Crouse Spine Care Aims to Reduce Surgeries, Opioid Use

Spine clinic is a “one-stop-shop” that gives patients access to chiropractors, pain management specialists, dietitians surgeons and imaging specialists in one visit

By Aaron Gifford

Most of the patients who visited the Spine Care center are given a conservative course of treatment that favors fitness, a healthier diet and regular communication with care team members instead of surgical intervention

Crumb
Crumb

Crouse Spine Care is following a collaborative approach that reduces the number of surgeries, curbs the use of opioids, potentially saves patients thousands of dollars, and conforms to what providers say will soon become the new standard of care across all specialty areas.

The concept of assigning a care team made up of a nurse navigator and various specialists is not brand new, explained Jameson Crumb, a Crouse Spine Care physician assistant, but the hospital is still evaluating the results since the model was put in place at the center in August 2018. Thus far, he added, the patients, providers, health care administrators and insurance companies are giving it a thumbs up.

“Everyone seems to like the idea of a more comprehensive, collaborative approach and a more personalized treatment plan for patients,” Crumb said during a recent interview.

In keeping with this concept, Crouse Spine Care recently entered into a partnership with the YMCA in which physical therapy patients can get a free three-month membership if they purchase personal training sessions there.

“For physical therapy, there is only so much reimbursement from insurance companies,” Crumb said. “This helps them [patients] to continue working toward recovery. So far, from the results we are seeing, it’s working tremendously.”

Most of the patients who visited the Spine Care center are given a conservative course of treatment that favors fitness, a healthier diet and regular communication with care team members instead of surgical intervention, Crumb explained.

As involved and labor intensive as a care team sounds, it’s still significantly cheaper than surgery and hospital stays. In cases where surgery is required, Crumb explained, minimally invasive options performed on an outpatient basis are preferred.

And as far as recovery goes, the pain management doctors assigned to Crouse Spine Care will be unlikely to prescribe opioids and more likely to prescribe anti-inflammatory drugs or other medications that are not addictive narcotics, Crumb said. Medical marijuana may become a more common option in the years to come.

Carl Butch, an internal medicine physician at Crouse, described the approach as a “one-stop shop” that give patients access to chiropractors, pain management specialists, dietitians and, in some cases, surgeons and imaging specialists. In many instances, patients have met with all of the providers on their team in one visit. The patient also has the ability to contact their nurse navigator at any time with questions or concerns.

“The quick response helps keep medications updated and accurate,” Butch said. “With this approach, our no-show [to medical appointments] rates have decreased.”

In addition, Crouse works with a network or providers that offer acupuncture treatment, yoga instruction and massage therapy.

Butch added, in the past year, Crouse has determined that about 90 percent of its Spine Care patients do not require costly MRI exams.

“It’s evidence-based medicine,” he said, “and everyone, including the insurance companies, is in favor of this approach. “This is where medicine is going, or needs to go.”

Butch
Butch

Other departments at Crouse are following the same model of care and additional specialties plan to incorporate it soon, Butch explained. He provided an example in which a patient recently complained to their nurse navigator that they gained three pounds in three days. As part of that patient’s initial care plan, he had been advised to report any drastic changes such as rapid weight gain, and the nurse navigator put him in touch with a cardiologist, who in turn got the patient back on track. The potential problem was not ignored, and a trip to the emergency room that might have otherwise occurred if the condition had a chance to worsen was avoided.

“They were able to get to the [cardiologist’s] office, and there were no barriers to getting medicine or getting medications changed,” Butch said. “There might be more office visits in some cases, but less emergency room visits. The main idea is directing money in a different direction.”

Crumb added, “Your pain doesn’t go away because you can’t get an appointment. There is definitely a need for this approach.”

An underlying theme to this approach is the mutual understanding between provider and patient that a simple problem can spiral out of control if ignored. Lower back pain, for example, can lead to a person becoming inactive and gaining an unhealthy amount of weight. That opens up the potential for heart problems, diabetes and other issues, not to mention psychological complications like depression.

Communication and accessibility to a nurse navigator and the appropriate physicians is key, but this system has not been set up to make money on unnecessary consultations. In fact, insurance companies traditionally did not reimburse providers for consultations if they were part of a care team arrangement. That changed in recent months so there is a code physicians and nurse navigators can bill for such services. The reimbursement amount is fairly low, and there are guidelines in place discouraging providers from initiating unnecessary services.

Spine Care services can and will be expanded using online telemedicine technology, Crouse plans to extend spine care services to patients in the North Country as well as areas east and south of Syracuse. Hospital officials are also planning to expand the hours at the two existing Syracuse area locations on Irving Avenue and Brittonfield Parkway.

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