Spine Centers of Excellence

Spine Centers of Excellence (COE) program launches in East Michigan
Priority Health is pleased to announce the physiatrist-led Spine Centers of Excellence (COE) program will be statewide in 2009. Starting May 1, 2009, the Spine COE program will expand to East Michigan. All other Priority Health regions have been in the program since November 2007.

Through these centers, patients will work with physical medicine and rehabilitation providers (physiatrists) to determine whether surgery is the best option. Physiatrists have advanced training in the management of musculoskeletal conditions, including disorders of the spine. They can provide not only diagnostic services but also develop treatment plans for the non-surgical management of back and neck pain.

Why has Priority Health established Spine COE?

• 90% of acute low-back pain resolves with conservative care, including physical medicine management.
• Physiatrist-led clinics have been shown to significantly reduce the need for surgery.
  
  

What does this mean to East Region providers?
Effective May 1, 2009,* all referrals for back and neck pain to orthopedic surgeons and neurosurgeons need prior authorization. Patients who have suspected trauma, infection, tumor, or evidence of bowel or bladder incontinence or retention or myelopathy will be approved for surgical evaluation. Patients who require emergency department follow-up also will be approved. All other patients will be required to be evaluated in a Spine COE. This won’t affect services by other specialists, such as pain specialists, or referrals for non-spine-related orthopedic or neurosurgical problems.

We have sent information to PCPs regarding this program. Information is also available online through the Provider Center.

*This effective date applies to the East Region. All other regions should continue to follow the Spine COE policy that has been in place since November 2007.

Spine Centers of Excellence program shows much success in first year*
*The Spine COE program launched in West and North Michigan only. East Michigan will be launching the program in May 2009.

Priority Health is committed to improving the health of the population, improving the patient experience, and reducing the per capita cost of health care. As part of this commitment, we launched the Spine Centers of Excellence (COE) program in November 2007.

The purpose of the program is to direct patients without clear surgical indications to physiatrists in a Spine COE. At these centers, members are provided with both surgical and non-surgical treatment options for their condition. Subsequent to this consultation, patients and referring physicians may continue treatment with the physiatrist or seek a surgical opinion.

In the first year of the program, there have been substantial changes in consultations rates for spine-related problems, imaging and surgery.

	Nov. '05 - Oct. '07	Nov. '07 - oct. '08	% change
Initial physiatrist visits (per 1,000)	16.9	26.6	+58%
Initial spine surgeon visits (per 1,000)	26.8	16.8	-37%
Spine CT or MRI (images per 1,000)	84.3	78.4	-7%
Spine surgery (per 1,000)	6.4	4.7	-26%

Visits to orthopedic surgeons and neurosurgeons continue to require prior authorization. Approximately 80% of visits are approved. The most common reasons that we’ve redirected requests for surgical evaluations to a spine center are:

• Patients who have a radiculopathy with a positive finding on an MRI. These are redirected because no surgical red flags – including tumor, trauma, infection, or progressive myelopathy – have been identified.
• Patients with recurrent back pain and a prior history of spine surgery. These are redirected because there are red flags.

The patient experience is a critical component to the spine centers program. To assess that experience, we completed a telephonic survey of patients seen in a center between July and November 2008. We called 740 patients and had a 48% response rate. The results included:

• Seen in a spine center within 10 days of call – 83%
• MD reviewed treatment options – 87%
• Educational information provided – 75%
• Watched a shared decision making video – 22%
• Satisfied or very satisfied with physiatrist – 74%
• Prior history of spine surgery – 19%
• Saw surgeon after a physiatry consultation – 34%
• Had surgery after a physiatry consultation – 27%

A prior history of surgery affected several responses. Patients with a prior history of surgery were not only less likely to be satisfied with the physiatrist consultation, they were 3-times more likely to see a surgeon subsequently. Furthermore, they were ten times more likely to have surgery. These findings have been incorporated into our program’s outreach to members.

The SCOE program is a clear win – for members, for providers and for the entire health care system. Thank you to all who have helped to make this program a success.