Latest / Becker’s Healthcare Podcast / Building a More Connected Approach to Spine Care with Maureen Cappola & Caitlin Rivet

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Building a More Connected Approach to Spine Care with Maureen Cappola & Caitlin Rivet · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - at the Hyatt Regency in Chicago,
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  - Register on our events page at beckershospitalreview.com
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  - upper right.
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  - Hi, everyone, and welcome to the Becker Spine
• 1:02
  - and Orthopedic podcast.
• 1:04
  - I am Sophie Ades, assistant
• 1:06
  - editor of Becker Spine Review.
• 1:09
  - And
• 1:10
  - today, we're pleased to be joined by Caitlin
• 1:13
  - Ribbet,
• 1:14
  - director of clinical operations at New England Neurological
• 1:18
  - Associates,
• 1:19
  - and Maureen Coppola,
• 1:22
  - executive director of anesthesia and perioperative medicine
• 1:27
  - medicine at Tufts Medicine. Caitlin
• 1:29
  - and Maureen are part of an effort to
• 1:31
  - build a more unified approach to spine care
• 1:33
  - across Tufts Medicine, connecting everything from conservative care
• 1:37
  - and pain management to surgery, recovery, and follow-up
• 1:41
  - across different specialties and locations.
• 1:45
  - And that raises an interesting question, which is
• 1:47
  - what does it actually take to make a
• 1:49
  - health system feel like one spine program to
• 1:52
  - the patient?
• 1:53
  - So today, we'll talk about where the traditional
• 1:56
  - patient journey breaks down,
• 1:58
  - what it takes to get different teams and
• 1:59
  - locations working together,
• 2:02
  - and whether better coordination
• 2:03
  - can improve not only the patient experience, but
• 2:06
  - also
• 2:07
  - how efficiently a spine program operates. So Caitlin
• 2:11
  - and Maureen,
• 2:12
  - thank you so much for joining us. And
• 2:16
  - with that,
• 2:17
  - we will dive right in,
• 2:20
  - into it all.
• 2:22
  - But I guess let's start
• 2:24
  - with the problem,
• 2:25
  - that you're trying to solve. So
• 2:28
  - to either of you, whoever wants to chime
• 2:30
  - in on this one, when you looked at
• 2:32
  - how a spine patient moved through the system,
• 2:36
  - where were you seeing the biggest opportunities
• 2:38
  - to make that journey a little bit easier?
• 2:42
  - Thank you for, having us, Sophie. It's a
• 2:45
  - pleasure to have an opportunity to talk about
• 2:47
  - sort of the up and coming efforts to
• 2:49
  - make these journeys
• 2:50
  - more seamless.
• 2:51
  - I think it's also important to point out
• 2:53
  - that it's equally important for the patient journey,
• 2:56
  - but also in the satisfaction
• 2:58
  - of the providers that are rendering care.
• 3:01
  - We often find that patients just don't land
• 3:03
  - in the first spot that makes the most
• 3:05
  - meaningful visit, and that's
• 3:07
  - one of the primary drivers behind this body
• 3:09
  - of work.
• 3:11
  - So a little bit more about our system,
• 3:13
  - we are a multifaceted,
• 3:15
  - multilevel system made up of three hospitals
• 3:18
  - at an integrated network of practices.
• 3:21
  - For us, the spine
• 3:22
  - disease team is made up of various specialties,
• 3:25
  - including
• 3:26
  - neurosurgery,
• 3:28
  - interventional
• 3:29
  - spine,
• 3:30
  - which is a background of PM and R.
• 3:32
  - You've got some ortho rehab, and you've got
• 3:34
  - anesthesia driven pain,
• 3:37
  - specialists.
• 3:38
  - We also have,
• 3:40
  - some nurse practitioners. We have PAs in those
• 3:42
  - departments,
• 3:43
  - and the entry points can vary. It also
• 3:46
  - varies not only on what a patient's complaining
• 3:48
  - about,
• 3:49
  - but around the knowledge that either primary care
• 3:52
  - or other specialties have and what the services
• 3:54
  - rendered,
• 3:56
  - within each of these subspecialties within spine can
• 3:59
  - offer a patient.
• 4:00
  - So the largest point has been trying to
• 4:02
  - take patients from the most conservative
• 4:04
  - measures through the process leading up to the
• 4:06
  - ultimate, which may end up being
• 4:09
  - spine surgery at the end of the day.
• 4:11
  - But we want it to be a very
• 4:12
  - fluid,
• 4:14
  - task, and the goal is to have a
• 4:15
  - coordinated journey with clear expectations,
• 4:19
  - access to a full range of spine care
• 4:21
  - across Tufts Medicine,
• 4:23
  - and for it to be equally accessible for
• 4:25
  - every geographic area that we touch. Ideally, the
• 4:28
  - right patient goes to the right place at
• 4:30
  - the right time in the right location for
• 4:32
  - them.
• 4:33
  - Mhmm. Yeah. It's,
• 4:35
  - so important because I think I talk to
• 4:37
  - so many different spine surgeons,
• 4:40
  - right now. And the one
• 4:42
  - problem that consistently comes up is that patients
• 4:45
  - oftentimes are kind of feeling, like, ping ponged,
• 4:48
  - between, like, all these different
• 4:51
  - specialties
• 4:52
  - and
• 4:53
  - just the care journey is just not as
• 4:55
  - seamless, you know, as maybe it should be
• 4:58
  - for these patients.
• 4:59
  - So I think, you know, everything that you
• 5:02
  - guys are doing is really
• 5:03
  - incredible.
• 5:05
  - And on that note, you know, obviously, you
• 5:07
  - are trying to build one spine approach across
• 5:10
  - different specialties and locations,
• 5:13
  - which sounds simple,
• 5:14
  - until you actually have to do it. Right?
• 5:17
  - So I guess just, like, thus far, what
• 5:19
  - has been the hardest to to get right?
• 5:23
  - Okay. So I'll speak to that.
• 5:25
  - I think what has been
• 5:27
  - the most rewarding
• 5:29
  - has been developing the group,
• 5:32
  - representatives
• 5:33
  - from each
• 5:34
  - disease care team area, and for us to
• 5:37
  - coordinate that,
• 5:39
  - with Caitlin and Jess O'Neil's leadership who's our,
• 5:42
  - vice president.
• 5:43
  - We have had the opportunity to collaborate as
• 5:47
  - a system more so than ever before
• 5:49
  - with partnering with the representatives from each,
• 5:53
  - physical location of our system and then the
• 5:55
  - different
• 5:57
  - care, aspects.
• 5:58
  - In terms of challenge, I would say
• 6:01
  - for us to really
• 6:03
  - identify
• 6:04
  - workflows
• 6:05
  - that currently exist and then develop
• 6:08
  - how could we map that for the future
• 6:10
  - to make it seamless for patients.
• 6:13
  - So each system,
• 6:14
  - location is doing things a little bit differently.
• 6:17
  - So being able to really walk through those
• 6:19
  - workflows and develop algorithms
• 6:22
  - that can
• 6:23
  - make a centralized process for patients coming in,
• 6:27
  - that kind of analysis work has been a
• 6:29
  - little bit challenging, but also super rewarding as
• 6:31
  - we're working together as a team. Mhmm.
• 6:34
  - Yeah. And I guess just a follow-up to
• 6:37
  - that too. How do you create
• 6:40
  - consistency
• 6:41
  - without expecting
• 6:43
  - every location
• 6:44
  - or clinical team to operate the same way?
• 6:48
  - That's the great work that we're doing now.
• 6:50
  - We've also expanded our representation
• 6:53
  - group to include frontline staff,
• 6:56
  - as well as nursing leaders that are closer
• 6:58
  - to the work in the clinics too.
• 7:01
  - And as we're developing our workflow groups, we've
• 7:04
  - developed subgroups as well so that we can
• 7:07
  - start to work together as a real team
• 7:09
  - and have one approach for each patient as
• 7:12
  - they come in through the process.
• 7:14
  - Yeah.
• 7:15
  - Yeah. That's that's great. And I know, Caitlin,
• 7:18
  - you bring a nursing and clinical operations perspective
• 7:22
  - while Maureen,
• 7:23
  - you're kinda looking at this through a broader
• 7:25
  - administrative and perioperative lens.
• 7:28
  - Where have those two perspectives,
• 7:31
  - led you to see the patient journey differently?
• 7:36
  - It's it's really a blend. I mean,
• 7:39
  - I often will say it's easy to learn
• 7:40
  - business. Not easy, but easier to learn business
• 7:43
  - than it is medicine.
• 7:44
  - But by identifying that these teams need to
• 7:46
  - work together,
• 7:48
  - we have
• 7:50
  - partnered to to the strongest extent. And so
• 7:53
  - we recognize that
• 7:55
  - the clinical nature is going to drive the
• 7:57
  - the what, but the how is a little
• 7:59
  - bit more on the administrative side. And at
• 8:02
  - the end of the day, it comes down
• 8:03
  - to being very relationship
• 8:05
  - based.
• 8:06
  - So while we are... We easily could be
• 8:08
  - disparate locations,
• 8:10
  - systems, specialties
• 8:12
  - altogether,
• 8:13
  - we make it more about the relationships, like
• 8:16
  - Maureen was mentioning with the frontline staff, bringing
• 8:19
  - them together, you know, a key representative from
• 8:21
  - each area that sort of brings that centralized
• 8:24
  - approach together.
• 8:25
  - It allows for the clinical sharing with the
• 8:28
  - operational support behind the scenes. And so it
• 8:31
  - takes away the silos
• 8:33
  - of, oh, you saw pain. Well, I'm gonna
• 8:35
  - refer you to neurosurgery
• 8:36
  - now. Great. Now those providers hardly ever talk.
• 8:39
  - Now it's, oh, you know, you saw
• 8:42
  - doctor Miller and he's going to... He's got
• 8:45
  - this great colleague, doctor Husseini, and then he's
• 8:48
  - gonna send her right down there. And the
• 8:49
  - person on doctor Miller's team will call doctor
• 8:52
  - Husseini's team, and it's a seamless integration. They're
• 8:55
  - talking together. The patients feel that direct handoff.
• 8:58
  - It's not just one department to another or
• 9:01
  - in the patient's perspective, one specialist to another
• 9:04
  - specialist. It's a journey that is interlinked.
• 9:07
  - Mhmm.
• 9:08
  - Yeah. Absolutely.
• 9:09
  - Maureen, anything to add, I guess, from your
• 9:12
  - end on the administrative,
• 9:14
  - side?
• 9:15
  - So one of the challenges I think that
• 9:17
  - we've all discussed
• 9:19
  - is the prior authorization
• 9:21
  - process, which is an administrative burden for clinicians
• 9:24
  - and administrators
• 9:25
  - alike.
• 9:26
  - Walking through each of the process workflows that
• 9:29
  - we have, I think to Caitlin's point, the
• 9:32
  - business piece is a little bit easier.
• 9:35
  - So I would agree with all of her
• 9:37
  - sentiments, but that is one area that we're
• 9:40
  - trying to figure out in a centralized
• 9:43
  - manner for us to be able to work
• 9:44
  - through those,
• 9:46
  - hurdles that we all,
• 9:48
  - face when we're we're setting up patient appointments
• 9:51
  - and interventions.
• 9:54
  - I think for us, the vision is to
• 9:56
  - eventually have colocated
• 9:58
  - clinics where a patient could walk right down
• 10:01
  - the hall to see a different specialist.
• 10:03
  - But what we're doing right now is building
• 10:06
  - those relationships across even though we're in disparate
• 10:09
  - locations
• 10:10
  - and trying to make it feel like there's
• 10:12
  - not a ping pong approach and that we're
• 10:14
  - all coordinating care. And that's gonna make a
• 10:17
  - big difference. And we're already doing a lot
• 10:19
  - of it now. It's just how can we
• 10:21
  - make it even better,
• 10:23
  - moving forward.
• 10:24
  - Yeah.
• 10:25
  - Absolutely. I think that's so important. And, obviously,
• 10:28
  - a big part of this work is getting
• 10:30
  - patients to the right care sooner, and that
• 10:33
  - doesn't necessarily mean kind of like we mentioned
• 10:35
  - at the beginning,
• 10:37
  - getting them to a surgeon sooner.
• 10:39
  - So how are you thinking about navigation
• 10:41
  - so patients reach the right specialist
• 10:44
  - treatment
• 10:45
  - and location without unnecessary
• 10:48
  - stops along the way?
• 10:50
  - We're trying to centralize the referral process,
• 10:53
  - and the points of contact. So not decentralization
• 10:57
  - in in the sense that you're losing that
• 10:59
  - personal touch because we know patients don't like
• 11:01
  - calling, you know, to a centralized call center
• 11:04
  - where they feel detached.
• 11:05
  - But by having the key members of the
• 11:07
  - team all, sort of at a central access
• 11:10
  - point, it allows them to have that conversation
• 11:12
  - when a referral referral comes in and clinically
• 11:15
  - deduce what is the most appropriate location and
• 11:18
  - then speak to the patient about the geographic
• 11:20
  - location.
• 11:21
  - So having all of these buckets sort of
• 11:23
  - funnel in, top of the funnel down into
• 11:26
  - a singular location, you can then choose the
• 11:29
  - most appropriate place for the patient. And it
• 11:31
  - also feels a little concierge, you know, like,
• 11:34
  - to... For the patient to know
• 11:36
  - that, you know, a team, if you will,
• 11:38
  - assess them, not in a burdensome way, but
• 11:40
  - in a very rapid
• 11:42
  - and and highly coordinated
• 11:44
  - manner, it gets them to the right place
• 11:46
  - instead of just passing a referral along to
• 11:49
  - each other.
• 11:50
  - Right.
• 11:51
  - A 100%.
• 11:53
  - And just to follow-up to that too, like,
• 11:55
  - as you shorten
• 11:57
  - that pathway,
• 11:58
  - is there somewhere where you see the biggest
• 12:00
  - opportunity
• 12:02
  - to improve capacity
• 12:03
  - or reduce delays?
• 12:06
  - Absolutely. So we know that a significant portion
• 12:09
  - of our patients that are referred to neurosurgery,
• 12:12
  - for example,
• 12:13
  - have yet to have even pursued any type
• 12:15
  - of conservative measure.
• 12:17
  - And this is not only a patient dissatisfier,
• 12:19
  - because they think that they're coming and they're
• 12:21
  - gonna get cancer on beta. Right? Like, they've
• 12:23
  - had this pain. It's been drastically,
• 12:26
  - deteriorating.
• 12:27
  - Their quality of life is down. We know
• 12:29
  - pain can lead to depression and all sorts
• 12:31
  - of other comorbidities.
• 12:33
  - But then now you face a surgeon who
• 12:35
  - says, you know what? I think we gotta
• 12:36
  - start with, like, picking. Right? And that's very
• 12:39
  - disheartening for some patients. For some, I had
• 12:42
  - relief. They didn't really want surgery, but it's
• 12:44
  - surgery may not be the answer for them.
• 12:46
  - So you use the poor amount of the
• 12:47
  - poor patient's time, poor use of the surgeon's
• 12:50
  - time, and you need the conservative measures to
• 12:52
  - even get a prior auth approved, like Wayne
• 12:55
  - said, whether it be for an injection or
• 12:58
  - a minor procedure all the way up to
• 13:00
  - a surgery.
• 13:01
  - So it's a satisfier
• 13:02
  - at every single level, but it will
• 13:05
  - intentionally
• 13:06
  - put more volume into pain, reduce the volume
• 13:09
  - in neurosurgery to be appropriate.
• 13:11
  - But by the other direction as well, you've
• 13:14
  - got patients going to pain because maybe it's
• 13:17
  - a path of least resistance that really have
• 13:19
  - already tried significant amount of conservative measures, or
• 13:22
  - perhaps enough time has passed,
• 13:25
  - that they really... These measures aren't gonna be
• 13:28
  - as as helpful and they should be at
• 13:30
  - the point of surgery. So the directionality can
• 13:32
  - go both ways. It's supposed to be bidirectional,
• 13:35
  - but by now, analyzing rather
• 13:38
  - the information in the chart or where the
• 13:40
  - patient's been, it creates gaps that then can
• 13:43
  - be filled with more appropriateness.
• 13:45
  - So far less about volume shifts and more
• 13:48
  - about appropriateness.
• 13:50
  - And thereby,
• 13:51
  - the patients are are more satisfied they've had
• 13:54
  - a outcome, if you will, that's in their
• 13:56
  - eyes beneficial from their visits.
• 13:59
  - But also from the provider lens,
• 14:02
  - they saw patients they felt they could help.
• 14:04
  - There's nothing more disheartening to a provider than
• 14:06
  - to be sitting across from a patient saying,
• 14:08
  - I don't have a service to provide for
• 14:10
  - you right now. Mhmm.
• 14:13
  - That is a great point too. I mean,
• 14:16
  - I think I talk to a... Again, a
• 14:19
  - lot of spine surgeons and I think one
• 14:20
  - part that comes up a lot is, you
• 14:23
  - know, a lot of patients might be coming
• 14:25
  - to
• 14:26
  - a surgeon who don't need surgery.
• 14:29
  - Right? And, you know, they sort of haven't
• 14:31
  - exhausted all the, you know, more conservative options
• 14:34
  - or really didn't have the proper pathway, you
• 14:37
  - know, to sort of get there.
• 14:40
  - So I think it's a huge thing. And
• 14:41
  - I think, like you mentioned, with prior authorization
• 14:44
  - and stuff like that, all this stuff really
• 14:46
  - just starts to compound,
• 14:49
  - and
• 14:50
  - it gets a little hectic and and and
• 14:52
  - tough. But,
• 14:55
  - if this model does work the way that
• 14:57
  - you envision it,
• 14:59
  - what will feel noticeably different for a spine
• 15:02
  - patient coming into Tufts Medicine a few years
• 15:05
  - from now?
• 15:06
  - If if we do as well, then it
• 15:09
  - does feel seamless. They should feel from the
• 15:11
  - touch point of number one that they have
• 15:14
  - been supported around their need regardless of where
• 15:17
  - that landed them, whether it be the specialist
• 15:20
  - or the location or the intervention.
• 15:23
  - Success would be the lack of of complaints
• 15:26
  - saying,
• 15:27
  - great. Now I gotta go here or now
• 15:29
  - I've gotta get my imaging and pass it
• 15:30
  - to another provider or, okay. I waited six
• 15:33
  - months for this appointment. Now I'm gonna wait
• 15:36
  - six months for another specialist, but then can
• 15:38
  - they have an answer a year later?
• 15:40
  - No. That... At that point, they may no
• 15:42
  - longer
• 15:43
  - even qualify
• 15:45
  - for one of the interventions that they could
• 15:47
  - have previously.
• 15:48
  - So success in all its forms just looks
• 15:51
  - like a smooth and seamless process where the
• 15:54
  - patient feels that they have been fully enveloped
• 15:56
  - in support
• 15:57
  - from the initial point of contact.
• 16:00
  - Right.
• 16:01
  - Absolutely.
• 16:02
  - Alright.
• 16:04
  - Well, that was pretty much all the questions
• 16:07
  - I had. I guess, is there anything else
• 16:09
  - we didn't touch on that you guys wanted
• 16:11
  - to make sure we did at all? I
• 16:13
  - don't think so. I think that, you know,
• 16:15
  - the biggest point that we like to enforce
• 16:17
  - is that it's
• 16:19
  - so cross collaborative or or multidisciplinary.
• 16:21
  - So I think if that's an area that
• 16:23
  - we can sort of touch on, it's great.
• 16:25
  - And I loved Maureen's point about the collocation.
• 16:28
  - And the reason we... We're thinking of collocation,
• 16:31
  - maybe you could snip this in, but,
• 16:34
  - the collocation part is so important for us
• 16:35
  - because, actually, at at MENA, we have done
• 16:37
  - that. MENA is made up of five specialties
• 16:39
  - of neurosciences, and we have collocation between neurology,
• 16:43
  - neurosurgery,
• 16:44
  - rheumatology,
• 16:45
  - interventional pain,
• 16:46
  - and psychiatry.
• 16:48
  - And that's shown us what this could look
• 16:50
  - like at scale. The challenges, like Maureen has
• 16:54
  - said, is doing it across, you know, upwards
• 16:57
  - of 10 locations and inclusive of about four
• 17:00
  - specialties.
• 17:02
  - But we have an amazing team. We have
• 17:04
  - very engaged providers.
• 17:06
  - And so we we know what we're looking
• 17:08
  - for, and we are figuring out the steps
• 17:10
  - to get there along the way. But everybody
• 17:12
  - is swimming in the same direction, which means
• 17:14
  - it's possible.
• 17:15
  - Yes.
• 17:16
  - And the goal is ultimately
• 17:18
  - just seamless care, you know, for the patient.
• 17:23
  - So Caitlin and
• 17:25
  - Maureen,
• 17:26
  - thank you so much
• 17:28
  - for for joining us.
• 17:30
  - And, yes, this can also be seamless for
• 17:33
  - referring clinicians
• 17:34
  - as well,
• 17:36
  - which is also
• 17:38
  - so, so important as we know.
• 17:41
  - But thank you both so much for for
• 17:43
  - joining us. It's been really interesting to hear
• 17:45
  - what it takes to look beyond individual specialties
• 17:49
  - and locations and really think about the entire
• 17:52
  - spine journey, not only from the patient's perspective,
• 17:55
  - but also from the clinician's perspective.
• 17:59
  - That is all for today's episode of the
• 18:02
  - Becker Spine and Orthopedic Conference. A big thank
• 18:05
  - you to both Caitlin and Maureen for sharing
• 18:08
  - how Tufts Medicine is working to create
• 18:11
  - a more connected approach to spine care. So
• 18:14
  - thank you for listening,
• 18:15
  - and we will see you next time.