Spine Care – From a PCP Perspective

Spine Care from a Primary Care Perspective

Being able to effectively build relationships with the medical community, particularly the Primary Care providers, requires your understanding of their limitations and frustrations.  Once you understand them, the process is simple.  You offer a solution without narcotics, without the side-effects of surgery.  You offer REAL doctoring for one of the most common medical conditions in the country, spine pain.  In this consultation, lets take a detailed look at were they stand on on spine care

Training Issue

Almost non-existent in Medical School, most medical schools give about 6 weeks of focus on musculoskeletal conditions.  Spine is a small portion of that training, that is didactic only, there is very little if any clinical training.  When you are marketing to them, you have to be sensitive to the learning curve, they don’t understand spine care, that is where you have to start. Talk in generalizations not in specifics.

Time Issue

Chronic disease management [hypertension, diabetes, Crohn’s disease] takes up most PCPs time.  The level of documentation, writing medication scripts and working within treatment protocols is a full time job, many take charts home with them and work through the night.  When a patient comes in with a spinal compliant, because of time and lack of training the PCP wants to triage them immediately.  Historically that was to the surgeon, then it started to go to the pain management physician [we know how that is turning out] now it is to the properly trained doctor of chiropractic.  The discussion with the PCP is about having place to START the spine pain patient on a care path, it starts with assessment to rule out serious pathology, then moves into biomechanical analysis and medical triage when appropriate.

Reimbursement Issue

This relates to the time issue as well.  Disease management is the priority, there is little room for anything else particularly the needed neurological and orthopedic evaluations required with spine care.  Often spine cases fall into the Workers’ Compensation and Personal Injury categories which requires attention to the medical legal requirements many of these patients face.  Many times there are additional requirements to get paid on evaluations and if those are missed or not followed up on, the provider looses income and operating capital. Taking into account the specific and necessary documentation required for chronic disease management and the specialty of spine care, you can see how frustrating these patients can be to the primary care provider

Documentation

Medical legal issues can complicate documentation and provider responsibility.  There is a difference between the EMR template for a general physical examination and a specialized spine evaluation.  Many PCP EMR are not set up for this type of documentation, particularly of there is a medical legal component

Anatomical Correction and Triage

This is the #1 medical approach for triaging spine pain patients, although it is estimated less that 25% of spine pain patients have a direct anatomical cause of their pain [fracture, dislocation, tumor or intervertebral disc pathology].  We also know that 100% of spine pain patients have a biomechanical component, since that is true why do we triage for the 25% when we should be referring spine cases to a provider that can manage the mechanical component and who is properly trained to “catch” the anatomical issues and refer properly.  That is where chiropractic can fill a huge need and be extremely relevant to the process of spine care.

Profiling

Advanced imaging is clinically indicated in non-responsive spine patients after 4-6 weeks of care, it is indicated immediately in patients with neurological deficits. Advanced imaging is the domain of spine specialists, including chiropractic.  Primary care physicians are not specialists and they are profiled negatively by insurance carriers when ordering.  They are happy to send those patients to you for work up, make sure you have this discussion with the primary medical doctors in your area.