I meet with different healthcare organizations and groups in the course of my work and it’s no surprise that I see a pretty wide range of environments, given the complexity of our industry. But after meeting two different spine groups a few weeks ago, I was confronted with a pretty dramatic difference.
At a glance, the groups had much in common, including strong reputations and highly skilled and experienced surgeons. In talking to them about care coordination and how Cordata’s spine solutions might help them improve their business and clinical outcomes, their responses could not have been more different.
A Perceived Loss of Control
The first group was highly resistant to the idea that a care coordinator – even one with an RN – could or should do anything more than capture patient information and basic data on symptoms before scheduling a consultation with whichever surgeon received the referral. Collectively, the surgeons seemed to think that any tool or algorithm that pointed patients with appropriate symptoms to physical therapy or a physiatrist was taking away their role in making diagnostic or clinical decisions. In other words, the surgeons more or less insisted on seeing all referred patients. That’s their prerogative, of course. So I realized this was going to be a pretty short meeting, giving their limited interest in care coordination.
But before I left, it came out that their surgical conversion rates were abysmally low – something like 3%. They were seeing more than 30 patients for each surgical procedure.
That is extraordinary and shows just how far down their license many surgeons are operating. Though comprehensive data on surgical conversion rates is hard to come by and they vary by procedure type, experience teaches that 10-20% is close to an average rate for spine surgeons.
Though the surgeons feel a strong and commendable responsibility to their patients and the doctors who refer to them. However, that commitment is a barrier to them operating at the top of their licenses and doing what they do best – which is surgery. It also presents real issues for patients. A huge number have to wait longer for the care they need, whether it’s physical therapy, physiatry or surgery, because they invest time, energy and money going to an unnecessary appointment.
For some patients (those with low-back pain, for instance), delays in treatment can cause their conditions to worsen. In some situations, there may be severe consequences. Consider a farmer with low-back problems who has to drive two or more hours to see a surgeon or specialist in a regional center of excellence (a drive which may worsen his pain). His work may be exacerbating his condition or perhaps he’s not working at all. Seeing a surgeon may be the right answer, but basic filtering of his case may indicate that injections or physical therapy is a better place to start. Think of all the wasted time and lost productivity that would be avoided.
The Value of Care Coordination
That brings me to another surgeon group, one I visited a few days later. Its surgical conversion rates were close to 10x higher. Again, there was not much to distinguish the groups, except the latter believed in intake coordination as an effective means to filter patients at the first point of contact. They were quite comfortable with care coordinators, who have been carefully trained and have tools to help them direct patients to the best first step on what is likely to be a multi-step care path.
Further, the surgeons had full confidence that their referrals would be protected – that is, patients originally referred to them would not go elsewhere if future surgery was necessary. And that they would be kept in the loop as the patient progressed along their care paths. This last point is especially important for surgeons who might run into referring doctors in social settings or at charitable events. The bottom line is that surgeons recognized that everyone is best served when they see only the right patients. After all, there’s no prize for seeing the most patients.
I’m not suggesting that surgical conversion rates are the ultimate end goal or most important metric for surgeons. But they are significant metric for helping surgeons operate at the top of their license and for helping patients connect with the right providers sooner and more efficiently. Perhaps given their rough experiences with EMRs, some doctors are simply skeptical of any technology. That means the care coordination community must do a better job of helping spine care providers understand the many ways care coordination adds value.
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