Jordan Hospital Article

Spine Care Partners founders, Dr Paskowski, Dr Ventura and Dr Justice have published an article about the first year of operation of the Jordan Hospital Spine Care Program. The article was published in the February 2011 issue of the Journal of Manipulative and Physiological Therapeutics.

A Hospital-Based Standardized Spine Care Pathway: Report of a multidisciplinary, evidence based process.            
I. Paskowski, DC, M. Schneider, DC, PhD, J. Stevens, DC, J.Ventura, DC, B. Justice, DC

ABSTRACT

Purpose
Jordan Hospital implemented a multidimensional spine care pathway utilizing the NCQA Back Pain Recognition Program (BPRP) as its foundation.  The goal was to implement an evidence-based standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.

Methods
A standardized Spine Care Pathway (SCP) was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for both the Spine Care Pathway and the valid metric to determine the level of quality care delivered. Patients were also triaged into one of six classifications based upon history and examination, Directional Exercise Flexion or Extension Biases, Spinal Manipulation, Traction, Spinal stabilization exercises, or Work conditioning.

Results
This paper reports the findings for 518 consecutive patients. 116 patients were seen once and triaged to specialty care; 7% of patients received MRIs. 432 patients (83%) were classified and treated with chiropractic care and/or physical therapy. Results for the patients treated with chiropractic care were: mean of 5.2 visits; mean cost per case of $302; mean intake pain rating score of 6.2/10 with mean discharge score of 1.9/10; 95% of patients rated their care as ‘excellent’.

Conclusions
By adopting the NCQA BPRP as a spine care pathway, training physicians in this spine care pathway and utilizing a back pain classification, Jordan Hospital Spine Center was able to demonstrate the quality and value of care rendered to a population of patients. This was accomplished with relatively low cost and with high patient satisfaction.

Keywords: Low Back Pain, Healthcare Quality Assurance, Chiropractic, Physical Therapy


NCQA BPRP

The National Committee for Quality Assurance Back Pain Recognition Program for physicians has been in operation since 2008. Medical physicians, osteopathic physicians and chiropractors from across the country have chosen to participate with this program and meet the demanding standards to achieve recognition status with NCQA.

The NCQA BPRP quality standards are largely process driven measures of the care rendered for back pain patients. The mission of NCQA is to improve the quality of care given by standardizing the evaluation and to certain extent, management, of back pain patients. By reducing variations in care, the quality of the care will improve and costs associated with care will be more appropriate. There are examples of misuse, overuse and under use with respect to the evaluation and treatment of back pain, and the clinical measures and structural standards of the NCQA BPRP help to reduce each of these categories.



PQRS of CMS   

The Center for Medicare and Medicaid Services (CMS) has established the Physician Quality Reporting System(PRQS) to improve the quality of care rendered to Medicare patients. Each discipline authorized to provide care to Medicare patients has certain quality metrics established which are included in the patient documentation and reported to CMS in billing through a series of G-codes. Similar to the mission of NCQA, CMS hopes to reduce variation in care and to prompt the reporting of quality metrics, initially through financial incentivization, and ultimately through financial punishment. For year 2011 CMS will reimburse a bonus payment of 1.5% to those providers who include PQRS reporting in their billing. By year 2015 CMS will with hold 1.5% of payment from those providers who do not include PQRS reporting in their billing.

ACOs

Accountable Care Organizations, or ACOs, appear to be the latest iteration of clinical care/reimbursement models seeking to increase the quality of care while managing the costs of care. According to Iglehart in the January 2011 issue of the New England Journal of Medicine, in 2005 CMS initiated a pilot project to evaluate 10 ACOs. Half were physician organizations integrated with hospital ownership directly  and the other 5 were affiliated with academic institutions or independent. The physician groups were charged with meeting certain quality metrics (process driven) and with meeting expenditure targets established prospectively. Those groups meeting the expenditure targets were paid a bonus of 80% of the savings to CMS. Curiously, none of the physician groups owned by hospitals were able to meet the expenditure targets. This CMS pilot project to test ACOs worked unilaterally though in that while physician groups meeting expenditure targets were paid a bonus, no physician group was financially penalized for not meeting the target.