Category Archives for "Primary Spine Provider"

Apr 19

Putting the patient first: Choosing Wisely

By Kanwal Sood | Cultural Authority , Primary Spine Provider , Spine Care , Value-Based Healthcare

A call to action for the chiropractic profession

Choosing Wisely is a campaign of the American Board of Internal Medicine to educate patients about services that have the potential to be misused and overused, so that patients are comfortable opening dialogue with their providers about the most appropriate course of action to take.

The participation of the chiropractic profession in this program is a major leap forward in demonstrating professional maturity. Chiropractic participation is a definitive statement that chiropractors put the interests of the patients at the forefront of clinical decision-making.

We encourage you to share these links with your colleagues and most importantly, with your patients.

Choosing Wisely for Doctors

Choosing Wisely for Patients

Mar 21

Meeting Dr Don Murphy #4 – why your tertiary chiropractic / physiotherapy training is not enough

By admin | Disruptive Innovation , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

Following on from Part 3, we continue with Dr Murphy at his practice, discussing the inadequacy of tertiary chiropractic & physiotherapy training to function as a Primary Spine Provider.

Keep training, learning, growing as a PSP – sign up at www.spinecloud.org/membership

Meeting Dr Don Murphy #4 – why your tertiary chiropractic / physiotherapy training is not enough

Meeting Dr Don Murphy #4 – why your tertiary chiropractic / physiotherapy training is not enough. Keep training, learning, growing as a PSP – sign up at www.spinecloud.org/membership

Posted by Spine Cloud International on Thursday, March 8, 2018

Mar 19

Meeting Dr Don Murphy #3 – Diagnostic acumen, communication & manual skills – functioning as a Primary Spine Provider

By admin | Disruptive Innovation , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

Following on from Part 2, we continue meeting Dr Don Murphy in #3 – Diagnostic acumen, communication & manual skills – functioning as a Primary Spine Provider. Sign up to take our PSP course online (first month free): http://www.spinecloud.org/membership – Also review the original PSP publication – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154851/

Meeting Dr Don Murphy #3 – The most important skill as a Primary Spine Provider

Meeting Dr Don Murphy #3! Diagnostic acumen, communication & manual skills – functioning as a Primary Spine Provider. Sign up to take our PSP course online (first month free): http://www.spinecloud.org/membership – Also review the original PSP publication – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154851/

Posted by Spine Cloud International on Wednesday, March 7, 2018

Mar 06

Meeting Dr Don Murphy #2 – Physical therapy as part of an integrated spine program

By admin | Clinical Pathways , Cultural Authority , Disruptive Innovation , Low Back Pain , Primary Spine Provider , Spine Care , Spine Pathway , Spine Related Disorders , Value-Based Healthcare , Videos

Following on from part 1 introduction to Dr Don Murphy’s Rhode Island Spine Centre, here is #2 where Dr Murphy takes us through to the larger room used for more extensive exercises and discusses the role of physical therapists in an integrated spine pathway. Sign up to take our PSP course online which covers these topics fully:

Meeting Dr Don Murphy #2 – Physical therapy as part of an integrated spine program

Following on from yesterday's intro video to Dr Don Murphy's Rhode Island Spine Centre, here is #2 where Dr Murphy takes us through to the larger room used for more extensive exercises and discusses the role of physical therapists in an integrated spine pathway. Sign up to take our PSP course online which covers these topics fully: https://www.spinecloud.org/courses/Some key questions that are answered here:What hi-tech equipment is used in the facility?What is the most important aspect (i.e.” the one thing”) of any PSP & pathway facility & services?Is there any animosity between Chiros and Physios in the program?How do they work together in this program? What is the baseline authority?

Posted by Spine Cloud International on Tuesday, March 6, 2018

Some key questions that are answered here:

  • What hi-tech equipment is used in the facility?
  • What is the most important aspect (i.e.” the one thing”) of any PSP & pathway facility & services?
  • Is there any animosity between Chiros and Physios in the program?
  • How do they work together in this program? What is the baseline authority?
Mar 05

Meeting Dr Don Murphy #1 – A private practice as part of an integrated spine program

By admin | Clinical Pathways , Cultural Authority , Disruptive Innovation , Low Back Pain , Primary Spine Provider , Spine Care , Spine Pathway , Spine Related Disorders , Value-Based Healthcare

In January, I met with Dr Don Murphy at his practice (Rhode Island Spine Centre) in Rhode Island.  His practice began as a chiropractic practice, grew in size and reputation, and at Care New England‘s invitation,  was embedded into a fully integrated, interdisciplinary spine care pathway/program, with Dr Murphy as Director of the Program.  He took me on a tour of his facilities, and I asked him a bunch of questions – see video below.  We expect to have Dr Murphy on upcoming webinars and mentorship sessions. Sign up for exclusive access!  Dr David Peyton, DC, South Africa.

Meeting Dr Don Murphy #1 – A private practice as part of an integrated spine program

In January, I met with Dr Don Murphy at his practice (Rhode Island Spine Centre) in Rhode Island. Rhode Island Spine Centre began as a chiropractic practice, grew in size and reputation, and at Care New England's invitation, was embedded into a fully integrated, interdisciplinary spine care pathway/program, with Dr Murphy as Director of the Program. He took me on a tour of his facilities, and I asked him a bunch of questions – see video below. We expect to have Dr Murphy on upcoming webinars and mentorship sessions. Sign up for exclusive access! https://www.spinecloud.org/membership –Dr David Peyton, DC, South Africa.

Posted by Spine Cloud International on Monday, March 5, 2018

  • What are the fundamentals of this approach?
  • Why have an integrated pathway- i.e. what is it that patients really want?
  • How does the patient flow work at this facility?
  • Who manages the patients?
  • What modalities does the primary spine practitioner use?
  • How much space is needed?

 

Feb 14

The Strategy That Will Fix Healthcare: Part III- The Model

By Kanwal Sood | Clinical Pathways , Disruptive Innovation , Primary Spine Provider , Spine Pathway , Value-Based Healthcare

Our review of Porter & Lee’s publication continues. This week we outline the model that defines the ‘value agenda’- the model that will transform healthcare. It’s six distinct, mutually reinforcing components are briefly described below:

1) Organise into integrated practice units (IPUs). In an IPU, a dedicated team made up of both clinical & non-clinical personnel provides the full care cycle for a patient’s condition. IPU’s treat not only a disease but also the related conditions, complications and circumstances that commonly occur along with it e.g. kidney disorders for diabetics. They also assume responsibility for engaging patients and their families in care e.g. by providing education and counselling, encouraging adherence to treatment & prevention protocols, and supporting needed behavioural changes  such as smoking cessation or weight loss

2) Measure outcomes and costs for every patient. Wherever we see systematic measurement of results in health care – no matter what the country – we see the results improve. The key is to measure outcomes that matter to patients i.e. key functional measures/functional status. Outcomes should cover the full cycle of care for the condition and track the patient’s health status after care is completed.

3) Move to bundled payments for care cycles. These cover the full cycle care for acute medical conditions, the overall care for chronic conditions for a defined period (usually a year), or primary and preventative care for a defined patient population (e.g. healthy kids). Well designed bundled payments directly encourage teamwork & high-value care.

4) Integrate care delivery systems. This eliminates the fragmentation & duplication of care and  optimizes the type of care delivered in each location. To achieve this, organizations must grapple with four related sets of choices: defining the scope of services, concentrating volume in fewer locations, choosing the right location for each service line, and integrating care for patients across locations.

5) Expand geographic reach– this takes two principle forms. The first is a hub-and spoke model- for each IPU, satellite facilities are established and staffed partly by clinicians & other personnel employed by the parent organization. The second model is clinical affiliation, in which an IPU partners with community providers or other local organizations, using their facilities rather than adding capacity.

6) Build an enabling IT platform– this powerfully enables the preceding five components. The right kind of system can help the parts of an IPU work with one another, enable measurement and new reimbursement approaches, and tie the parts of a well-structured delivery system together.

Implementing the value agenda is not a one-shot effort; it is an open-ended commitment that requires strong leadership. For most providers, creating IPUs and measuring outcomes and costs should take the lead. Superior IPUs will be sought out as partners of choice, enabling them to expand across their local regions and beyond.

Feb 05

The Strategy That Will Fix Healthcare: Part II- The Goal

By Kanwal Sood | Disruptive Innovation , Primary Spine Provider , Spine Care , Value-Based Healthcare

We continue our review of Porter & Lee’s ‘The Strategy that will fix Healthcare’.

As discussed last week in Part I, in the existing approach, patients most often receive portions of their care from a variety of types of clinicians, usually in several different locations, who function more like a spontaneously assembled “pickup team” than an integrated unit. They might undergo special testing e.g. radiology at any point- even before seeing a physician. Essentially, no one:

– measures patient outcomes
– measures how long the process takes
– measures how much the care costs

Thus, the VALUE of care never improves.

This problem has been reinforced by payment structures- however, all this is now changing. With massive pressure to contain costs, payors are aggressively reducing reimbursements and finally moving away from fee-for service and toward performance-based reimbursement. We are entering a period during which providers will work under multiple payment models with varying risk exposure. The days of charging higher fees for routine services in high-cost settings (e.g. hospitals) are quickly coming to an end.

In this environment, providers need a strategy that transcends traditional cost reduction and responds to new payment models. Providers that improve the efficiency of providing excellent care will:
– grow their market share
– be more competitive
– enter any contracting discussion from a position of strength

Let’s move away from a supply-driven health care system organized around what physicians do and towards a patient-centered system organized around what patients need. Let’s shift the focus from the volume & profitability of services provided- physician visits, hospitalizations, procedures and tests- to the patient outcomes achieved. And let’s replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health delivery organizations and in the right locations to deliver high-value care

So, let us all agree on the overarching core goal of Value for health care systems – improving outcomes that matter to patients relative to the cost of achieving those outcomes- so that we can begin to make progress. How does that sound?

This ‘value agenda’ will require a restructuring of how health care delivery is organised, measured and reimbursed. The revolution is well under way- organisations such as the Cleveland clinic and Germany’s Schὅn Klinik have undertaken large-scale changes involving multiple components of the value agenda- leading to striking improvements in outcomes & efficiency, as well as growth in market share.

In Part III next week we’ll analyse the model for change that defines this ‘value agenda’, with its six interdependent components. The model for transformation of healthcare delivery.

Jan 29

The Strategy That Will Fix Healthcare: Part I- The Problem

By Kanwal Sood | Clinical Pathways , Disruptive Innovation , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

This is the first article in our Harvard Business Review series. Over the next few weeks we’ll review Professor Michael Porter and Dr Thomas Lee’s publication from October 2013, ‘The Strategy that will fix healthcare- Providers must lead the way in making value the overarching goal’. The discussion relates to all health systems & delivery organisations- private practices, medical centres, physician organisations, hospitals and insurer groups.

The Problem

Healthcare systems worldwide are battling with rising costs and unsatisfactory quality. Why is this? Well, for several decades the current structure of healthcare delivery has been sustained by resting on its own set of mutually reinforcing elements:

The absence of accurate cost information: Do clinicians have any knowledge of what each component of care costs? Or any idea of how costs relate to the outcomes achieved? In most health organisations there is virtually no accurate information on the cost of the full cycle of care for a patient with a particular medical condition. Also, cost allocations are often based on charges, not actual costs.

The way clinicians are organised to deliver care: Largely siloed organization by specialty department and discrete service or independent private practice physicians. Delivery systems with duplicative service lines,  as well as minimal integration of providers & service lines.

“Quality” measurement/metrics: Most often, these don’t gauge actual quality. Rather, they are process measures that capture compliance with practice guidelines and easy-to-measure, non-controversial clinical indicators (e.g. mortality, safety) that fall well short of actual outcomes.

Fee-for-service payments by specialty: Providers are generally rewarded for increasing volume, but that does not necessarily increase value! The focus is supply driven and centered around physician visits, hospitalizations, procedures and tests.

Fragmentation of patient populations: Every provider offers a full range of services; thus, most providers don’t see enough patients with a given medical condition

Limited Geographic reach: Health care delivery remains heavily local

IT systems: Siloed by department, location, type of service, and type of data (e.g. images). Existing IT systems often complicate rather than support integrated, multidisciplinary care.

This of course means that patients most often receive portions of their care from a variety of types of clinicians, usually in several different locations. Each encounter is separate from the others, and no one coordinates the care. Naturally, this leads to duplication of efforts, delays, and more expensive care.

As this goes on, providers will face lower incomes, patients will incur higher costs, and services will be restricted. In Part II of this article next week we’ll discuss the approach that’s needed in order for us to turn this around.

Jan 28

The Choosing Wisely® Campaign- NCLC 2018

By Kanwal Sood | Clinical Pathways , Cultural Authority , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

The Choosing Wisely® campaign was developed by the American Board of Internal Medicine Foundation to facilitate informed and collaborative discussions between doctors and patients about the necessity, efficacy and risks and benefits of common tests and procedures. The Choosing Wisely initiative looks to doctors and the societies representing them to underpin these efforts by identifying a “Top Five” list of evidence-based recommendations that draw attention to potentially unnecessary tests or therapies. ACA‘s Choosing Wisely list was developed after several months of careful consideration and thorough review, using the most current evidence about management and treatment options.

The National Chiropractic Leadership Conference presents Am I Choosing Wisely? How to Implement Choosing Wisely in Your Practice on Saturday, March 3. Join us as we discuss the background of Choosing Wisely and the development of the ACA Choosing Wisely statements. Additionally, attendees will hear how the panelists are implementing the recommendations into their practices.

Register here

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