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practices may need to drop those cases in the future to stay profitable. “We haven’t closed the door on Medicare patients yet because we feel it’s important to care for this population,” says Dr. Crandall. “However, we can’t follow Medicare if rates keep declining. Many of our colleagues have already decided they can’t see Medicare patients.” 5. Hire quality providers to work with your patients. If providing high-quality patient care and promoting a positive patient experience is what differentiates your practice, then you want to attract and maintain “A level” staff and employees, says Dr. Crandall. High quality employees can boost patient satisfaction and promote better treatment outcomes. “We don’t settle for less than ‘A level’ providers because we think as the future evolves there will be more stress on getting patient volume through the door; in that environment, our best asset is our service quality,” says Dr. Crandall. “If we have ‘B level’ or ‘C level’ people working for us, we won’t be able to compete well.” The quality of care begins with the physicians, which is why Sonoran Spine Center only brings on like-minded physicians focused on providing a high level of service. “These are the type of people who enjoy interacting with patients and the private practice environment,” says Dr. Crandall. “Our office manager is also completely in step with the overall patient care ethic we embrace as physicians.” With physicians leading the charge, the culture of excellent patient care becomes pervasive among the practice staff, especially when they are incentivized. At Sonoran Spine Center, employees undergo yearly evaluations and are rewarded with bonuses or raises based on how consistent their performance was with the group’s overall outlook on patient care. 6. Focus on the patient-physician relationship. Healthcare legislation and regulation is constantly changing, which makes it difficult for providers to run their businesses. Despite these challenges, it’s important to maintain a focus on the patient-physician relationship to provide a higher level of care. “I see significant changes regardless of who wins the election in 2012,” says Dr. Crandall. “The healthcare economics of 2012 are going to require changes regardless of your politics. At the end of the day, healthcare delivery will still depend on physicians taking care of patients.” Some providers are forming accountable care organizations for shared savings, but Dr. Crandall doesn’t see his group joining an ACO any time soon. Instead, the group plans to tackle today’s challenges by devising new ways to capture outcomes and patient satisfaction data as well as strengthening relationships with referral sources. “Our biggest referral sources are prior patients, so we want to make sure that doesn’t change,” says Dr. Crandall. “If that continues, we’ll be in a good place for the future. We fully expect competitive pressure from other groups, but having a positive patient care experience can give our group the edge.” The group also takes time to thank referring physicians and is exploring new ways to build a relationship with those colleagues as well. 7. Project leadership through teaching and education. In the professional and local community, it’s important to accept leadership roles. The physicians of Sonoran Spine Center are involved in teaching residents and spine training for the residency program in Phoenix. They also host community outreach educational programs and present research at professional society meetings. “We want to continue to project leadership through teaching programs and the research presentations we give,” says Dr. Crandall. Last year, the surgeons presented 22 different research papers based on their practice data at national and international meetings. Next year, the group is on track to present 30 or more papers, some with an average follow-up period of five years. 8. Initiate research and share results. Many of the physicians at Sonoran Spine Center engage in spine research, education and innovation in addition to their regular practice. The group includes Sonoran Spine Research and Education Foundation, which is an independent, non-profit organization that supports public awareness programs, spinal advocacy groups and research activities. “Since we have the research foundation, our research costs aren’t direct overhead for the practice,” says Dr. Crandall. “They are handled under the foundation overhead. As a result, partners who aren’t active in research don’t feel the pinch on their salaries when they aren’t participating in research efforts to the degree of other partners.” The surgeons gather data from their all patients at Sonoran Spine Center, regardless of their research intentions. This data includes patient outcomes and satisfaction scores. Then, two full-time research coordinators gather and organize data from the practice so the surgeons can easily analyze and present their findings. “For us, the key is that every single patient on every single visit fills out research and outcomes forms,” says Dr. Crandall. “We try not to make them long but still capture the data we need. When I ask my research coordinators to look up data on 15 projects on long term patient outcomes, they can easily pull the information from our database.” n info@physiciancontrol.com Spine 15 Dr. Frank Cammisa: 8 Top Challenges for Spine Surgeons This Year By Laura Miller Frank Cammisa, MD, chief of
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