Transcription:
The Next Frontier in Spine Care: Northwestern Medicine Expands Non-Surgical Offerings to Improve Patient Outcomes

Melanie Cole (Host):  Welcome. Today, we’re talking about the Spine Health Program at Northwestern Medicine. My guest Dr. Alpesh Patel is a Professor of Orthopedic Surgery and Neurological Surgery at Northwestern Medicine. Dr. Patel, what a pleasure to have you with us today. Please start by telling us a little bit about yourself and your areas of expertise.

Alpesh Patel, MD (Guest):  My background is as an orthopedic surgeon with then subspecialty training in spine surgery. So, I’ve been in practice now for about 13 years, the last seven of which have been here at Northwestern Medicine. And my practice and my partner’s practice really focus in around all spine conditions. So, oftentimes, we think of these as painful conditions in the neck or painful conditions in the lower back. And that’s been the focus of our practice to date. And the Spine Health Program which we’ll talk more about here is sort or our opportunity or our new frontier if you will in how we expand the care that we are providing to patients at Northwestern.

Host:  Well thank you for that. So, in your experience, Dr. Patel, explain the deficits in patients understanding of what spine health means. What does that mean to patients and does it mean something different to providers?

Dr. Patel:  Sure, absolutely. I think one of the problems that we face for patients and for providers in terms of I wont call it so much deficit as I would call it a setting of confusion. I think when it comes to back conditions and neck conditions; there is just a lot of uncertainty and a lot of confusion around what’s actually going on. What’s causing pain and what are the appropriate treatments for those conditions? And I think a lot of that has to do with the fact that A. back pain and neck pain are really common. I mean we’re talking about conditions that affect upwards of 90% of the US population at some point in their life. B. Everybody seems to have an opinion on a back problem because they’ve had somebody in their family or somebody, they work with that’s had a back issue and C. Unfortunately, there is a lot of terminology that gets thrown around and gets confusing unnecessarily. You’ll hear about things like disc bulges or disc herniations, defecated discs. We’ll hear about pinched nerves. And unfortunately, these are terms that we’ve used over time to explain things to lay or a general population, but they’ve only added to the confusion. They haven’t really provided any degree of clarity for patients or family or for referring providers.

Host:  Well I couldn’t agree with you more. As an exercise physiologist, I’ve heard that myself and many different definitions and everyone has advice on back and neck issues. So, based on that, how is this current state of affairs affecting the way patients seek and receive care for back and neck spine conditions and why do you see that this might be a problem?

Dr. Patel:  So, as you would imagine with so many people having these conditions and so many people having different opinions what we end up seeing not surprisingly, is a lot of inconsistency in the care that people seek. People seek out a variety of treatments. They will seek out exercise options. They will look for chiropractic care. They will look for acupuncture care. They will look for medications. They will look for injections. They even may come to surgeons and so right now, sort of in our current state or our historical state is that patients or providers seem to find their way through an otherwise fairly complex system, it seems either based on historical preferences, on historical patterns or based on sort of whoever is the most convenient, right. What’s the easiest pathway for a patient with lower back or neck problems to get someone to see them? And unfortunately, what that creates is it creates a lot of problems that we see. It creates patients sometimes waiting a long time obviously to see physicians with painful conditions. It means that patients will sometimes end up at the wrong type of specialist so you may end up with a patient who really needs maybe some exercise, some physical therapy, some very straightforward medications and they’ll end up in my practice which is a complex spinal surgical practice.

And so there ends up being a big mismatch in terms of what the patient needs and then what we as subspecialists provide. And not surprisingly, beyond just that one to one confusion it creates for patients and inconveniences; when you start to look at spine health care provided to large numbers of patients; not surprisingly, it tends to drive a lot of unnecessary care, it tends to drive a lot of extra costs of care without necessarily really improving the quality or the outcomes that we are providing patients.

So, I think there’s a lot of our current state of confusion around spine conditions if you will, confusion or lack of clarity around the optimal or the best way to manage patients that then leads to a lot of problems at the individual patient level but then even amongst larger populations of people.

Host:  That’s so interesting. I found in my practice, Dr. Patel, that it seems like we are all coming together, chiropractors and as you mentioned physical therapists and trainers and orthopods and neuro surgeons and people are now recommending so many of the same treatment courses with the exception of the surgical options. Do you feel that this is a good thing? Do you see this as more confusing for both other providers and for patients?

Dr. Patel:  Yeah, I think you bring up a really good point, a really in-depth point which is as there’s been some increased agreement if you will, around what appropriate conservative care, exercise care or nonsurgical care is; it becomes a little bit confusing for patients to understand well then who do I turn to, right? If it’s not a specialty level care; do I go straight to my physical therapist, do I go straight to my primary doctor, do I go to a rehabilitation specialist, a physiatrist so there tends to be again, as we’ve moved into some commonalities, some confusion around exactly well who is it that I need to start my care with. And so, I think in the grand scheme, I think it’s a good thing that we are getting to the point where there are more and more commonalities in the care that we provide.

I’d argue that we could be even more. There’s a lot more we could do to make that process even more consistent. But on top of that, we need to be able to communicate to patients with more clarity and referring providers with more clarity around again, who is the right person, the right provider to initiate care for a patient. And on the back end, when you talk about surgical options, it’s interesting you mentioned the fact that there are still these historical divisions out there between neurosurgery and orthopedic surgery, both being spine surgeons. We hear from patients; we hear from referring providers all the time that they are not really sure where to turn. When do I send the patient to an orthopedic surgeon? When do I send them to a neuro surgeon? And I think what we’ve done at Northwestern over the last number of years is we’ve done a really phenomenal job of integrating our neurosurgery and orthopedic surgery spine practices essentially into one practice.

Where we function, we act as partners, we review patients together, we take care of patients together. And in doing so, we found that some of that surgical variability that’s out there starts to dissipate and we start to get a lot more consistency in our surgical plans and then in our surgical outcomes. We see a lot fewer complications than we used to see. So, we see a lot of improvements on the surgical side as we come towards again more consistency and more of a working together if you will under one roof.

And I would argue that’s pretty unique to what we have to offer at Northwestern. I’m not aware certainly in the Chicagoland area of any other large academic medical practices that has integrated neurosurgery and orthopedic surgery together in such a fine manner.

Host:  I agree with you and I think it’s really cool because I’ve been hearing about orthopods versus neurosurgeons for years. So, this comprehensive multidisciplinary approach is unique. Why don’t you tell us then a little bit about the Spine Health Program at Northwestern Medicine and how you’re trying to bring together these specialties and trying to solve this problem of confusion.

Dr. Patel:  Absolutely and I think again, it’s a building out if you will, or expansion of what we have been able to really successfully accomplish on the surgical side of things which is to provide patients we hope with a very consistent surgical pathway if you will in their healthcare journey. What we are attempting to do and what we are looking forward to doing with the Spine Health Program is to expand that into the nonsurgical aspects of care, which is again, what most people with lower back and neck conditions need. Thankfully, the majority of people that have these problems will never end up needing surgery. And our goal now is to say well can we bring more clarity, can we bring more consistency, can we give patients a clearer pathway as they journey along through back and neck conditions.

So, with that in mind, what we’re doing is again, coming under one roof, integrating a number of what used to be disparate or very separate medical subspecialties into one working functional unit or functional team. That includes physiatry non-surgical care, it includes pain management, it includes physical therapy. We have a very, very extensive and awesome group of nurse practitioners and physician assistants that we work with as well to be able to sort of scale up care and provide a lot of the care that we need to give our patients. So, really, it’s a very strong multidisciplinary team that spans across surgical disciplines, nonsurgical disciplines. We partner very closely with chiropractors. We partner very closely with integrative medicine. We partner very closely with dieticians. We partner very closely with people for smoking cessation. We really try to look at neck and back problems from as holistic or an approach as we can. Which I think is the exact opposite of how it’s traditionally been done which is to sort of take a problem if you will or a painful condition and dissect it down amongst ten or 15 different specialty providers.

So, we think in the end, that that philosophical approach to taking care of patients is going to definitely give better results both in terms of patient convenience and access but also in terms of their actual care we provide them, the outcomes we get them, and we hope we can even do that at a much more cost effective manner to be able to provide care to that many more people.

Host:  Well it is unique and a very robust comprehensive program. Dr. Patel so how do you see this care model improving the way patients receive their care? Tell us a little bit briefly about your vision for the program and how it’s going to change the way patients receive that care.

Dr. Patel:  Absolutely. So, I think the best way to summarize it in a single sentence if you will, is the idea of what we’re striving for here is to get the right patient to the right provider at the right time with as frictionless of an experience as possible for that patient and for the referring provider. And that really comes down to the concepts we’ve laid out which is identifying patients and what they need on the front end and then matching that need to the actual provider that they are treating with. And then that way, we can hopefully take a lot of the confusion as we’ve talked about. Do I go to a chiropractor, do I go to a neurosurgeon, do I go to a neurologist or orthopedic surgeon. We want to take that confusion, that decision making process if you will and provide a lot of clarity around it.

And not just clarity meaning our opinions but actually the data that we have in real time showing good outcomes, good healthcare outcomes for our patients to use that data to drive that decision making process again for our patients and for our referring providers so that what we want is an experience where somebody calls or is referred in with a condition, let’s say it’s back pain and rather than that person or that referring provider trying to navigate the complexities that we’ve laid out in spine care; they know they can go to one location, one site which is our Spine Health Program at Northwestern and know that their patient is going to get excellent care that’s going to be absolutely appropriate for what they need and will get them better. I mean those are our ultimate goals.

Host:  Before we wrap up, are there other programs like yours in the country? Is this model based off of some research or scientific studies? And when you answer that question, feel free to wrap up with your best advice what you’d like to summarize and what you’d like other providers to take away from this segment and when you feel that it’s going to be really important that they refer to the specialists at the Spine Health Program at Northwestern Medicine.

Dr. Patel:  Absolutely. So, in terms of a reference point, there is really nothing else like this in certainly in the Chicago area. There’s a program in Cleveland that has had about seven or eight years of experience with it and we actually are working with them, this is the Cleveland Clinic. We are planning on working with them very closely to try to get best practices, best ideas shared across large really influential academic centers like Cleveland Clinic and like Northwestern. And so, we look at that one program as an opportunity to build iteratively and make Northwestern’s program and hopefully Cleveland’s program even that much better.

Other than those, this is really very cutting edge ideas that we are pushing through here. And I think that it’s a very unique opportunity that we have at Northwestern that we’ve got such great support around us to make a very innovative program like this come to life. So, that’s sort of what our basis is. That’s where we’re going from a planning standpoint.

In terms of a summary statement, or a summary thought for people that might be listening, the referring physicians or referring providers that are listening; is to really understand that like listen we get it. As spine specialists, we understand that spine care is pretty complicated. We understand that it’s confusing. We understand that there’s not a lot of clarity there and then at times it feels like there’s a lot of inconsistency. You can have a patient see different providers and get different opinions. And the opinions don’t seem to match very much at all. You may have one surgeon recommending surgery, you may have another provider say you should never have an operation and we understand that that’s confusing. What we’re trying to accomplish here, what we want to provide is a reliable, safe sort of top of mind reference to where you can turn to if you have a patient who is unfortunately dealing with a painful back or neck condition to where they can turn to. And where we can again, try to make that as frictionless of an experience as we can both for the referring provider but then also for the patient themselves.

Host:  Wow, what an informative segment. Thank you so much Dr. Patel. What a great program that you’ve got going on there. Thank you so much for joining us. That wraps up this episode of Better Edge a Northwestern Medicine Podcast for physicians. To refer your patient or for more information on the latest advances in medicine; head on over to our website at www.nm.org to get connected with one of our providers. If you found this podcast as informative and interesting as I did; please share on your social media, share with other providers, share with your patients. And be sure not to miss all the other fascinating podcasts in the Northwestern Medicine library. Until next time, I’m Melanie Cole.