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These cost savings may be realized through drastically decreased reliance on Urgent Care and Emergency Room visits, unnecessary diagnostic testing, and rapid progression through the various treatment protocols. The case management model will also incorporate the patient’s individual preferences regarding less expensive and Alternative Medicine-type modalities that show promise, such as acupuncture and massage therapy. Managed properly, this model should result in both improved patient outcomes and reduced healthcare costs. Did you know that approximately 80% of the population will suffer from debilitating back pain at some time in their life? The resultant direct health care costs including doctor and emergency room visits, medications, Physical Therapy, Chiropractic, and interventional procedures are estimated at a staggering $90 billion. And they are increasing. The associated costs of related medical problems, disability, lost productivity, family issues, substance abuse, and decreased quality of life spike the cost burden well above $100 billion. While there is documented concern about these costs on a daily basis throughout the country, there is, unfortunately, a tremendous amount of confusion in both the medical and lay communities as to the best approach to treat back pain. Research shows that nearly everyone will develop radiographic evidence of Degenerative Disc Disease of the Lumbar Spine (meaning the spine is breaking down) over the course of a normal lifespan. This suggests that lumbar spine “issues” should be considered a normal part of aging and managed as such, as opposed to the traditional approach of ad hoc interventional measures. This means that people need to manage their spine health in the same way they need to manage their weight and cardiovascular health. It is important to regularly address spine health as a component of overall health including cardiovascular fitness, exercise, diet and lifestyle, instead of patients seeking care when they cannot stand the pain anymore. The annual incidence of debilitating low back pain ranges from 10-20% of the population, and this only reflects the patients that present in some manner to the health care system. The actual numbers may be even higher, and when family, coworkers, and others are taken into account the number of people affected in some way by back pain is astounding. In addition to the exorbitant costs associated with back pain, there is some evidence that this money is actually producing diminishing returns, as recent studies have shown that while the cost of care is rising, the percentage of people improving, or satisfied with their care, is decreasing. Clearly, despite increasing financial constraints, the system needs to be improved, and patients better served. One of the biggest challenges facing patients with back pain is that their care is directly related to who they see first. Their management is clearly different if they initially present to a Chiropractor versus a Family Doctor versus a Pain Management Specialist. The time over which a patient is treated conservatively, to when they are referred for diagnostic imaging, to when (and if) they are referred for or offered more aggressive treatment varies greatly. There is also tremendous variation in the treatments offered based on where patients live, as there are significant regional differences in the United States in the amount of spine surgery performed. Further, there is significantly more spine surgery performed in the United States than anywhere else in the world. These discrepancies are not explained by differences in patients presenting with spine related pain. However, there is no significant difference in the outcomes of treatment in the United States as compared to other countries, so the higher rate of surgical interventions does not result in better care. In fact, when one takes into account the data that suggests that spine surgeries in general and spinal fusions in particular, accelerate the degenerative process, it can be argued that the higher rate of surgery is actually doing more harm than good. Spine surgery does seem to provide initial relief from back pain, although there may be little to no long term benefit. Therefore, if surgical intervention is coupled with psychological assessments, aggressive rehabilitation, and lifestyle changes the result may well be improved long term outcomes. Traditional spine surgery is typically not even offered until patients have failed months of conservative care, and then requires weeks to months of recovery. The protracted timeline of this course is one of the principal reasons why back pain patients experience so many associated problems. Much of this can be avoided when minimally invasive procedures such as the AccuraScope™ procedure, performed exclusively by North American Spine, are part of the paradigm because they can be offered much earlier and promote much faster recovery, and thus result in an expedited return to normal function. Some providers are moving toward the multi-disciplinary approach in order to ensure that patients follow a logical course of treatments along the continuum of care. These programs may include specialists in fields as wide-ranging as nutrition, personal training, massage, physical therapy & chiropractic care and may include physicians trained in fields like interventional pain, orthopedics and neurosurgery. Such programs typically use a point person with some clinical training -- physical therapists or chiropractors in many cases -- to work with patients from the onset of their spine-related pain problem. In these programs, patients receive an initial assessment from a “Patient Advocate” over the phone, at their home, or possibly in conjunction with a more formal assessment by one of the patient’s existing healthcare providers. The Advocate will communicate with the medical team to help assess if the patient even needs to go to an Urgent or Emergency Care facility. They are generally trained to assess whether the patient may or may not benefit from Chiropractic care, or other alternative medicine modalities. Depending on the situation, the Advocate can coordinate care with Pain Management Physicians, and Physical Therapists, who work within previously agreed upon treatment protocols. If the patients improve, they can continue to work with the Advocate in an ongoing exercise and nutritional program. If they do not improve in an expeditious manner, then the patients will be referred for more aggressive treatments including minimally invasive options such as the AccuraScope™ procedure. Finally, depending on need and their response to more conservative treatments, patients may be referred for traditional spine surgeries or other aggressive treatments. Regardless of the outcome of any intervention, the Advocate may continue to work with the patient for ongoing rehabilitation, exercise, and nutritional guidance. There is a clear need to help patients navigate the system. More and more providers are moving toward a comprehensive, individualized approach designed to ensure that patients are cared for from the initial onset of an acute problem, through conservative management, possible interventional procedures, and then recovery, rehabilitation and prevention. The future for sufferers of back pain will be brighter if the health care system responds with a case management approach, better care, improved medical procedures and reduced costs. Significant improvement is possible in the not too distant future if we start today. http://northamericanspine.com Pioneered the AccuraScope procedure Lawrence B. Rothstein, M.D. Education: Lawrence B. Rothstein is a graduate of Miami University, Oxford, Ohio and The Ohio State University School of Medicine. He completed his internship, residency in Anesthesia, and fellowship in Interventional Pain Management at the Cleveland Clinic where he was named Chief Fellow. He is board certified in Anesthesia and Pain Medicine. Subscribe to our FREE Ezine and be eligible for Health News, discounted products/services and coupons related to your Health. We publish 24/7. HealthNewsDigest.com We videotape Press Conferences, produce Satellite MediaTour's, B-rolls, PSA's, - all with distribution: HealthyTelevisionProductionstvmike13@healthnewsdigest.com Top of Page 
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