Spine care, including the management of low back pain (LBP), is one of the major areas of musculoskeletal treatment in our country. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Spine Care Toolkit is a clinical and educational resource that AAPM&R members, payers and healthcare systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value spine care.
This toolkit offers members the tools they need to develop a physiatrist-led spine care APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in spine care across the continuum.
Highlights from the AAPM&R Spine Care Toolkit include:
Description of the Economic Considerations
To effectively improve spine care value, one must consider not only clinical factors but also the economic model in which one is practicing.
- Understand the current models of care and its financial arrangements for alternative payment structures, which include accountable care organizations (ACOs), bundled payments, shared savings arrangements, integrated delivery and finance systems (IDFS) and “one-sided” and “two-sided” risk.
Current Environmental Assessment
To effectively improve spine care value, one must assess the existing healthcare environment before, while, and after building a spine care APM.
- Learn the framework to conduct an internal assessment of strengths and challenges and regional assessment of opportunities and threats to assist one’s program in determining their most appropriate next strategic steps.
This approach enables the model to gather a broad range of information about its current functioning, and allows leadership to consider strategies to mitigate risk, improve market share and address deficits.
Essential Components of an Effective Organizational Team
To effectively improve spine care value, one must build an effective organizational team comprised of both clinical and non-clinical stakeholders.
- Consider the elements of building a team of critical stakeholders, engaging providers in change and providing support to achieve the mission of the APM.
Engaging Senior Leadership in APM Adoption
To effectively improve spine care value, one must prioritize the direct engagement of senior leadership.
- Understand the steps in obtaining buy-in and involvement of senior leadership through studying the institution or system’s mission and core values and creating an elevator pitch to justify the need for an APM.
Key Talking Points
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✔ Physiatry led spine care is a team-based program that has been shown to improve value and decrease cost.
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✔ A high-quality physiatry led program is aligned with future payment initiatives, which will transition from a FFS model to APMs.
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✔ Physiatry-based models may be applicable to a specific condition, a care episode or a population.
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Recommendations for Quality, Clinical, and Financial Outcome Metrics, Data Analysis, and Program Assessment
To effectively improve spine care value, one must consider outcomes data that is relevant to both the patient and the model.
- Identify the different types of outcome measures (structure, process, and outcomes), structures of data (registries), and examples of measures (PROMIS, ODI, Roland Morris Disability Questionnaire, Visual Analog Score for pain, Short Form 36 Health Survey, and Euro-QOL 5D).
Identify Key Clinical Team Members and Their Roles
To effectively improve spine care value, one must create a list of clinical team members whose input is essential to establish and run a spine care APM.
This may include:
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✔ Physiatrist
✔ Nutritionist/Dietician
✔ Surgeon
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✔ Referral sources
✔ Pain Management Provider
✔ Care Manager, Coordinator, Navigator
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✔ Physical Therapist
✔ Pain Psychologist
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Considerations in Care Pathway Development
To effectively improve spine care value, one must consider care pathways as a way to ideally integrate evidence-based medicine and utilize exemplary or best practices to manage patient care, diminish variation, advance quality, and increase efficient use of healthcare resources.
- Distinguish the components of a seamless spine continuum of care, including criteria for entry to, care transition in, and exit from the APM.
Recommendations for Increasing Awareness and Influence of Program
To effectively improve spine care value, one must consider opportunities to increase awareness.
- Learn how to engage and increase awareness of APM at local, regional, and national levels.