HealthPartners: Medical Spine Centers

[101N]

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Like Kaiser, Priority, and Lovelace, HealthPartners adopts a PM&R spine clinic model prior to surgical evaluation.

February 08, 2012 01:18 PM Eastern Time
Program helps patients consider all options for back surgery

MINNEAPOLIS--(BUSINESS WIRE)--HealthPartners is implementing a new program to help patients considering back surgery understand all of their treatment options before committing to surgery.

“There are multiple options for many patients with back pain”
Chronic low back pain is one of the most common reasons that people seek health care. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for problems such as herniated discs, spinal stenosis or lumbar pain.

But for many patients, comparing treatment options and alternatives can be confusing. In addition, there’s also a growing body of evidence that many patients with back pain can be treated effectively without surgery.

As part of the new program, patients will be referred to a medical spine specialist, a clinician trained in areas including physical medicine and rehabilitation, occupational medicine, sports medicine or other advanced training in spine care. The spine specialist will help the patient understand surgical and non-surgical options, and the benefits and risks of both. There are no restrictions on surgery in the program and the process is similar to seeing a cardiologist prior to visiting a heart surgeon.

“There are multiple options for many patients with back pain,” said Dr. Thomas Marr, HealthPartners medical director of clinical relations. “Often when patients fully understand all of their options, they may choose rehabilitation rather than surgery.”

Medical Spine Centers are clinics with one or more medical spine specialists who focus on the non-surgical comprehensive evaluation of spine problems. In a one-time evaluation lasting about an hour, medical spine specialists help patients understand surgical and non-surgical options and the benefits, risks and costs associated with various treatment options.

The addition of Medical Spine Centers to HealthPartners’ overall spine protocol is likely to help make health care more affordable. This comes at a time when consumers are paying a greater share of their own health care costs and when orthopedic costs are an increasingly significant cost driver for employers.

More than 1,100 people enrolled in a HealthPartners plan underwent spinal surgery in 2011. With the average surgery costing more than $25,000, HealthPartners spent more than $28.3 million on lumbar fusions and other spine surgeries in the past year.

In addition to cost, another challenge is that once a person has had surgery, if they have pain again, their options can be limited.

“Patients can still see a surgeon after their evaluation if they wish,” Marr said. “Their next steps are up to them to choose. But after this visit, they'll be better informed about all of their options, and can make choices more aligned with their own values. They may find that less expensive and less-invasive alternatives to surgery are a better choice for them.”



Contacts

HealthPartners
Jeff Shelman
Office: 952-883-6198
Cell: 612-859-4632
[email protected]

 

[Taus]

👍👍👍

 

[clubdeac]

Like Kaiser, Priority, and Lovelace, HealthPartners adopts a PM&R spine clinic model prior to surgical evaluation.

February 08, 2012 01:18 PM Eastern Time
Program helps patients consider all options for back surgery

MINNEAPOLIS--(BUSINESS WIRE)--HealthPartners is implementing a new program to help patients considering back surgery understand all of their treatment options before committing to surgery.

“There are multiple options for many patients with back pain”
Chronic low back pain is one of the most common reasons that people seek health care. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for problems such as herniated discs, spinal stenosis or lumbar pain.

But for many patients, comparing treatment options and alternatives can be confusing. In addition, there’s also a growing body of evidence that many patients with back pain can be treated effectively without surgery.

As part of the new program, patients will be referred to a medical spine specialist, a clinician trained in areas including physical medicine and rehabilitation, occupational medicine, sports medicine or other advanced training in spine care. The spine specialist will help the patient understand surgical and non-surgical options, and the benefits and risks of both. There are no restrictions on surgery in the program and the process is similar to seeing a cardiologist prior to visiting a heart surgeon.

“There are multiple options for many patients with back pain,” said Dr. Thomas Marr, HealthPartners medical director of clinical relations. “Often when patients fully understand all of their options, they may choose rehabilitation rather than surgery.”

Medical Spine Centers are clinics with one or more medical spine specialists who focus on the non-surgical comprehensive evaluation of spine problems. In a one-time evaluation lasting about an hour, medical spine specialists help patients understand surgical and non-surgical options and the benefits, risks and costs associated with various treatment options.

The addition of Medical Spine Centers to HealthPartners’ overall spine protocol is likely to help make health care more affordable. This comes at a time when consumers are paying a greater share of their own health care costs and when orthopedic costs are an increasingly significant cost driver for employers.

More than 1,100 people enrolled in a HealthPartners plan underwent spinal surgery in 2011. With the average surgery costing more than $25,000, HealthPartners spent more than $28.3 million on lumbar fusions and other spine surgeries in the past year.

In addition to cost, another challenge is that once a person has had surgery, if they have pain again, their options can be limited.

“Patients can still see a surgeon after their evaluation if they wish,” Marr said. “Their next steps are up to them to choose. But after this visit, they'll be better informed about all of their options, and can make choices more aligned with their own values. They may find that less expensive and less-invasive alternatives to surgery are a better choice for them.”



Contacts

HealthPartners
Jeff Shelman
Office: 952-883-6198
Cell: 612-859-4632
[email protected]

I interviewed with them! Maybe I should've taken the job. At that time however, they already had one pain guy who had been there for a year. He said he was having problems getting reimbursed for RFA, stim and even TFESIs. From what I understood, HealthPartners is an insurance company owned hospital and everyone working for them is insured by them. There was some financial incentive to be as hands off as possible. At the time I thought there could possibly be too much politics and conflicts of interest for me to be able to practice as I saw fit.... oh what might have been

 

[bedrock]

I interviewed with them! Maybe I should've taken the job. At that time however, they already had one pain guy who had been there for a year. He said he was having problems getting reimbursed for RFA, stim and even TFESIs. From what I understood, HealthPartners is an insurance company owned hospital and everyone working for them is insured by them. There was some financial incentive to be as hands off as possible. At the time I thought there could possibly be too much politics and conflicts of interest for me to be able to practice as I saw fit.... oh what might have been

A lot of these places prefer PM&R docs(without fellowship training), because they're inexpensive (not doing procedures beyond trigger points on spine patients), but they don't realize what they're missing but not having a pain physician who can guide all aspects of non-surgical care for these patients.

I think some of these models are just there to reduce costs, and are not outcomes oriented. Sure, you can send a patient to a cardiologist before a CT surgeon or to a pain doc before a spine surgeon, but if the cardiologist/pain doc can't offer the minimally invasive options such as stents/ESI-RFA, then many patients will just end up with open heart surgery/spinal fusion anyway.........

 

[SSdoc33]

A lot of these places prefer PM&R docs(without fellowship training), because they're inexpensive (not doing procedures beyond trigger points on spine patients), but they don't realize what they're missing but not having a pain physician who can guide all aspects of non-surgical care for these patients.

I think some of these models are just there to reduce costs, and are not outcomes oriented. Sure, you can send a patient to a cardiologist before a CT surgeon or to a pain doc before a spine surgeon, but if the cardiologist/pain doc can't offer the minimally invasive options such as stents/ESI-RFA, then many patients will just end up with open heart surgery/spinal fusion anyway.........

spine surgeons are more expensive than pain docs, who are more expensive than non-fellowship physiatrists, who are more expensive than primary care.

THE cheapest way to treat spine patients is to throw opioids at them. thats the common demonimator in "inexpensive" spine care.

i really do worry about our specialty

 

[Jcm800]

spine surgeons are more expensive than pain docs, who are more expensive than non-fellowship physiatrists, who are more expensive than primary care.

THE cheapest way to treat spine patients is to throw opioids at them. thats the common demonimator in "inexpensive" spine care.

i really do worry about our specialty

me to! it seems that this is really the answer that our government and society/patients want...

its a concern that seems more real every day. In fact, as a guy who doesnt reall believe too much in opiates, I loose out to the guys that are liberal with doling the opiates and who then also get the procedure patients...

 

[lobelsteve]

me to! it seems that this is really the answer that our government and society/patients want...

its a concern that seems more real every day. In fact, as a guy who doesnt reall believe too much in opiates, I loose out to the guys that are liberal with doling the opiates and who then also get the procedure patients...

Yup, throw it PT, counseling, (via clinical Psych or SW) and modalities like TENS and you end up treating the whole patient.

Not just the wallet and disk.

Boo-yeah.

 

[101N]

Yup, throw it PT, counseling, (via clinical Psych or SW) and modalities like TENS and you end up treating the whole patient.

Not just the wallet and disk.

Boo-yeah.

I know the studies that lead to the development of this model. There is generally either no change in patient satisfaction - vs a direct surgical referral - or an improvement in patient satisfaction. One could argue that, given equivalent patient satisfaction, this is a better model because there is much less morbidity with nonoperative care than that associated with direct surgical referrals and surgical over utilization. Over-utilization of surgery is more than a cost issue, there are real iatrogenic harms that arise. However, in those areas of the country where there isn't surgical over-utilization - Dartmouth Database - this model probably holds no advantage morbidity advantage over direct surgical referral. In those places this model would probably be cheaper, albeit, not 'better'.

In the words of Rick Deyo: "Who you see is what you get."

 

[101N]

Those of you with access to the WSJ will get a kick out of this article. A proof of concept for non-operative spine clinics.

HEALTH INDUSTRYFEBRUARY 9, 2012
In Small California Hospitals, the Marketing of Back Surgery
By JOHN CARREYROU, TOM MCGINTY and JOEL MILLMAN

 

[bedrock]

Those of you with access to the WSJ will get a kick out of this article. A proof of concept for non-operative spine clinics.

HEALTH INDUSTRYFEBRUARY 9, 2012
In Small California Hospitals, the Marketing of Back Surgery
By JOHN CARREYROU, TOM MCGINTY and JOEL MILLMAN

"proof of concept"?
Can you give us the high points for those of us without WSJ accounts?

 

[ziggyziggy]

spine surgeons are more expensive than pain docs, who are more expensive than non-fellowship physiatrists, who are more expensive than primary care.

THE cheapest way to treat spine patients is to throw opioids at them. thats the common demonimator in "inexpensive" spine care.

i really do worry about our specialty

I don't know if opiates is the cheapest way, some of the patients on meds would be spending a lot more then few procedures with good outcomes.

But the costliest, is definitely a patient with FBSS and back on opiates.

 

[SSdoc33]

I don't know if opiates is the cheapest way, some of the patients on meds would be spending a lot more then few procedures with good outcomes.

But the costliest, is definitely a patient with FBSS and back on opiates.

vicodin and percocet are dirt-cheap, ziggy. MS contin is pretty cheap as well. i am in no way arguing for the use of opioids, just that they are the cheapest option

 

[Ducttape]

vicodin is about $100-180 per month. MS contin is cheaper mostly because ins. covers, but without insurance is not that different.

Methadone is cheapest by far.

In fact, i had a patient once who was addicted to vicodin. He told me that a dealer would give him methadone for free when he couldnt afford to buy vicodin.

 

[Gauss]

All HMO's and ACO's are moving to this model, so the pain and spine surgeons in town are now hiring PM&R to capture the referrals and triage it to them. easy prey, especially new grads

 

[drusso]

Rick Deyo is not a spine nor pain specialist. He's a methodologist and internist by training.

 

[101N]

Rick Deyo is not a spine nor pain specialist. He's a methodologist and internist by training.

So the implication is that, not being a spine or pain specialist, disqualies him from understanding our data? You are reverting to immenece-based medicine.

 

[lobelsteve]

So the implication is that, not being a spine or pain specialist, disqualies him from understanding our data? You are reverting to immenece-based medicine.

I believe it is who funds him that gets their opinion across.

 

[101N]

I believe it is who funds him that gets their opinion across.

Bingo, Rick - and Roger - have incentives too. Levy brought this up in an editorial in Neuromod a few months ago.

 

[101N]

Bingo, Rick - and Roger - have incentives too. Levy brought this up in an editorial in Neuromod a few months ago.

BTW: While Rick endorsed this model, itd wasn't he that came up with it .

 

[drusso]

No. Real science involves the expertise from both methodologists and content experts on the topic. It's the content experts who contextualize what the data actually mean. This is the problem I have with the meta-analyticians. They completely lack expertise in how what they're studying works on a day-to-day basis.

If we're going to actually make policy decisions based upon "data" derived from the bluntest form of statistical inference (meta-analysis), then we better be certain that we've got the problem right, the data right, and the conclusions right.

I'll let Ligament recount his experiences at the Washington State Technology Assessment Committee where policymakers were more than happy to listen to methodologists,but ignore content experts like Paul Dreyfuss, Nicholas Bogduk, etc.

"The map is not the territory."

 

[101N]

No. Real science involves the expertise from both methodologists and content experts on the topic. It's the content experts who contextualize what the data actually mean. This is the problem I have with the meta-analyticians. They completely lack expertise in how what they're studying works on a day-to-day basis.

If we're going to actually make policy decisions based upon "data" derived from the bluntest form of statistical inference (meta-analysis), then we better be certain that we've got the problem right, the data right, and the conclusions right.

I'll let Ligament recount his experiences at the Washington State Technology Assessment Committee where policymakers were more than happy to listen to methodologists,but ignore content experts like Paul Dreyfuss, Nicholas Bogduk, etc.

"The map is not the territory."

I understand what you are getting but don't see how it pertains to this post.

Academia is full of statisticians, MPH's, PhD's, mathematicians & economists who study data at the meta level: Archie Cochrane, John Wennberg, Uwe Reinhardt, etc. Often times the models that these folks develop to explain medical phenomena - benchmarking for example- seems to better explain/predict behavior than our own outcome data, if we have it.

The person who came up with the physiatric spine clinic model was Ben Klein, PhD, a clinical psychologist. Klein discovered that the model reduced surgical rates with no change in patient satisfaction. Kaiser adopted the model shortly after Klein published his findings in Spine. Rick, who had nothing to do with Klein, wrote an editorial in Spine endorsing the model. A few years later John Fox developed a variant of the model in MI. Now it's rolling out all over the US. I do not see this as a bad thing as our - US - surgical rate is the highest in the world.

I think most folks who study variation in spine surgery in the US would attribute it to physician incentives. What Rick, Gene, Roger, Stuart, et al won't say in public is that this curve is a better predictor of surgeon income than spine surgery outcome:

http://www.dartmouthatlas.org/data/distribution.aspx?ind=73&tf=10&ch=32&loct=3&fmt=98

 

[Ligament]

No. Real science involves the expertise from both methodologists and content experts on the topic. It's the content experts who contextualize what the data actually mean. This is the problem I have with the meta-analyticians. They completely lack expertise in how what they're studying works on a day-to-day basis.

If we're going to actually make policy decisions based upon "data" derived from the bluntest form of statistical inference (meta-analysis), then we better be certain that we've got the problem right, the data right, and the conclusions right.

I'll let Ligament recount his experiences at the Washington State Technology Assessment Committee where policymakers were more than happy to listen to methodologists,but ignore content experts like Paul Dreyfuss, Nicholas Bogduk, etc.

"The map is not the territory."

Just to expound; Nik Bogduk, Paul Dreyfuss, Ray Baker, Way Yin, Richard Rosenquist, were all PHYSICALLY IN THE SAME ROOM IN FRONT OF THE COMMITTEE, and they were completely ignored. Yes, Bogduk flew in from Australia to Seattle specifically for this meeting! They were not called upon when they raised hands to comment. Nobody on the panel asked any opinions of these world authorities!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[101N]

Jeebus, where are the air marshals when you need them...

 

[lobelsteve]

Jeebus, where are the air marshals when you need them...

I'm sure Nik had his 555's confiscated prior to the flight. (Unsure of his brand or if he quit, but I remember he had a bit of a habit back in 1993).