successful spine organizations will face another challenge: doing more with less.
That will require greater precision around whether a patient needs an intervention at all and, if so, which intervention is appropriate.
“We have to have a better sense of whether an intervention is needed, which intervention is appropriate and for which patients,” he said.
Navigating the payer landscape is another part of that challenge. Dr. Patel is reluctant to frame physicians and insurers as opposing sides. He hopes both ultimately share the goal of ensuring patients receive appropriate care.
He believes Spine Team Texas’ structure can help. By the time a patient reaches a surgeon, the record of conservative care that preceded the referral can strengthen both the clinical recommendation and the documentation needed for payers, he said.
“That allows us to not only meet the patient where they’re at, but where they should be,” he said.
The model also changes the role of the surgeon. Rather than serving as the default entry point for spine care, surgeons become one part of a broader continuum. For most patients, they may never need to become part of the treatment plan at all.
Why hasn’t the model spread further?
After 22 years, Dr. Patel is left wondering why the structure remains unusual.
“I don’t know why there isn’t a model like ours more broadly,” he said. “Why isn’t this taking flight?”
For Dr. Patel, the answer is not simply putting more specialties under one roof. It requires communication and culture to make them function as one team.
As spine practices face pressure to navigate patients more precisely and do more with less, Spine Team Texas offers a different way to think about the surgeon’s role in that system.
In a specialty built around the ability to operate, its model is designed so most patients never need to.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
