Blog Post

The solution to rising spinal fusion rates? Multidisciplinary care.

March 6, 2018

    Surgical fusion volumes have spiked over the last few decades, with the incidence of lumbar fusion increasing by nearly 240% between 2000 and 2009. This is troubling because fusions can increase complication risks over decompression procedures, an alternative for some conditions, and raise costs without improving care quality. In fact, spinal fusion costs per case increased from $24,676 to $81,960 over the same 2000-2009 period.

    In response to this trend, organizations have developed new protocols for multidisciplinary case review aimed at reducing overutilization and unnecessary costs. Below, we've discussed two studies supporting the effectiveness of multidisciplinary case review—and best practices for employing multidisciplinary approaches at your organization.

    Multidisciplinary case review addresses rising, unnecessary spinal fusion rates

    Multidisciplinary care protocols can reduce unnecessary spinal fusion rates by allowing multiple providers to weigh in on the appropriateness of the surgery. They formalize the need for a second opinion, reducing the risk of isolated decision-making.

    Virginia Mason identifies unnecessary spinal fusions 

    In a recent study, researchers evaluated 100 patients who were referred to Virginia Mason over a 10-month period for spinal fusion by an outside surgeon. These patients were reviewed by a multidisciplinary panel including physiatrists, nurses, spine surgeons, and other care team members. After reviewing patients' medical charts and other information, the committee determined that 58% of the patients referred to Virginia Mason for fusion surgery by an outside surgeon were better suited by non-operative treatment.

    Norton Leatherman sees reduction in length of stay

    Norton Leatherman significantly reduced their lumbar fusion patients' average length of stay by implementing a multidisciplinary committee to identify the possible causes behind extended hospital stays. The committee included surgeons, nurses, program managers, and directors, among others. Three years after implementing the multidisciplinary committee, the institution found significant reductions in its average direct variable costs and average length of stay for lumbar fusion patients.

    Making multidisciplinary case reviews a reality at your organization

    Virginia Mason and Norton Leatherman found success through multidisciplinary approaches to spine care, and so can you. Here are some best practices to help you make multidisciplinary case review work at your organization:

    • Leverage the knowledge of the entire spine care team. At Norton Leatherman, the entire spine care team was included in the multidisciplinary committee, allowing for a wide range of actionable insights.
    • Set aside additional resources for committee support staff. Virginia Mason directed resources to multiple specialties, including nurses, physician assistants, spine fellows, and research staff to ensure records are up-to-date and to allow the multidisciplinary committee to devote ample time for case review.
    • Engage in routine multidisciplinary case reviews. Virginia Mason reviews all proposed lumbar fusions on a weekly basis. Determine the ideal frequency of case reviews for your organization and maintain consistency as a way to streamline the process.
     

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