Regional registry shows cost of spine surgery must be examined at state level

The Michigan Spine Surgery Improvement Collaborative, created in 2011, represents a regional registry that encompasses all spine surgeries performed in Michigan to identify areas of potential cost savings and quality improvement, according to a presenter at the Congress of Neurological Surgeons Annual Meeting.

The Michigan Spine Surgery Improvement Collaborative (MSSIC) now includes more than 20 hospitals in Michigan that supply data on patients, outcomes and costs to a central database. Representatives then use those data to evaluate the value of spine surgery and ways to improve outcomes and reduce complications, Muwaffak M. Abdulhak, MD, said.

“The MSSIC registry provides a great platform for quality improvement by identifying and adopting best practices in a setting of trusted community. Finally, the value of the partnership of the ‘Blues’ is an innovative approach and it is a first of its kind. Its unique funding model will ensure its longevity, as it has been provided and proven by the previous [collaborate quality initiatives] CQIs,” he said.

An innovative partnership

The MSSIC is part of the Michigan Blue Cross Blue Shield value partnership program. The MSSIC began its first phase of hospital enrollment in early 2014 after a year spent developing and testing its data software. To participate, hospitals need a minimum of 200 spine surgeries performed annually, must have both neurosurgeons and orthopedic surgeons performing spine cases and the willingness of one neurology and one orthopedic surgeon to act as a “champion” for the hospital.

Hospital records abstractors must input into the MSSIC database billing codes for cervical and lumbar procedures, as well as codes for indications for surgery, such as spondylosis, intervertebral disc disease and acquired spondylolisthesis grades 1 and 2, Abdulhak noted.

Data are key

“Each site is responsible for identifying all surgical cases using inclusion and exclusion criteria. Data are extracted from patient medical records and by patient-reported outcomes questionnaires. Patient-reported pain and function status measures are obtained before surgery, 90-days postoperatively and 1 year or 2 years postoperatively, either by telephone, paper or web portal. The data must be entered within 30 days from each milestone,” Abdulhak said.

Each participating surgeon is given access to a web portal that allows him or her to query his or her own data 24/7 and use data from other participating hospitals for benchmarking and comparison purposes. Hospitals and surgeons use the data to engage in their own local quality improvement initiatives and track their own data over time, he said.

Database exceeds 8,600 patients

As of September 2015, the database included information for about 8,600 patients. Surgeons can now use the data in the MSSIC to identify patterns and possible outcomes for patients undergoing various spinal procedures, according to Abdulhak.

“A patient undergoing multilevel lumbar decompression surgery in Michigan can expect his or her preoperative lower back pain to drop five points [on a 0 to 10 pain scale] postoperatively. If we use a [minimal clinically important difference] MCID of two points or more, it can be fairly stated 75% of patients undergoing a lumbar decompression surgery in Michigan by a surgeon can expect to have their back pain improve by two points or more,” he said.

By working together in this collaborative, hospitals have the opportunity to cut costs related to procedures and optimize best practices, Abdulhak noted. – by Robert Linnehan

Reference:
Abdulhak MM. Developing a spine outcomes collaborative. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 26-30, 2015; New Orleans.

For more information:

Muwaffak M. Abdulhak, MD, can be reached at Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202; email: mabdulh1@hfhs.org.

Disclosure: Abdulhak reports he is a consultant for Integra and DePuy Spine.