Reimagining Spine Surgery: A Q&A With Jacob P. Schwarz, MD, on the MySpineHealth Bundle

A new Vanderbilt Health program—MySpineHealth—is reimagining spine surgery and making the process much smoother for patients who qualify. The program "bundles" all of the services needed for a successful procedure and recovery. This coordination helps ensure appropriate care and can lead to a faster return to life and work. A patient’s experience is streamlined with the high-touch service of a personal patient navigator who helps manage care at every step of the process. Employers benefit, too, because healthcare costs are transparent, predictable and more affordable.

“Patients in the MySpineHealth bundle have access to a comprehensive spine team that is 100% dedicated to finding the best intervention for each individual patient,” says Jacob P. Schwarz, MD, Assistant Professor, VUMC’s Department of Neurological Surgery. “If surgery is the best option for the patient, the bundle covers the three most typical surgical inventions that they face—cervical fusion, lumbar fusion and lumbar laminectomy.”

Dr. Schwarz discussed other features of the new and improved spine surgery experience in the following Q&A.

Many can identify with the problem of back pain. How do these surgeries change the lives of patients who have exhausted all other treatments?

It can be quite dramatic. Not every person who has back pain is a candidate for surgery, but among those who are, published studies have shown that the outcomes in terms of their quality of life and standard of living can be substantial. These are patients who are typically having trouble with the activities of daily living before they have an operation. After certain procedures, they are very often able to return to work. Our patient outcome scores show return-to-work rates are greater than 90%.

What are the goals of the MySpineHealth surgical evaluation?

The primary goal is to ensure the patient sees the right provider and gets the greatest improvements in their pain during their first few visits. If the patient is approved for surgery, we want to give them an idea of what that spine bundle experience is going to look like.

Another goal is to be able to provide employers or insurers—whoever is paying for those patients’ care—a more consistent expectation of what the costs will be. Experiences that are variable, or ones in which patients get extra tests or procedures that they don't need, mean the patient and insurer are wasting time and financial resources. We want to refine that process to provide care in as financially efficient manner as possible.

What can a patient expect once approved for the MySpineHealth bundle?

Once a patient identifies as a candidate for the bundle, they will receive a designated phone number to call their patient navigator. The navigator will coordinate the patient’s care and can help schedule appointments if needed. The patient navigator serves as a primary point of contact for patients. If they have questions about the bundle, billing, Vanderbilt's clinics or facilities, the patient navigator is standing by and ready to help. This cuts a lot of common frustrations out of the process for patients. 

How does the bundle streamline the spine care experience for patients?

It compresses the care pathway and filters out unnecessary visits. In a typical—and inefficient—scenario, a patient may visit a healthcare provider who then orders an imaging study. That patient returns to find out that that the provider wasn’t the one they needed to see after all. That patient is forced to go on a third visit before they see a provider who can give them the appropriate guidance. That same process might be repeated when it comes to the patient being sent to physical therapy or getting insurance approval for an imaging study. All the unnecessary visits can extend the process by weeks.

Our hope for patients participating in this bundle is to build in efficiencies. That includes eliminating some of the issues regarding insurance approval or making sure patients get to the right place with the right information from the very beginning with help from their patient navigator.

What kind of education is provided to patients along their journey?

Again, that’s the power of the patient navigator: They can provide guidance and education every step of the way. In addition, we have educational classes and clinic providers who explain the procedure in detail. Before any procedure, patients get answers to all their questions, such as, “Where do I go for surgery? What time do I show up? What do I do afterwards? What can I expect regarding at-home wound care?” A plan for post-surgery recovery is explained and put in place ahead of time.

There's evidence that having such a care pathway and setting appropriate expectations are very effective in preventing post-operative complications or hospital readmissions—preventions that save money and are attractive to potential payers.

How does the spine bundle lower costs for employers whose benefits dollars may be even more stretched this year and next?

There are financial savings inherent in the efficiency of making sure that every visit counts. So unlike other experiences, when a patient comes to Vanderbilt, they immediately have access to our physiatrist, interventional pain providers, nurse practitioners and surgeons, all of whom can help a patient across the entire spectrum of potential spine treatments. In a different scenario, a patient might be referred to a surgeon only to be told that they don't need surgery and then are referred outside that particular surgeon's office. That process can be very cumbersome. Because we can provide a whole host of treatments, there's less of a likelihood that a patient is told that it’s surgery or nothing—a scenario that may lead to operations that could have been avoided. A comprehensive team like ours allows us to try a whole host of treatments. If an intervention other than surgery provides the definitive treatment for these patients, that could lead to savings.

If you have a dedicated team and a focused set of surgeons, then they tend to do more of the same procedures over and over again. That’s the case with our team. There's evidence that our strategy yields operator efficiency, better outcomes and, ultimately, greater cost savings. We continuously scrutinize the way we use our resources to ensure that we remain as effective as possible.

To learn more about the features of Vanderbilt Health’s innovative MySpineHealth and how the experience can help your workforce, click here.