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Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD

Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD. AAPM&R Innovations in Spine Care Summit October 2, 2015. Current State—The Problem Statement. Musculoskeletal Pain Costs. Spine Clinic Design. Goals of Spine Clinic. Quick access for the patient

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Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD

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  1. Spine ClinicInnovating and Spreading Better CareAndrew Friedman MD AAPM&R Innovations in Spine Care SummitOctober 2, 2015

  2. Current State—The Problem Statement

  3. Musculoskeletal Pain Costs

  4. Spine Clinic Design

  5. Goals of Spine Clinic • Quick access for the patient • The ‘right’ care at the ‘right’ time • Evidenced based care • High patient satisfaction • Quick return to function • Win for patient, win for employer, win for payer and win for us

  6. Patient Priorities 1. Reassurance no serious disease 2. Relief of symptoms 3. Rapid return to function • Patient priorities in complicated cases include management of disability claims, legal claims, ongoing symptoms, suffering

  7. Evidence-basedappropriate care

  8. Spine Clinic Appointment Sorting • Series of questions asked of the patient • chief complaint • red flag symptoms • mechanism of injury • date of onset • previous evaluation • previous diagnostic studies • previous diagnosis • previous treatment • co-morbidities • referral for care • Each response is weighted based upon clinical relevance • Based upon the patient response as score is assigned that correlates to the clinic that the patient will be scheduled into. • 0-15 Acute Spine Clinic – 60 minutes with PT and 20 minutes with MD • 15+ Physical Medicine Consultation - 60 minutes with MD (no PT)

  9. Flow of visit

  10. Outcomes

  11. The New Approach Details Back pain best practice • Same day access for patients • Concurrent visits with doctors and physical therapists • Over-the-counter pain medicine and structured follow-up • Downstream referral if red flag symptoms Results • 55% reduction in spend per episode of back pain • 1/3 fewer diagnostic imaging procedures performed • 67% fewer missed days of work • 91% patient satisfaction SOURCE: Fuhrmans, Vanessa. "A Novel Plan Helps Hospital Wean Itself Off Pricey Tests." The Wall Street Journal. N.p., 12 Jan. 2007. Web. 04 Aug. 2015. <http://www.wsj.com/articles/SB116857143155174786>.

  12. Evidence-based ImagingLower Utilization Without Pre-authorization Mistake-proofing Implemented Reduction in imaging Headache: -23% Low back pain: -23% Sinusitis: -27% J Am Coll Radiol 2011;8: 19-25.

  13. Disc Decompression 2007-2010 More Consistent Less Consistent More Intense Less Intense

  14. The Bigger Picture

  15. Stepped-Care Model Step Two ssssYour text here S Step One Step Three

  16. Stepped Care Step 1—most patients. Low-cost intervention which addresses fears and encourages return to normal function Step 2—targets patients who need more than simple advice to resume activities. Brief structured interventions Step 3—targets pts who require more intensive interventions including treatment of psychological illness before they can return to work/family activities

  17. Stepped Care Model Requires accurate stratification Relies on Patient Measurement Captures greater value for complex patients Key to population managment

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