24 evolving approaches to patient care

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Patients are changing how they approach their care, and providers are doing the same.

These 24 industry leaders explain how they're adapting their approach to patient care. The executives featured in this article are all speaking at Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference which is set for June 19-22 at the Swissotel in Chicago. 

If you would like to join either event as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.

Question: How is your approach to patient care evolving?

Christopher Baggott. Neurosurgeon at SSM Health Dean Medical Group: Analytics, particularly in spine surgery, define many pathologic states affecting quality of life for patients that heretofore could not be described nor studied consistently, specifically when it comes to spinopelvic harmony. Goals of all spinal fusion operations are enlightened by precise preop and postop analytics optimizing spinal balance, either in large spinal deformity operations or in single level fusions for focal degenerative disease. 

Aman Mahajan, MD. Senior vice president for health innovation at UPMC Enterprises and executive director of UPMC perioperative and surgical services: As a physician, my approach to patient care is evolving in several ways. I am placing greater emphasis on patient-centered care. I strive to understand the patient's perspective and involve them more actively in our shared decision-making process. I aim to have a collaborative relationship with patients and their families. 

I am also leveraging new digital health technologies to improve the patient experience and clinical outcomes. Digital health tools have the ability to enhance access, empower patients and ultimately lead to better results for patients and health systems. Change is constant in healthcare, and I recognize the need to be agile and adaptable to thrive in this evolving landscape and deliver patients the best possible care.

Grant Booher. Neurosurgeon at Longhorn Brain and Spine: As I continue to expand my knowledge and skill set, I find my surgeries becoming less and less invasive. The evolution of ultra-minimally invasive spine surgery, robotics and regional anesthetic blocks have allowed me to move more of my surgical care to an outpatient facility. That being said, I continue to expand my repertoire of non-operative interventions. I utilize more and more pain management interventions, physical therapy and, many times, I incorporate airrosti therapy as well. 

Earl Kilbride, MD. Orthopedic surgeon at Austin Orthopedic Institute: As we finish training, we have a wealth of new knowledge and technologies to complement our base clinical knowledge. We have a hammer and are just looking for a nail. As we mature, that changes. We gain a vast bank of real world clinical experience. We continue to learn new techniques as well. The biggest change, however, is that we can see through our patients' points of view. In many cases, friends, family or even myself have experienced the same conditions I am treating. As a result, I treat patients along those lines. I have found that I am incorporating more alternative measures. In those that will definitely require surgery, I feel more comfortable being definitive in a quicker fashion. In those who may be poor candidates, I am just as definitive but in the nonoperative direction. Even though it seems to be a shrinking cohort, I am still in a single-specialty private practice. As a result, I do not feel many outside pressures to alter our current algorithms. In short, I think patients appreciate an independent, weathered practitioner with a couple of decades of clinical and intellectual experience.

Thomas Hudgins, MD. Section head for physical medicine and rehabilitation outpatient specialty programs at Endeavor Health Neurosciences Institute: During my 30 years of practice, more options have become available to help patients manage their spine conditions. Due to these additional viable avenues, which can incorporate a multidisciplinary approach, there can be more than one path for patients to pursue to achieve a successful outcome when managing musculoskeletal issues. As a result, I have evolved to view my role as an educator for the patient to convey the specifics about each reasonable option available. This allows the patient to play an integral part in determining their treatment plan, making an informed decision that is most desirable for them.

Zeeshan Tayeb, MD. Owner and medical director of Pain Specialists of Cincinnati: Every patient encounter holds a unique opportunity to employ proven and advanced therapies. Evolving treatment plans into a multidisciplinary approach and addressing the underlying, and sometimes hidden, pathology yields better outcomes for long term success in treating the chronic patients. The utilization of screening tools, validated ratings, colleague consults and various testing helps to paint a more detailed picture of what is truly needed for the success of a patient. Evolving as a provider is understanding the depth of the disease through utilization of resources.

Thomas C. Schuler, MD. Spine surgeon and founder of Virginia Spine Institute: Evolving treatment options are improving our patient outcomes. Motion preservation tops that list. Lumbar and cervical arthroplasty preserves motion and realigns the spine while eliminating pain generators. This results in great news and success for our patients. Regenerative medicine techniques, especially using bone marrow aspirate, are the ultimate motion-preserving, non-surgical treatment for select patients. The clinical success in properly selected patients is outstanding. It is exciting to be treating patients with these vastly improved resources compared to when I started practicing in 1992. Miraculous advancements in patient care produce happier and healthier patients.

Robert Tatsumi, MD. President of Oregon Spine Care: In today's fast paced world with the internet at our fingertips via the cell phone, patients want immediate access to information, especially if it relates to their personal health. Patients desire direct communication with their medical providers and our clinic relies more on digital methods, like text and email, rather than traditional means like phones and snail mail. With the use of AI technology, it is possible to utilize digital forms of communication at a reduced labor cost versus traditional forms of communication. 

Ken Rich, MD. President of Raleigh Neurosurgical Clinic: It isn’t. We have always been a patient-first practice. Whatever we need to do to get a good result for the patient is what we have to do. In our practice of 10 neurosurgeons, it’s not unusual at all to see a patient and then have one of our other partners become the primary surgeon because that will get the best result. If we ever evolve beyond best results for the patient, we’re heading down the wrong path.

John DeLucchi. Clinic manager and sport and ortho physical therapist at OrthoCarolina: My approach to patient care has evolved by incorporating cognitive behaviorally informed skills training that I learned from Duke University. I have completed several pain education courses and always seek ways to apply concepts within a comprehensive biopsychosocial model. Integrating cognitive behavioral theory-based strategies into my practice allows me to address not only the physical aspects of rehabilitation, but also the psychosocial factors that impact patients’ pain, well-being and function. By recognizing and addressing negative thought patterns, emotions and behaviors, I can utilize strategies like the activity-recovery cycle, imagery, adaptation, reinforcement, coping, behavioral activation and value-based goal setting to promote recovery. I actively engage patients in setting realistic goals, emphasizing self-management and fostering a collaborative therapeutic alliance. This comprehensive approach can lead to improved patient outcomes and greater satisfaction with their rehabilitation journey.

Yesh Navalgund, MD. Chief medical officer of National Spine & Pain Centers: My approach to patient care has evolved to include discussions about cost as most patients are evolving as healthcare consumers. They are much more savvy with where they spend their money, and we have to match them or fall behind.

James B. Chen, MD. Orthopedic surgeon at DISC Sports & Spine Center: My approach to patient care is evolving to incorporate more virtual tools to more efficiently monitor and prepare my patients for surgery. Utilizing these tools to educate them on the basics of the surgery process, allowing for remote communication and preparing them for surgery gives me time back. Then when meeting with my patients, I can better focus on understanding their goals and concerns as well as review the things that are specific to each patient. 

Jason Koh, MD. Orthopedic surgeon, sports medicine specialist and director at Endeavor Health Orthopaedic & Spine Institute: My approach to patient care is evolving to respond to the way patients’ needs and expectations are changing. We are moving to immediate access to care through walk-in clinics and focusing on high-touch yet efficient connection to the patient using more digital messaging and communication. This has resulted in increased patient satisfaction and volume.

Zoher Ghogawala, MD. Chair of the neurosurgery department at Lahey Clinic: My approach to patient care is increasingly more focused on how to get people back to productivity than ever before. I am focused on surgical strategies that are less invasive in order to get people back to work safely and efficiently. In addition, I am attentive to athletes who wish to resume playing sports. Spinal surgery can be highly effective in getting people back to work and back to sports.

Kimberley Haynes-Henson, MD. Associate professor for anesthesiology, pain management and addiction medicine; associate program director for the pain medicine fellowship; and medical director for the pain management program at University of Nebraska Medical Center: Over time, my approach to pain patients has centered more on behavioral and interventional options as many of the medications traditionally used have significant side effects and limited efficacy. Treatment begins with nonpharmacological treatments such as physical therapy, counseling on smoking cessation, weight loss, sleep and good nutrition. I utilize non-opioid medications but spend less time switching medications prior to recommending interventional options. The efficacy of spinal cord stimulation has risen dramatically, creating exciting options for better pain control for more types of pain.

Shane Nho, MD. Co-director for the sports medicine division and sports medicine fellowship and head for the section of young adult hip surgery at Rush University Medical Center: Patient care is evolving to provide an experience that is personal yet modern. Our practice provides digital engagements throughout the scheduling process to office visits. Our EHR and practice software also allows for easy access through communication as well as SMS and text messages for continuous engagements for patients who are going through surgery. 

Michael D. Burdi, MD. Partner at Community Orthopedic Medical Group: Since my partners and I work in a multi-subspecialty orthopedic practice and with all the other demands put upon us with documentation and insurance hurdles, we are focusing more on one problem with new patient visits. We are also utilizing the subspecialty expertise of our partners when a patient has multiple issues. We are bringing more typically hospital-done procedures to the ASC and bringing some procedures typically done in ASCs, such as epidural steroid injections, to the office setting to maximize efficiency.

Alfonso Garcia, MD. Spine surgeon at Cirugía Endoscópica de Columna: Since the last 10 years, I’ve seen a gradual change in patients’ preparedness. Fortunately for me, they are finding useful information about their condition before they even step foot into my office. With that taken care of, I focus on empowering my patients by enriching the consultation experience with added information that they can use to make improved decisions and, at the same time, tailor my clinical assessment to serve their needs.

Katherine Wagner, MD. Neurosurgeon at Ventura Neurosurgery: The COVID pandemic made me acutely aware of some of the pressures patients and families face. Besides being ill, patients are often confused about their care. Brief bedside visits by multiple doctors sometimes add to this confusion. I am more proactive now and think about how to streamline and simplify my patients' care. Apps like Playback Health and Doximity have been very helpful for this.

Brett Shore, MD. Orthopedic surgeon at DISC Sports & Spine Center: The natural history of all living things is that they either evolve or die out, and the practice of orthopedic surgery is no exception. Perhaps the most important evolution in my approach to patient care has been an appreciation of the importance of the mind-body connection in a patient’s experience of pain and disability. Modern medicine exists in part because of the separation of mind and body that occurred in medicine over 100 years ago; it has allowed us to better understand human physiology and pathology in great detail, and many of our treatments exist because of this split.

This separation, however, is ultimately artificial; the more we learn about the effects of trauma on human physiology (increased risk of heart disease, cancer, autoimmune disease, etc, in people with serious trauma in their history), the more clear it becomes that without addressing the supra-tentorial aspect of pain and disability, we will never be able to help our patients fully heal. For this reason, I take time to listen to and understand my patients’ complaints in order to help them feel heard and cared for. Additionally, I often recommend mental health interventions in conjunction with medical and surgical treatments, knowing that a mentally well patient is more likely to have a good surgical outcome. None of us went into orthopedic surgery to become therapists (we like power tools), but understanding the role of mental health in our patients’ recovery process will help improve surgical outcomes going forward.

Timothy Lubenow, MD. Professor for anesthesia and pain medicine and program director for pain medicine fellowship at Rush University Medical Center: There have been several new advances in minimally invasive procedures to treat spinal pain. Many of these have been brought to market with FDA approval. These new procedures have a randomized, controlled study spanning 12 months to five years to demonstrate effectiveness and safety. Employing these new procedures has meant fewer patients require fluoroscopically injections which generally do not have the same duration of effectiveness. 

Ronjon Paul, MD. Chief emeritus for the spine surgery department at Duly Health and Care: We are becoming more personalized in our approach towards patients. Our communication, education and referrals to other providers is taking on an individualized and customized focus. Surgical planning as well as postoperative care has also taken leaps forward with a more bespoke attitude.

Cheraire Lyons. Vice president for revenue cycle at Alliance Spine and Pain Centers: When it comes to patient care, the shift of the patient being more aligned with the revenue cycle has evolved over the years. Patients are being asked to be a part of their care decisions from the initial consultation. Creating a more patient-centric revenue cycle management strategy allows the patient experiences with RCM to strengthen creating a supportive relationship. The evolution of the patient experience should incorporate RCM from the initial consultation not just the backend experience. 

Brandon Burnsed, MD. Neurosurgeon at Raleigh Neurosurgical Clinic: Within the neurovascular realm, we have adapted our approach to diagnostic patient care, pivoting away from the congestion of the hospital, to an office based lab for cerebral angiography. In the past, our scheduling was at the mercy of the hospital’s availability, but now we have more control in the care of our patients. This additionally offers a lower expense to the patient, improved convenience and greater satisfaction.

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