Structuring a Spine Program

Joe Cantlupe, for HealthLeaders Media , August 15, 2011
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An estimated 10 million Americans over age 50 have osteoporosis, the most common bone disease, while another 34 million are at risk, the according to the U.S. Surgeon General. Each year, an estimated 1.5 million people suffer an osteoporotic-related fracture, an event that often leads to a downward spiral in physical and mental health.

"Due primarily to the aging of the population and the previous lack of focus on bone health, the number of hip fractures in the United States could double or even triple by the year 2000," a Surgeon General's report states.

Once patients are advised about osteoporosis conditions, "patient adherence to treatment is another problem that must be overcome," Shepherd says.

Success Key No. 3: Chiropractic options

The Winchester Hospital has a spine service center that includes surgery programs. But it also incorporates an option that has led to greater ROI and more patient involvement: chiropractic care. The hospital emphasizes a conservative approach within its orthopedic system for improved patient volumes and outcomes, says Zohn, director of the chiropractic center.

Winchester is among a growing number of hospitals incorporating chiropractic units in the hospital, says Zohn.

The model enables hospital leadership to overcome concerns that there may be too many spine-related surgeries.

"People in communities where they have easy access to MRIs have significantly more back surgeries than those who don't," Zohn says. "But we feel that this approach is good because conservative approaches and treatment need to be eliminated first as a possibility before surgery. We do a lot of spine surgeries in this country, from herniated discs to generative disc disease. A lot of money is spent on this, but it needs to be cost effective."

At least 10,000 patients visits have occurred at the off-site location for chiropractic care in each of the past several years, Zohn says. The chiropractic center ranks among the highest in patient satisfaction scores in all hospital units, he adds.

"Doctors who work within the hospital are very receptive to the program and refer a lot of patients here. It also goes both ways; the chiropractic clinic refers patients to the hospitals," he says. The hospital administration has reported patient satisfaction scores in the high 90% range, "one of the highest in the whole hospital system," Zohn says. "With that satisfaction, it brings more people into the Winchester Hospital system."

Chiropractic care often focuses on bulging discs, which indicates problems in the muscular or neurological areas surrounding spinal structures and joints. A bulging disc itself is not actually painful, but it can be a musculoskeletal problem that affects other spinal conditions such as spinal stenosis, sciatica, or nerve compression.

"We've been very busy here with the patient population," Zohn says. "The doctors are seeing a lot of patients, but the docs want to eliminate the conservative approaches first before the need for surgery. We have orthopedic surgeons, for anything from tennis elbow to shoulder problems. But I think patients love this; they want a nonsurgical and drug-free approach to their problems. If there is no other alternative solution, at least they know about it."

Another key aspect of the hospital's care program includes maintenance, which often has been not fully realized in spine care, Zohn says. The hospital works to ensure proper follow-up once the patient leaves the facility, he says.

The federal Agency for Health Care Policy and Research encouraged the "utilization of chiropractic services for the management of low-back pain, given the impressive body of evidence on the effectiveness and comparative cost-effectiveness of these services."

Success Key No. 4: Negotiating for implants


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