Although spine procedures are considered to be a bread and butter service of hospital business units, there are a number of challenges that will affect the pace at which these procedures are poised to grow in the future. The traditional growth drivers of the past, such as demographics and advances in technology, may actually temper growth in coming years. The utilization of certain spine procedures, spinal fusion in particular, may begin to slow as baby boomers continue to age—the utilization of spine surgery peaks between ages 45 and 64.
Advances in technology and treatment techniques may also reduce inpatient volumes by pushing procedures to outpatient settings (see the Marketing and Planning Leadership Council’s Service Line Forecast Compendium for inpatient and outpatient forecasts).
Commercial payers and government agencies are also increasing their scrutiny of spine surgery utilization, putting additional pressure on growth prospects. For example, CMS recently announced (and then postponed) plans to launch a demonstration in 11 states evaluating the appropriateness of high-end procedures, including common spine procedures, by conducting prepayment reviews to ensure medical necessity before providers are reimbursed. Such efforts, along with news coverage putting “unnecessary” utilization of spine procedures in the spotlight, are likely to push providers to offer more conservative therapies as penalties and denied payments increase.
Expanding spine services across the care continuum
Developing a multidisciplinary stroke service is an emerging imperative for institutions looking to drive outcome improvements and extend patient care coordination across the broader continuum. Multidisciplinary care consists of the following components:
1) Interdisciplinary team structure: The ideal model includes:
- Medical director
- Clinical stroke coordinator
- Vascular neurologists
- Neuroscience nurses
- Rehabilitation specialists
- Operations coordinator
The collaborative nature of this type of stroke services allows the clinicians to develop a robust and individualized, nuanced treatment plan for each patient. Previous research has shown that such models result in incremental improvement in both outcomes and patient satisfaction by facilitating streamlined decision making and standardization of processes and goals.
Five essential elements of multidisciplinary stroke teams
The mandate to elevate the value of care across our service lines—the key driver behind service line transformation—requires organizations to first strengthen their service line infrastructure and then make use of the improved infrastructure to redesign their care processes. To that end, we have recently added to Blueprint for Service Line Transformation, updating the study with a section on Re-Designing Care Processes for Value. This second section complements the earlier piece, which provides guidance for Building a Dynamic Leadership Structure. Together, the two sections detail near-term imperatives facing hospitals and health systems, providing actionable steps that yield improved performance under today’s fee-for-service incentives while also preparing organizations for future value-based incentives.
The role of service lines in re-designing care processes