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A practical and occasionally provocative look at the state of spinal surgical care Just a few decades ago most spine surgery was literally a gamble: maybe you'd get better and maybe you wouldn't. Today we have the knowledge, understanding, and technology to predictably relieve pain and neurological deficits like never before -- yet many patients are still getting subpar care. Foundational knowledge of surgical spine care isn't spreading to the medical community, let alone to patients, whose quality of life hangs in the balance. With The Back Story on Spine Care, orthopedic specialist Dr. Drew Bednar presents case studies that illuminate the common issues plaguing patients -- and their treatment -- today. Back problems are among the most common health issues, and with Dr. Bednar's insights, knowledge, and practical tips, medical professionals can provide care that leads to healthier backs and happier lives.
Unsustainable healthcare costs and sophisticated predictive modeling based on large-scale medical data is rapidly changing models of healthcare delivery. The shift towards a value-based, consumer-driven industry has created an urgent need for validated tools to increase cost efficiency, reduce rates of adverse events, and improve patient outcomes. Value-based approaches to spine care will be presented, highlighting models for the future. These approaches stress cost effectiveness and sustainable approaches to spinal disease, where quality and safety are paramount. Beginning with a review of current trends in health care delivery leading to more value-based platforms, the discussion then focuses on how modern spine care is being shaped by the aging population, scientific and technological advancements, and the economic impact of various treatment modalities, providing insight into the seminal efforts surrounding sustainable spine care guideline development. The over-utilization of spine fusion surgery and adult spinal deformity are presented as examples that have led to a decline in the value of care delivered, as well as how a multidisciplinary evaluation by the range of clinicians involved in spine surgery can revise recommendations for management. The benefits and risks of LEAN methodology for streamlining and standardizing spine care approaches are discussed, and the specific approach of the Seattle Spine Team is presented as an example of successful system-wide improvement. Similar changes to outcome measurement, specifically for adult spinal deformity, are described. Last, the future of technology in spine care is presented, including robotics, nanotechnology, 3D printing, and the use of biologics and biomaterials. Given the broad scope of topics covered in this book, the intended audience includes not only orthopedic and spinal surgeons, neurosurgeons, physiatrists, and medical students, residents and fellows, but also hospital CEOs, CMOs, administrators, health services researchers, and health care policymakers, consultants and strategists.
“A tour de force of spine care from a master spine surgeon who has literally seen it all over the course of a four-decade career! This book is a must-read that is accessible to both the layperson and healthcare professionals. I found it both enjoyable and informative.” — Dr. Andrew J. Schoenfeld, Harvard Medical School professor and Spine editor in chief A practical and occasionally provocative look at the state of spinal surgical care Just a few decades ago most spine surgery was literally a gamble: maybe you’d get better and maybe you wouldn’t. Today we have the knowledge, understanding, and technology to predictably relieve pain and neurological deficits like never before — yet many patients are still getting subpar care. Foundational knowledge of surgical spine care isn’t spreading to the medical community, let alone to patients, whose quality of life hangs in the balance. With The Back Story on Spine Care, orthopedic specialist Dr. Drew Bednar presents case studies that illuminate the common issues plaguing patients — and their treatment — today. Back problems are among the most common health issues, and with Dr. Bednar’s insights, knowledge, and practical tips, medical professionals can provide care that leads to healthier backs and happier lives.
Quality reporting is a rapidly growing area. Each year, new regulations in the US from the Council of Medicare and Medicaid Services make quality reporting a larger factor in determining reimbursement practices. Quality metrics are common parts of European clinical practice. Value of care is a focus of all payers, with specific interest directed at assessing the quality of care provided by a given healthcare team. While there are many publications in this space, no text has sought to provide an overview of quality in spine care. Quality measurement and quality reporting are ever growing aspects of the healthcare environment. Quality assessment is valuable to all healthcare stakeholders: patients, physicians, facilities, and payers. Patients are drawn to facilities that provide high value care; public reporting systems and grading systems for hospitals offer one opinion with regard to “high quality care.” Most physicians email inboxes are inundated with offers of recognition for being a “Top Doc” for a nominal fee. Some payers offer incentives to patients who chose to be treated at “Centers of Excellence” or similar facilities; the definition of “Excellence” may be unclear. There is little consensus on how to measure quality, how to incorporate patient and procedure factors and achieve accurate risk adjustment, and how to define value of care. Regardless of these challenges, regulatory efforts in the US, as well as numerous international efforts, make quality assessment and quality reporting an important part of physician behaviour. Physician and facility reimbursement for procedures are often tied to quality metrics. Spine procedures are costly, elective, and are a focus of many payer-based programs. Hence, spine care is often a focus of quality reporting efforts. This text summarizes the state of the art with regard to quality measurement, reporting, and value assessment in spine care. We will review quality reporting in the US and internationally. Chapters will outline how quality improvement efforts have achieved success in hospital systems. The reader will be provided with insights in how to achieve success incorporating quality metrics into spine care. Features: 1. Illustrates the state of the art in spine quality reporting: There is no text that thoroughly addresses quality assessment and quality reporting in spine care; there are, however, numerous articles in this space. This book provides a definitive text covering the state of the art for quality reporting in spine care and will be of value to the international orthopedic and neurosurgical spine community. 2. Provides insight on quality reporting in different healthcare systems: The text will allow for comparison of different quality reporting systems from different health care systems. This will provide practitioners with insight into the strengths and weaknesses of different approaches to quality reporting, and may drive improvement in quality assessment and reporting systems. A single text that features review of US, European, and Australia/Asian health care systems’ quality reporting is novel and will be thought provoking for readers. 3. Describes the US and international Healthcare reimbursement systems: Practicing physicians are provided with little information and less insight into the vagaries of the US and other healthcare systems. The text will provide insight into code development, valuation, and how quality reporting affects physician reimbursement 4. Explains risk adjustment: Appropriate risk adjustment and assessing patient and procedure factors that may impact quality reporting are invaluable to accurate quality measurement. The text will review risk adjustment, different approaches to risk assessment/mitigation, and provide physicians with insights into appropriate measures to capture in their clinical practices 5. Provides a foundation for improved quality assessment in spine care: While there are many disparate elements and differing approaches to capturing spine quality metrics, no definitive text has attempted to summarize these efforts in a single volume. By synthesizing these variable approaches, the reader may be provided with insights into superior approaches to quality assessment and a foundation will be provided for improving healthcare systems.
This book is a comprehensive guide to defining the value of spine care. Beginning with an introduction and definition of common terminology, the following chapters evaluate the processes and outcomes of spinal surgery. Written by recognised, US-based experts in the field, this practical manual provides spine care specialists with an in depth understanding of the key concepts, measurement tools and methods for value-based spine care.
Beginning with a review of current trends in health care delivery leading to more value-based platforms, this unique and up-to-date book then focuses on how modern spine care is being shaped by the aging population, scientific and technological advancements, and the economic impact of various treatment modalities, providing insight into the seminal efforts surrounding sustainable spine care guideline development. The over-utilization of spine fusion surgery and adult spinal deformity are presented as examples that have led to a decline in the value of care delivered, as well as how a multidisciplinary evaluation by the range of clinicians involved in spine surgery can revise recommendations for management. The benefits and risks of LEAN methodology for streamlining and standardizing spine care approaches are discussed, and the specific approach of the Seattle Spine Team is presented as an example of successful system-wide improvement. Similar changes to outcome measurement, specifically for adult spinal deformity, are described. Last, the future of technology in spine care is presented, including robotics, nanotechnology, 3D printing, and the use of biologics and biomaterials. Given the broad scope of topics covered in this book, the intended audience includes not only orthopedic and spinal surgeons, neurosurgeons, physiatrists, and medical students, residents and fellows, but also hospital CEOs, CMOs, administrators, health services researchers, and health care policymakers, consultants and strategists.
This book presents multiple aspects of spine care from the perspective of different disciplines. It's organized by sections focused on non-operative care, spine injections and procedures, perioperative care, operative care, pediatric care, and special topics. Each chapter has been written by a clinician whose active practice involves the topic of their chapter. Practical and clinically relevant, this book educates any practitioner who cares for patients with back and neck pain and other spine conditions about implementing a multidisciplinary team to treat the spine.
There has been an exponential increase in the volume and quality of published research relating to spine care over the last several decades. Among thousands of articles, a small fraction has been shown to be truly "game changing," forcing the entire field to pause and take notice. These landmark studies may describe a new procedure or surgical approach, evaluate the relative effects of known treatments or techniques, introduce a new classification system, or provide new insights into natural history or disease prognosis. Such studies form the foundations of spine surgery today.This book will be a useful reference not only to the established spine surgeon, but also to neurosurgery and orthopedic residents, as well as to spine surgery fellows as they continue to fortify their knowledge surrounding spinal disorders. Further, this will no doubt serve as a useful evidence-based resource for trainees studying for professional examinations and perhaps most importantly challenge and inspire clinicians to produce high-quality impactful research.
The acclaimed author of Carved in Sand—a veteran investigative journalist who endured persistent back pain for decades—delivers the definitive book on the subject: an essential examination of all facets of the back pain industry, exploring what works, what doesn't, what may cause harm, and how to get on the road to recovery. In her effort to manage her chronic back pain, investigative reporter Cathryn Jakobson Ramin spent years and a small fortune on a panoply of treatments. But her discomfort only intensified, leaving her feeling frustrated and perplexed. As she searched for better solutions, she exposed a much bigger problem. Costing roughly $100 billion a year, spine medicine—often ineffective and sometimes harmful —exemplified the worst aspects of the U.S. health care system. The result of six years of intensive investigation, Crooked offers a startling look at the poorly identified risks of spine medicine, and provides practical advice and solutions. Ramin interviewed scores of spine surgeons, pain management doctors, physical medicine and rehabilitation physicians, exercise physiologists, physical therapists, chiropractors, specialized bodywork practitioners. She met with many patients whose pain and desperation led them to make life-altering decisions, and with others who triumphed over their limitations. The result is a brilliant and comprehensive book that is not only important but essential to millions of back pain sufferers, and all types of health care professionals. Ramin shatters assumptions about surgery, chiropractic methods, physical therapy, spinal injections and painkillers, and addresses evidence-based rehabilitation options—showing, in detail, how to avoid therapeutic dead ends, while saving money, time, and considerable anguish. With Crooked, she reveals what it takes to outwit the back pain industry and get on the road to recovery.