The Spine Center

One of the more exciting recent developments in healthcare is the formation of Healthcare Service Lines.   The Service Line concept creates a multidisciplinary one-stop-shop.  One good example is breast care centers.  Breast care centers place internal medicine, surgery, radiology, oncology, social work and physical therapy in one convenient location.   The patient has all of her breast care provided by a co-located team of professionals. 

The Spine Center is a naturally good fit for chiropractors seeking to join an integrated service line.  These centers combine various spine related specialties.  The specialties may include neurosurgery, orthopedics, PMR, pain, chiropractic, psychology or psychiatry, physical therapy and patient education specialists.

In a spine center, the whole is greater than the sum of its parts.  The advantage of forming a multi-specialty clinic is not just having a bigger “box of tools,” but is the wise use of each “tool.”   Subsequently the hallmark of a great center is its patient management.  A well-managed specialty center will make sure that patients are referred to the appropriate provider(s) early, and that conservative methods are exhausted before the patient is seen by an interventional specialist such as a surgeon.   Selecting the proper case managers is key in having a successful spine center.   Physician assistants and nurses are commonly used as case managers, but chiropractors are extremely well suited to be case managers.    

Two models are commonly used to manage patients in spine centers.  In one model patients are screened by a case manager when they enter the clinic.  The case manager then directs the patient to the most appropriate provider, usually conservative care such as chiropractic. In the second model of case management the patient enters the clinic through any of the clinic’s direct access providers.  That provider may initiate care or refer to one of the other specialties.  The portal of entry provider may orchestrate future care of the patient or defer this task to a case manager.  In either case, decisions should be based upon an evidence-based algorithm of care.

For complex cases a focus-group approach is used.  Gathering together as a group at a round table (or more commonly, informally in the hallway) physicians will discuss more difficult cases and plan more complex and integrated treatment programs.   At our hospital we can use our secure internet for group discussions.  We use digital MRI, CT and X-rays so our emails can include the patient’s radiographic imagery. The patient benefits from the combined efforts of several specialists.

Complex cases may require synchronized use of different specialties.  Our patients may be under the active care of a surgeon, chiropractor, physical therapist and behavioral health specialist simultaneously.

Chiropractors should be included in every progressive spine center, however if you are not able to join a spine center, you can create a virtual spine center by establishing alliances with other specialties.  You would be a portal of entry and the primary center for conservative care and would refer to interventionalists for evaluation, consultation or treatment when appropriate. 

Creating a spine center can be a win-win relationship for everyone involved: the patients win because they enter into a multidisciplinary clinic that should have the best treatment for them; the providers win because they will have an ample amount of appropriate patients.  Chiropractors can treat with chiropractic and not have to dabble in someone else’s specialty; other professions in the clinic likewise will practice within their specialty and not dabble in chiropractic.  Moreover, a well-run spine center will reduce the number of unnecessary surgeries, prescriptions, and redundant services.