The Salem Spine Center brings together six independently practicing neurosurgeons to serve patients within a hospital-based comprehensive treatment program. With the Portland market just 60 miles away, Salem’s integrated spine center faced stiff competition. That’s why the center recognized the need to effectively coordinate with referring physicians, patients, spine specialists and surgeons to accelerate treatment for patients needing care for spine, neck and back pain.
Challenge: Improve Collaboration, Reduce Time to Treatment and Embrace a New Model

As with many spine centers, the Salem Spine Center wanted to help patients navigate their many options for spine care and potentially complex treatment paths. Those paths could involve primary care physicians, spine surgeons, physical therapists, pain specialists, imaging centers, physiatrists and chiropractors. Better coordination and collaboration were critical not just to reduce complexity for patients, but also for the business; much of the surgical caseload came from primary care physicians no longer able to manage their patients’ spine-related symptoms.
With a large volume of referrals, some patients had to wait 12-18 weeks for a neurosurgery consultation. In some cases, surgery was not required and patients were referred for other treatment with other specialists or facilities. In fact, less than 20 percent of the patients seen by Salem’s neurosurgeons actually required surgery. So Salem set out to devise a system to reduce the time to treatment, refer patients sooner and decrease unnecessary physician visits.
At the same time, Salem wanted to transition its spine care program to a highly efficient, patient-centered and evidence-based model that would focus on value-based reimbursement rather than volume-based reimbursement. The health system assembled an advisory council of multi-disciplinary providers to develop a set of best practices and standards for spine care. Specifically, the council developed treatment algorithms to standardize patient care, collect data on patient outcomes and respond appropriately to emerging trends.
Solution: Cordata Spine Solution for More Effective Coordination

Salem Health adopted the Cordata Spine solution to establish an effective approach to triage, based on patient and physician communication, coordination referral and patient care management. Using Cordata, Salem physicians and staff can coordinate care right from the first contact – directing patients to the right treatment step with the right provider at the right facility at the right time.
Nurse coordinators at Salem virtually triage each patient prior to a physical appointment utilizing Cordata. They collect patient symptoms and assessments, diagnostic imaging, medical history, and any other relevant information. That data is sent electronically to a specialist for review. Specialists can then make an informed recommendation for immediate surgery, expedited treatment or another consultation. Once such recommendations are made, nurse coordinators can help the patient navigate the next step of the treatment plan. And they communicate the plan to the referring physician, specialist and other facilities or clinicians as required.

“Cordata Spine allows our neurosurgeons to systematically and efficiently screen patients and guide them to the right practitioner. There’s no more waiting 10 to 12 weeks just to hear that they’re not a candidate for surgery,” said Dr. Maurice Collada, Medical Director of Salem Spine Center. “We review the cases and decide if a consultation with a neurosurgeon is necessary In this way, we don’t waste a patient’s time or money.”

Results: Shorter Treatment Times, Better Outcomes Data and Clinical Leadership

With Cordata Spine, the Salem Spine Center is able to triage more than 280 patients a month. Between 2012 to 2013, hospital length of stay decreased and surgical volume increased. In-patient hospital stays declined from 3.55 days to 2.8 days. Patients discharged home after surgery averaged 91.7% compared to less than 75% nationally.

Surgeon focus has been another clear benefit. Instead of the neurosurgeons at Salem Spine Center having 75% of their appointments with non-surgical patients, today 75% of their appointments are with surgical patients. Faster treatment timelines have also helped increased patient satisfaction. Plus, patients are engaged, thanks to regular interactions and timely follow-ups from nurse coordinators.

“Prior to Cordata Spine, patients were getting lost in the system; no one was monitoring them,” said Jane Ray, program manager, Salem Spine Center. “But today, patients are tracked carefully, throughout the duration of their care.”

The Cordata solution also provides detailed reporting metrics, outcomes data and real-time program validation. Salem tracks Oswestry, Neck Disability Index, VAS pain scale, as well as patient satisfaction with the Cordata software and the results allow them to evaluate and alter their treatment strategies.

“We set up the advisory council to develop algorithms that show whether we are following best practice standards,” Dr. Collada said. “Cordata Spine is the platform we use to establish connectivity among ourselves and to launch our efforts to standardize and improve spine treatment in the community.”

The data and reporting metrics have also streamlined the accreditation process. As a result of the reporting metrics and data captured in Cordata Spine, the Salem Spine Center received the official Spine Center of Excellence certification from the Joint Commission in April 2013, making it a model for spine centers nationwide to follow. And the program’s success has positioned Salem as a leader in spine care; many hospitals have shadowed Salem to learn how to implement similar programs in their communities

“It’s not until we went and saw the spine center and how it functions and the components that we knew what to set up at our facility,” Karen Lewis, Pardee.