Becoming the Preferred Surgical Vendor for Back Pain

Becoming the Preferred Surgical Vendor for Back Pain

December 11th, 2017 | Clinical Connections

by Webster Pilcher, MD

The AHP Back Pain IPC brings together a broad group of stakeholders with a shared commitment to improving the continuum of spine care within our community. The past 20 years have witnessed a significant expansion of back pain related clinical services which are often provided in an uncoordinated fashion and which are not clearly linked to improvements in “spine health.” These services include imaging, medical and interventional pain management, PT, chiropractic and surgery. Significant “variation in care” has been noted between providers and geographic locations in Western New York, which is not explained simply by differences in populations of patients.

Within the surgical subcommittee our ambition is to better understand how surgical care is currently delivered in our community as a preamble to the development of clinically appropriate and cost effective models of surgical care within AHP. This will be accomplished through an in depth analysis of current practices, which will be undertaken with AHP spine surgeons and other key stakeholders. Once a snapshot of current practice within AHP is available we plan to address variation in care, cost drivers, best practices and outcomes of care.

While it is clear that lumbar fusion surgery is a cost driver nationally there is less clarity around surgical treatment matching for back pain patients. Among the goals of the surgical subcommittee is our intention to build consensus around the imaging, the classification and the recommended surgical treatment options for our patients. Consistent imaging reports will facilitate the appropriate classification of patients who are candidates for surgery. Establishing clarity around the definitions of “instability” and “spondylolisthesis” and the surgical options in stable spondylolisthesis are important initial goals of our committee. Understanding variation in care in the surgical domain and the surgical “value equation” will be important next steps.

The analysis of surgical practice will not be viewed in isolation but in the context of myriad surgical and non-surgical treatments which are available to patients with back pain and the “curative fantasy” which drives the utilization of expensive and variably effective services including surgery. A “shared decision making” collaborative between primary care, PT, chiropractic, interventional pain management and surgery providers will be developed which will promote patient engagement and understanding and a cost effective continuum of care within AHP.

As an overarching objective, the surgical subcommittee hopes to distinguish AHP in the “value” domain” in which the surgical care of patients will make us the preferred vendor for surgical care of back pain in Western New York.