The nonsurgical spine care clinic of the Potomac Valley Orthopaedic Associates features a variety of therapeutic fitness equipment.


Published 7/1/2007
Jennie McKee

Are you spineless—and is it hurting your bottom line?

Opening a nonsurgical spine clinic can have several benefits for your practice.

Spine care is big business; approximately $80 billion are spent on spine-related health care each year in the United States, and about 80 percent of adults will experience back pain during their lifetimes. Significantly, most spine care is nonsurgical and conservative.

According to a panel of experts at the recent BONES Society annual conference, developing and implementing a nonsurgical spine care center at your practice may benefit not only your patients, but your bottom line as well.

The presenters included Thomas “Ted” Dreisinger, PhD, who has decades of clinical experience in rehabilitation, orthopaedics, and physical medicine; Thomas G. Montebell, MEd, a representative of a consulting company that specializes in the design, development, and management of physician-owned, outpatient rehabilitation facilities; Dana Walker, MPT, general manager of Potomac Valley Sports Medicine and Rehabilitation; and Anthony Kling, MBA, CFO, of Potomac Valley Orthopaedic Associates, Chartered.

Basics of nonsurgical spine care
According to the presenters, nonsurgical spine care is the treatment of spine abnormalities and deficits with noninvasive, well-defined, conservative care. The emphasis is on functional restoration rather than short-term symptom management. This type of care relies on the body’s ability to heal itself with appropriate stimulation.

Conservative treatments may involve stretching, core stabilization, and the MacKenzie, Mulligan, and Williams flexion techniques. Patients may also use mechanical equipment that isolates and supports the affected area of the spine (lumbar or cervical).

Why opening a spine clinic can make sense
According to Dr. Dreisinger, there is a “tremendous, unmet, and growing need” for nonsurgical spine care as payors become less enamored with traditional care such as bed rest, pain medication, and steroid injections. In addition, because patients often perceive surgery as the last resort, orthopaedists may be able to generate significant revenue from a nonsurgical spine clinic.

Is it right for you?
If you are considering adding a spine clinic to your practice, said Montebell, you should first evaluate the potential patient base. One way to accomplish this is to perform a patient census using ICD-9 codes to evaluate how many of your patients might use the spine clinic’s services. You should also obtain feedback from referring physicians about patients who could potentially benefit from a spine clinic. According to Montebell, the location of your clinic is a crucial predictor of how many patients will seek treatment there.

“The fact is that patients will visit a spine clinic only if it’s within 10 to 15 minutes of where they work or where they live,” he said. “Patients will drive for hours or fly across the country to see a physician, but they’re not going to do that for therapy.”

Another important consideration is your physical plant. The revenue from adding a spine clinic to your physical space may far outweigh remodeling costs.

“We’re talking about significant passive income,” said Montebell. “This model takes into account that you are leveraging the physician’s influence to generate income for the practice without increasing the physicians’ workload.”

Whether opening a spine clinic makes sense for your practice comes down to—you guessed it—dollars and cents. An orthopaedist shouldn’t open this kind of clinic just to be “the only one on the block.” It’s important to know the costs, as well as the potential patient volume, collections, profits, and operating margins.

“If it makes economic sense, then doing spine is something your practice should consider,” summarized Montebell.

According to Kling, implementing spine clinics as part of Potomac Valley Orthopaedic Associates, Chartered, has paid off financially. The practice added its first nonsurgical spine clinic (Potomac Valley Sports Medicine & Rehabilitation) in 2002 and now has four locations. The organization has gone from providing therapy to 12 spine patients prior to 2002 to providing treatment for more than 800 spine patients as of last year. It cost around $300,000 to develop and build the first clinic, which measures 3,500 square feet. To better serve its patients, the clinic hired two aides per therapist and instituted convenient evening hours.

You’ve decided to open a clinic—now what?
Developing and maintaining a successful spine clinic necessitates, among other things, a functional, practical design. Open areas support active rehabilitation, so it’s important to have a minimal number of offices and treatment rooms. Facility size and design directly affect the patient volume potential, so larger facilities will provide greater flexibility and growth potential.

Properly equipping your facility is also key; proper equipment selection contributes to versatility and optimal patient benefits. Medical rehabilitation and fitness equipment provide objective data and standardization of treatment. Appropriately scheduling patients to maximize equipment usage can enable you to successfully and efficiently treat more patients.

Staffing and billing are two other areas that need careful planning and attention. Additional staff members may be needed to maximize the patient volume, and support staff, such as aides and administrative assistants, must have appropriate roles so that their productivity is maximized. Your staff must also understand Medicare billing guidelines and restrictions and properly bill for the services of physical therapists and other staff.

Getting the word out about your clinic
Positioning and marketing your spine clinic as a facility where patients can receive state-of-the-art treatment for their aching backs will keep new patients coming in the door. It’s a good idea to document your success in peer-reviewed journals, for example, and to market your clinic by sending out mailings to your referring physicians and current patients. In addition, use advertisements and local media coverage to reach new patients.

Realistic productivity and revenue goals
Be sure to set reasonable goals for the performance of your spine clinic. For example, one goal might be that each licensed staff member have 350 patient sessions each month. Assuming a 37.5-hour work week, staff would see 2.33 patients each hour.

You can use that same model to generate expected revenue goals. Assuming that you’ll collect $80 for each patient session yields an expected revenue goal for each licensed staff member of $28,000. Because Medicare patients must be seen on a one-on-one basis, front-desk staff must schedule only one Medicare patient per hour per staff member.

Measuring—and maintaining—success
The following measures are useful in determining the success of a nonsurgical spine clinic: the number of patient visits per provider, types of modality,

collections per session, reimbursement ratios for visits, average number of patient visits before discharge, and patient satisfaction at discharge. In addition, you should monitor the no-show percentage, which should never exceed 10 percent.

Just as important as monitoring your clinic’s success is making sure that you and your staff members maintain a total commitment to patient satisfaction. Providing friendly, patient-centered care will help your clinic retain its patients and acquire new ones.

Jennie McKee is a staff writer for AAOS Now.