An Innovative Approach on Mississippi Medical News

An Innovative Approach

By: LYNNE JETER

NewSouth NeuroSpine a Combination of Five Groups with Focused Plan

FLOWOOD—Several years ago, leaders of three spine surgery groups, a physical medicine and a pain management group in Central Mississippi began discussing ways to establish a more effective and efficient practice for their patients.

"We were already working together as a relatively cohesive unit, but we weren't in the same location and we weren't able to transfer patients between each other as seamlessly as we'd like and also have easy access to patient records," said Jack Moriarty, MD, a board-certified, Stanford University and Johns Hopkins-trained neurosurgeon in Jackson.

The physicians recognized that spine care as a specialty was too fragmented, and the quality of patient care wasn't improving as rapidly as it could as new procedures and technologies became available.

Non-Surgical Treatment Options

If surgical treatment isn't the best solution for the patient, NewSouth NeuroSpine provides non-surgical and ancillary treatment options, including interventional pain management, physical medicine and rehabilitation, physical therapy, and pain psychological services.

"The pain management side of our specialty involves the non-operative management of patients with chronic or acute musculoskeletal issues. Our job is to evaluate that person from a biomechanical standpoint to determine what may be contributing to their pain," said Rahul Vohra, MD, board-certified in physical medicine and rehabilitation and pain medicine. Because the state doesn't offer a training program in the specialty, Vohra, who studied at the Baylor College of Medicine in Texas, and his two associates bring a unique specialty to the Mississippi practice.

"We're different from similar practices because we don't just send patients to therapists with instructions to evaluate and treat," he said. "We'll write out very specific orders to address a patient's specific diagnosis to provide them with an individualized program for care rather than a general rehabilitation program."

Patients who live nearby have access to onsite therapists. "If they live some distance away," he said, "we'll set them up closer to home to get appropriate treatment."

NS2 physicians manage pain medication treatment onsite when appropriate, and coordinate care with the pain division.

"We also work closely with a pain psychologist for patients who have chronic pain and are also dealing with depression and anxiety issues that can become quite overwhelming," said Vohra. "Very few practices have access to a pain psychologist, and none that I know have access to one full time. Usually a pain psychologist sees pain patients and also does family therapy. We made the decision to go this route because it became very clear to us that pain management for patients often isn't enough. Surgery, medication and therapy are very useful treatments but often you have to go above and beyond and treat the underlying psychological or psychiatric issues that are sometimes present in patients with chronic pain. We agreed long ago that it's important to treat the whole person to achieve the best outcomes for patients."

"Once we had the people in place, the business and practice plan evolved," said Moriarity. "We all had the overarching principle that we wanted to do for patients what we'd want done for our family. We also found non-surgical and pain management people that shared our vision and began molding our practice patterns and pulling in one main direction. Then we sat down and said, 'how do we do that? Rent space? Build?' Then the opportunity came up for us to have our own land and build a facility to shape our practice space."

On April 1, 2008—no fooling—NewSouth NeuroSpine, also known as NS2, was established, immediately making it Mississippi's most comprehensive spine care provider. Its seven board-certified spine surgeons represented the most of its kind in one place statewide, even counting the University of Mississippi Medical Center.

Moriarity was named chairman and Frank York the CEO of the practice, which has 12 physicians covering four specialties—neurosurgery, orthopedic spine surgery, interventional pain management and physician medicine and rehabilitation—along with a staff of 50 highly trained nurses and healthcare professionals.

The new 50,000-square-foot facility in Flowood features 30 exam rooms, digital X-ray and MRI technology. A pain psychologist and a chiropractor also share building space. The practice includes a pain management clinic and a physical therapy center equipped with a hydrotherapy pool.

"We've been in the center for about two years, and I can't think of anything else we might have included that wasn't on our wish list when the designs were drawn up," said Moriarity. "We have room to expand, which we'll probably do in two to four years as patient volume grows by adding professionals in each division."

As soon as they were all housed under one roof, NS2 leaders incorporated an unusual yet highly effective ritual into their weekly practice routine. Every Friday at midday, all 12 physicians, along with nonsurgical specialists, gather for a lunchtime weekly surgical conference.

"Our challenge is to treat each case as the most special and unique case because for the patient, it is the most important and critical case," explained Moriarity. "For that reason, we made a conscious decision to intentionally alter our Friday morning clinical schedule to meet together at noon and stay until 1 o'clock so we could present and hear cases in a room we have set up with audiovisual equipment. Often, they're not odd or unique cases, but for the patient's benefit, we're getting opinions from everyone at the table. We all have our niche. For example, Dr. Eric Amundson handles particularly complex and elaborate spinal reconstructions. Holding these meetings is such a simple and obvious thing, but it wasn't being done by any of our individual practices, mainly because it requires a critical mass."

NS2's program is working especially well for Flowood's River Oaks Hospital, a Health Management Associates (HMA) facility that Healthgrades recently named Mississippi's leading spine surgery hospital and one of the top 5 percent of spine surgery hospitals nationwide. NewSouth surgeons performed 99 percent of the surveyed surgeries during the study.

"I believe we've been successful," theorized Moriarity, "because we do treat each patient as we would want our loved ones treated."

Rounding Out the Practice

NewSouth NeuroSpine's Interventional Pain Medicine Division specializes in the performance of minimally invasive procedures—joint and spine injections, for example—that are used both diagnostically and therapeutically, with the goal of improving a patient's pain and allowing an accelerated return to normal function.

"The advantages of a large multi-specialty practice include being able to address different facets of a patient's chronic pain problem simultaneously," said Jeff Summers, MD. "Rarely do patients with chronic pain have a single pain generator that accounts for all of the disabling aspects of their condition. For example, patients with painful degenerative disc problems often have back pain, radiating nerve pain, gait disturbances and severe deconditioning. Often, addressing only a single component of the problem does little to improve the patient's functional level. Coordinating therapeutic injections, for example, with a tailored rehab program allows the patient to take advantage of any pain relief from the injections to perform more aggressively in therapy. This often results in an accelerated improvement in function and allows a rapid return to pre-injury lifestyle."

Both interventional pain specialists are fellowship-trained in pain management and are involved in national pain management societies. Laseter received fellowship training at the Cleveland Clinic and serves on the guideline committee for the International Spine Intervention Society. Summers was trained at the University of Texas Health Science Center, and had an additional fellowship in advanced pain management and research at the Walton Centre for Neurology and Neurosurgery in Walton, England. He serves on the research committee and board of directors for the International Spine Intervention Society, and is an instructor in advanced pain management procedures for multiple spine societies.