How Primary Spine Care Providers Change the Game of Spinal Care | Podcast Ep. 318

Foreign welcome to the evidence based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with the research and this one is hot off the press. It is literally a study that was released this year in 2022. We're only in the first two weeks of the year and it is a great one. So many chiropractors out there have heard of the primary spine care model. This is one of the first studies I've seen comparing it to traditional primary care. Great take home messages, a couple clinically actionable items as well in this study. We're gonna hit it and much more on today's episode. Before we get started, I wanna say a few words about the smart chiropractor. The smart chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better retention, consistent reactivations with without spending any money on advertising. At Smart Chiropractor we believe staying top of mind, teaching and inviting consistently in utilizing the automation such as social media, email marketing and more are really what can make you exceptionally successful. Help you stand out and do it with consistency having those proven systems. So check out the smart chiropractor if you were looking to build and grow your practice this year year now as I said at the top, today's episode we're talking research. This was released in chiropractic and manual therapies within the last couple days and it is titled Efficiency of Primary Spine care as compared to conventional Primary care. A retrospective observational study at an academic medical center. So over the last few years, I know I have seen a lot online, heard a lot of chatter about the primary spine care model and again, this study takes it and says okay, well let's put it up head to head against primary care, see what the results are and let it sort out. And I think this is a fantastic opportunity to look at the benefits of that model as well as some of the challenges currently experienced in a traditional primary care setting. So why is this important? This is important for the same reasons we talk about each and every. Weak low back pain is the largest contributing factor to outpatient health care utilization and expenditures. Spending for low back and neck is the highest cost in the US health care system and it's estimated at over 134 billion bucks per year. That is a lot of money being spent on low back and neck pain with increased expenditures for spine care interventions that have not correlated with improved results. What does that mean? Well, if you've seen me speak, I show the chart and it literally is the average cost per person for neck and back care over the last 25 years. And you compare that against the chart for the number of spinal fusions and laminectomies done over the last 25 years and they're identical. And there is quite often insufficient evidence to justify the use of a lot of these expensive procedures. There's a time and a place for everything, don't get me wrong. But there is no question in my mind when we look at the number of ESIs, epidural steroid injections, when we look at the number of laminectomies, foraminotomies, laminotomies, spinal decompression procedures, instrumented and or uninstrumented, it's outrageous. And we don't see it showcasing results in the literature yet. It's supposed to be science based care. So this sort of sets the stage for that and basically says, quote, you know, quote, medical management of back pain can also be hazardous as back pain is one of the most common conditions for which opioids are prescribed. Here we go again. Right. Last week we talked about all of those gains in the opioid epidemic being completely wiped out over the last 18 months. And back pain remains one of the most common conditions for which opioids are prescribed. And once those have their hooks in a patient, it's really difficult to change that course. It's not impossible. You should never give up. But it certainly becomes much more challenging. So most patients with back pain in the US are initially seen by a primary care physician. I wish it was. Most were being seen by a chiropractor, but many start in the primary care model. So when you look at a primary spine care clinician, the goal of it is to provide non pharmacological care and really to coordinate the spine care of patients from initial presentation through discharge. So in an ideal world, in an ideal model, the psc, the primary spine clinician, spine care clinician, excuse me, provides the care from front to back. And that has a tremendous amount of benefits in terms of routing patients, in terms of diagnostic imaging, in terms of medications, et cetera, that can't be overstated. So the aim of this study was to evaluate the outcomes for a primary spine care clinician versus a primary care clinician after three years of following this model. So a lot of data and for all the patients, they measured six month outcomes. So nice long look at what's happened in the last few years. This is a newer model, but it started quite a few years back. Now it's becoming more popular. Let's take a look at the data. A couple of the things that the researchers noted are basically those barriers to implementation and they noted three separate barriers and these are super powerful. If you've listened to this over time with the evidence based chiropractor, when we talk about building referral relationships, these barriers are going to ring true and they're going to be, they're going to sound quite familiar. The first barrier that they identified was what they called explicit bias, which is a belief that providers other than medical physicians are not suited or untrained to assume the role of the primary care type physician. So that's a real thing. The second barrier was what they called structural bias. This was limited insurance reimbursement for non medical providers. I think we've heard for the last 25 years that that's supposed to be equitable. I'm not holding my breath, let's put it that way. And the last, so it's a real thing as well. And the last barrier was implicit bias, which was associated with physician and administrator lack of familiarity with the primary care, primary spine care physician's training, expertise and competencies. So a couple things here to note. One, when we look at the explicit bias, which is the belief that providers, if you're not a medical doctor, you're not suited to really manage the case. That's something that can be overcome, but it has to be proactively overcome. We'll talk about that in a second. The structural bias, the insurance reimbursement, that's a challenge, right? And I think a lot of here's the good News is that 20 years ago being a cash based practice was pretty weird and you were deemed outside the norm. Now you see many orthopedic groups, medical doctors, you name it, adding on cash services because they've got crunched so hard on reimbursement. So it's far less of a quote, unquote weird thing or challenge than it was five to 10 years ago. And that's a good thing to overcome that structural bias in the implicit bias, Administrators, other physicians, not knowing what the heck the chiropractor or primary spine care physician does. That's what we deal with every single day, right? As we get out and build relationships. So again, education's a key component. So how did they overcome it? In this study, explicit bias was, they say, successfully addressed by communicating the evidence supporting the suitability of non physicians in treating pain. I say non physicians, meaning non MDs. Structural bias was overcome because of the availability and reduced leakage of patients to external providers. So I'm going to hold on that for a second. Implicit bias was preemptively tackled through one on one education. So let's go back. When we talk about the reduced leakage of patients to external providers, I can tell you when sometimes people ask me, hey, how did you get those initial positions in those large multidisciplinary groups? And the answer is it's a business. So when you sit down with a C level executive and you showcase, hey, you have a 20% churn of physical therapy patients that either aren't returning for care, fail PT and don't want surgery, that's dollars out the door, that's a hole in their bucket. And if you're able to reduce the leakage, quote unquote, of patients to external providers by adding on a service line and filling a hole in a bucket, that becomes pretty powerful when you have one on one conversations with executive team leaders at large scale physician groups. Because once you get to a physician group that's more than a couple docs, typically they're bringing in business people, an executive team beyond themselves who are going to look at spreadsheets and numbers and showcasing that you can reduce leakage is so, so, uh, however, when we look at the explicit bias and the implicit bias, it's education. So the three pillars that we talk about with the evidence based chiropractor, how do you build successful referral relationships? Consistency is key. You do it by case notes, research and meetings. That really is the educational foundation that they're showcasing in this study. Exactly. That's how you get over things, whether you're the doctor, the primary spine care physician in the practice, or whether you're externally looking to build those relationships and bridge those gaps. So how did the PSC really manage the case? They used the CRISP protocols. So those clinical reasoning in spine pain, that was really the guideline and pathway that was utilized in this case. And I think it's a great way to go about it. So the data, it was almost about 2,700 patients were included in this study. So a good number of people over a good period of time. Let's see what the outcomes showcased. Well, they said the frequency of patients who filled a prescription for opioid medication six months after initial visit was significantly higher in the group that started with the primary care physician as opposed to the primary spine care physician. No surprise there. A smaller percentage of the primary spine care patients filled prescriptions for opioids, a fewer percentage had hospitalizations, a fewer percentage had surgery, and a fewer percentage had Referrals to a specialist. So right in line with what we would assume and hope. And this study showcases it. So primary spine care patients were 53% less likely to be hospitalized, 57% less likely to fill a prescription for an opioid, and 44% less likely to obtain spinal injections. That is super, super powerful. Cutting the hospitalization rate in half is a win that is beyond reproach amongst itself. When you talk about nearly 60% less likely to fill a prescription for an opioid, that's changing lives, that's changing generations, that's changing families. And it sounds maybe a little melodramatic, but it is true. If you've seen the devastation, 100,000 deaths last year due to opioids, a million cumulative or more, that's a big deal. And getting out there and making an impact on that. And not a 1% impact, which would be valuable in and amongst itself, but 57% is wild and it is awesome. And a 44% less likely to obtain spinal injections. You know, I talk about the journey of professional indifference when I talk about primary care physicians. Sometimes in terms of a patient comes in with clear radiculopathy, they don't have really have any tools to do anything, so they prescribe a medication. Medication, quote, unquote, doesn't work because it's a structural issue. MRI gets taken by or ordered by the primary care physician. Primary care physician says, oh my gosh, you have a disc herniation, which was obvious from the get go off to get injections. Injections temporarily leave the pain off to get the neurosurgeon, you know, look at the disc, quote, unquote, which means that surgery is highly likely. So a 44% decrease in the number of spinal injections being performed. Big, big deal. So this is a great study. It really showcases how I'm gonna say us. I'm gonna extend it a little bit maybe, and say us as chiropractors. I think the broader scope of this study is how do we as chiropractors fit within the system? What benefits can we provide patients? And obviously the specificity of this study is truly comparing that primary spine care physician model to a primary. And ultimately the researchers found, quote, the results demonstrated that within six months of an initial visit for a srd, a significantly smaller portion of PSC patients had escalation of spine care as compared to PC patients. Primary spine care to primary care. So a big deal. A great study to kick off 2022 and some really interesting messaging. Right? What's the Take home messaging on this. Number one, having a chiropractor involved in the of spine related complaints is a big deal. And it is not only AIT's not a luxury, it's a necessity. The second thing that's a take home message here is that we can make as chiropractors a huge impact on the lives of people in our community. We already know that, but we leave a lot on the table. Most people are seeing their primary care physician first. As they outline in this study. If you're not getting involved with those primary care physicians, if you're not generating any referrals from them, you have a lot of leakage, you have a lot of patients going down a path they shouldn't be going on. So I'm gonna say it's our professional responsibility practically to get out there and build relationships. Because even if it's for one patient a year, you've changed that individual's life. And we see opioids being reduced in half or more, we see injections reduced in half or more, we see hospitalizations reduced in half or more. Is there anything more important that you could be doing than getting out there and building those relationships? And the biggest take home message, the final take home message I should say, is education reigns supreme. Consistent education to these providers is necessary. They don't know who you are, they don't know what you do and they don't know how you fit in. So having the systems and processes to tell that story this month, next month, the month after, is absolutely critically important in building and bridging that gap. So if you're interested in building referral relationships this year and beyond, head over to the evidence based chiropractor. We've helped thousands of chiropractors generate tens of thousands of referrals. The system is easy, it's step by step, but you have to get out there and do something. It's not going to happen on its own. And this sort of study we're going to definitely put in queue also to highlight with one of our MD marketing research briefs that come out monthly for our members. So that's really all that I took away from this study. If you have any additional insights, you can always hit me up. Jeff the evidencebasedchiropractor.com and as we are kicking into 2022, if this year you are looking to build your team, if you're looking to add on a new doc that as chiromatch makers we always say, you know, hiring the right person can generate seven figures for your practice highlighting the Excuse me, hiring the wrong person can cost you six figures. So that's why we go through a proprietary assessment process to ensure that anybody who comes into your practice as an associate is a great cultural fit. Doing that work before you hire is so, so important to finding a great long term solution where everybody is happy and profitable and taking care of patients. So if you're looking to build and grow your team in 2022, head over to ChiroMatchmakers do if you are looking for your next step, we have over 100 open positions paying $85,000 base salary and more@chiromatchmakers.com you can search our map there and see what's available all throughout the US and beyond. And also our locum services. We had a great year with locum coverage last year and we take that just as seriously as we take our DC and CA staffing and placement. So Chiromatchmakers.com for all of your recruiting and staffing needs, have an awesome week in practice and I will talk to you soon.

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