A few weeks ago, I blogged about our San Diego medical consultation center - LSI's first of four medical offices in the U.S. During the first year of the San Diego office, we noticed many patients were traveling from the Los Angeles area to meet with Dr. Richley and learn about LSI's endoscopic approach to spine surgery. In fall of 2009, we opened a Los Angeles medical consultation facility in Beverly Hills.

What I have learned over the last year about the west coast from traveling to our medical offices and attending many seminars throughout the great state of California is that California residents truly enjoy life and won't let anything affect their lifestyle. I completely understand because there are so many things to enjoy in California; hiking, biking, skiing, surfing, driving along the coast, dining at many fine restaurants and traveling to various parts of the state from San Francisco and Napa Valley to the desert of Palm Springs. I have traveled throughout California and loved every region. If you are a California resident, I don't blame you for enjoying every minute!

If you live an active lifestyle, but are faced with chronic back or neck pain, don't suffer any longer. Let me know what conservative treatments you have tried and how they have worked for you.

The infection preventionists at Laser Spine Institute have designed a coordinated infection prevention and control program to protect everyone who comes into the facility, including patients, healthcare workers and the public. Here are the steps we have taken at Laser Spine Institute to reduce the risk of infection.

Our program incorporates evidence-based practices from leading authorities in infection prevention including the Centers for Disease Control and Prevention (CDC) and the Association for Professionals in Infection Control and Epidemiology (APIC). In addition, we comply with regulations from government agencies such as the state and local health departments, the Occupational Safety and Health Administration (OHSHA) and the Centers for Medicare and Medicaid Services (CMS), as well as accrediting bodies, such as the American Association of Ambulatory Healthcare.

The essential elements of an infection prevention and control program to prevent healthcare-associated infections include:

• Rigorous hand hygiene practices that ensure healthcare providers clean their hands before and after providing patient care and after having contact with the patient's environment.
• Patients as well as visitors need to practice good hand hygiene.  We encourage our patients to be partners in their care and talk with their healthcare providers about hand hygiene.
• Use of barrier precautions, such as gloves, gowns, masks, caps, etc. by healthcare workers and visitors.
• Separating patients with serious infections from other patients to prevent the transmission of infection.
• Proper disinfection of the patient's skin prior to surgical procedures.
• Environmental cleaning and decontamination of equipment, especially items that are frequently touched or are close to patients, such as bedrails and bedside equipment.
• Monitoring the cleaning, disinfection and sterilization of instruments and equipment used for patient care.
• Staff education on best practices to prevent infections including the spread of resistant organisms such as MRSA (Methacillin Resistant Staph Aureous) and VRE (Vancomycin Resistant Enterococci).
• Sharing information with patients and families so they understand the importance of infection prevention practices in all healthcare settings and at home.

In order to ensure patient safety, the medical team is trained to identify any breaks in infection prevention and control practices and prepared to intervene, if such breaks are identified.

I am pleased to hear that our patients have truly benefited from a visit to one of our medical consultation centers. Since 2005, we have offered several different ways for patients to discuss their diagnosis and symptoms whether over the phone or at a seminar. Our new medical offices offer a different dynamic to the Laser Spine Institute consultation for chronic back and neck pain sufferers. In July 2008, we entered our first consultation market in beautiful San Diego, which is truly one of my favorite places to visit. Please allow me to share the LSI San Diego story with you.

Dr. Richard C. Richley, our managing physician in California, has been practicing in San Diego as a board-certified orthopedic surgeon and pioneer of minimally invasive spine surgery for over 34 years.  After his service in the U.S. Army Security Agency and four years of playing football for The Ohio State University, where he graduated from medical school, Dr. Richley came to San Diego for his residency at the University of California San Diego.

In 1976, Dr. Richley started his practice before opening his Point Loma office in 1991. Nestled in the historical seaside community of San Diego, Dr. Richley grew his orthopedic practice through community involvement, love for local sports teams and philanthropic work on the Arthritis Foundation Board of Directors. He also served as a doctor with the Chargers and team physician for the Padres and U.S. Olympics. In the early 90's, Dr. Richley focused on new laser technology used in orthopedic medicine. He invited surgeons to learn new laser procedures and traveled the world to help apply the techniques within their practice.

In 2008, we were fortunate to add Dr. Richley to our medical team and adapt his practice to our first medical center. He now heads the LSI San Diego and Beverly Hills medical offices as well as travels the western U.S. and Canada to educate back pain sufferers on the anatomy of the spine, treatment options and Laser Spine Institute advanced procedures.

When you meet Dr. Richley, he will conduct a thorough medical examination and orthopedic assessment to understand the pain you're experiencing. Then, he will review your MRI films or CT scans to pinpoint the causes of your suffering, and explain how our advanced approach will get you relief. As he often reminds me about San Diego, "there's a little bit of ocean breeze and a lot of sunshine, not to mention the caring staff that has been with me for years offering patients a comfortable and engaging environment." And I have to agree it is one of the best places on Earth.

I think it is safe to say we expect the healthcare industry to provide the best care available. With higher insurance coverage, out-of-pocket expenses and prescription drug costs, why shouldn't we also expect the best service by our chosen healthcare providers?

Taking into consideration my personal medical and surgical experiences, I have made a commitment to deliver the best service and exceed expectations of our patients here at Laser Spine Institute. Not only do we treat our patients and their loved ones like family during their journey with us but we remain in constant contact after they return home.

Our patient services team is devoted to each patient keeping an eye and ear open throughout their recovery for weeks to years after their procedure. This dedicated team provides support to patients who have post-operative questions about anything from caring for their incision area to returning to the activities that they love. Their goal is to help each and every patient achieve a successful recovery and get their lives back. We are proud to share in each patient's experience every step of the way.

Many patients want to be vigilant and proactive in choosing a healthcare provider, but are uncertain of where or how they can access credible information.  Filtering through the cloud of information is often both tedious and confusing for patients. So, what is the alternative? Whenever patients ask me this question, the best advice I can provide is to verify the provider's practice history and credentials through independent and reliable sources, such as local departments of health websites or hotlines. Examples of questions you should ask or factors you should consider are as follows:

•    Has the provider's medical license been suspended or revoked due to negligence or
     medical malpractice?
•    Has any disciplinary action been taken against the facility or its providers?
•    Does the provider practice transparency, i.e., do they provide a forum through which
     patients can publicly voice their concerns, opinions, and experience, and interact with
     existing and former patients?
•    Does the provider have a referral list with a reasonable number of patients? For example, if
     the facility claims to perform 30,000 procedures, but can only offer a list with 10 patients,
     then you should probably be skeptical and do further research.
•    Does the provider focus on criticizing other providers, rather than justifying their value on
     the basis of merit and success? If so, this is a propagandistic technique known as
     diversion and you should exercise caution when this approach is taken.

Please note that the list I have provided is by no means exhaustive, but it can be used as a starting point or guide.  Remember, there are inherent risks involved with any surgery, but these risks can often be mitigated, or in some cases eliminated. As such, you should always exercise due diligence when selecting a provider.  

At Laser Spine Institute, we can determine a patient's total upfront cost after we verify their current insurance coverage.  We strive to make our surgical procedures as affordable as possible with hopes of alleviating as much back and neck pain as possible.  Through this effort, LSI has partnered with a few new insurance carriers, including United Health Care & affiliates, and also has the opportunity to lower our Medicare pricing.  With these new agreements in place, moving forward in 2010 - LSI patients will experience the same state of the art, highest level of medical treatment available, with lower cost and commitments.   


With regard to payment plans for those patients with upfront cost, LSI has established relationships with a few national healthcare finance companies that offer affordable monthly payments.  And, while most financial lenders are currently restricting available credit, LSI has actually seen an increase in the average credit line approval.

This type of financing is a great option, but not necessarily the best for everyone. I recommend first looking into your personal resources, for instance:
 
1) Retirement/savings accounts (i.e. 401(K), IRA...)
2) FSA (Flexible Spending Account) - medical payment plan offered by your employer
3) The equity built in your home (i.e. Home Equity Loan, Reverse Mortgage, and Refinance & Consolidate Debt)

Even though the economy has tightened, these are viable options offering the lowest interest rates. For example, it is realistic to find a Home Equity Loan for 4 to 6 percent because the current Prime Rate is at all-time lows. If equity is not available, you may want to take advantage of your 401(K) or IRA funds. A majority of finance companies are offering loans penalty-free from a retirement account. This type of loan provides a greater return than the current average retirement plan.

It is my goal to help patients gain a better understanding of the programs, specifically created to offset any additional healthcare expenses after insurance reimbursement and tailor the right solution for each patient.

Minimally invasive spine surgery succeeds in large part due to the skill and experience of our surgeons in identifying the primary target in the spine responsible for the pain and selectively decompressing the nerve in that spot. Once the patient is evaluated and examined and the MRI is reviewed, the need for a diagnostic test will be considered.

Spine Treatment: More Than Meets the Eye

Conventional imaging studies such as an MRI, provide the foundation of the surgical order, however, often, the MRI shows abnormalities that are in fact asymptomatic.  Careful assessment of patients' symptoms and comparing them to the imaging study usually allow the surgeon to plan the operation only on necessary areas.  However, in some patients, the MRI is inconclusive in appearance. In those cases, selective pre-operative diagnostic injections are ordered.

 For patients with primarily neck or lower back pain, the MRI may not fully identify the exact area causing pain, as some spine conditions result from microscopic injury or disease.  In those cases, diagnostic injections can locate the areas of pain and allow surgery to be performed on the correct area based upon knowledge of those unseen, but now understood abnormalities.


Selective Nerve Root Block (SNRB)

For patients with the appearance of more than one area of nerve root compression, there may be a role for a selective nerve root injection.  In this test, the suspected nerve root is identified and then "blocked" using x-ray guided placement of an anesthetic agent (lidocaine) to determine what symptoms are resulting from that area of compression.  The immediate relief is reported in a percentage of reduction in pain and those results are then used to develop the final surgical order.  In cases, the results are negative or no relief and a second area may need testing.  In other cases, it may be determined that more than one area is involved and so may require additional surgery at a later date.

In part three, we will discuss additional diagnostic tests and explain what happens during these procedures.

Dr. Robert Gruber is the Director of Spinal Diagnostics and Therapeutics at Laser Spine Institute. Click here to learn more.

I am pleased to announce that we have partnered with United Healthcare. This new development will allow many more persons suffering from back and neck pain to access some of the most innovative spine procedures available.  Over the past year, I have communicated with many of you about the state of our current healthcare system and the challenges we face.  However, most of us can agree that our focus must be on creating solutions, though sometimes difficult to attain and often isn't achieved quickly. Today marks an exciting milestone in Laser Spine Institute's history and symbolizes a new horizon for those of you who are seeking relief through minimally invasive surgical options.

LSI's surgical team is committed to providing the most effective treatment to our patients. In order to do so, we conduct an extremely thorough evaluation process before performing surgery. One important aspect of our evaluation process is our diagnostic testing. The purpose of diagnostic testing is to identify and isolate the specific source of pain in a particular area, allowing our surgeons to provide the most appropriate and effective treatment for each patient's spine condition.

Examples of diagnostic tests performed at Laser Spine Institute include: selective nerve root block (SNRB), discogram and diagnostic facet injections. In part two of this post, our surgeons will provide detailed information about each procedure. Among the topics that will be discussed are as follows:
 
•    Instances in which each test is ordered and performed
•    How is each test performed?
•    What can patients expect during and after the procedure?

Please feel free to submit questions, whether specifically related to diagnostic testing or general spine procedures that you would like our surgeons to address in part two of this post.  While all questions will be addressed, we learn from each other, so it would be beneficial to click the Submit Questions link above to make your question visible to everyone, rather than clicking the Contact Bill Horne tab, which defaults to my personal email.

By now, readers of my blog, employees, and colleagues know how much I value doing the right thing. I received the email below from a prospective patient and cannot recall experiencing a greater sense of pride than I did when I read her comments.

Earning customer trust and confidence is not the easiest task, especially where health care services are concerned. Without the dedication and commitment of LSI's phenomenal staff and your continuous feedback through emails and comments, accomplishing this feat would not be possible. Both components have been essential attaining our goal of providing our patients the highest level of service.
 
Please feel free to comment on this post and share your experience, whether at LSI or other health care facilities.

Dear Bill:

I contacted the Laser Spine Institute a few weeks ago and found out I was a candidate for cervical surgery.  I was so excited and worked with a wonderful patient advocate, Casey Sanders.  I was put in touch with a nurse, Dee, because I am a coumadin and plavix patient because I am positive for Factor II and my body makes blood clots.  I got clearance from my blood specialist and he sent all the information down.

After three of your anesthesiologists looked at
my records they all agreed that the risk was too high that I could have substantial visual loss from possible blood clots. (that is where my blood clots tend to go, the retinal arteries.)  They told me I was not a candidate for ambulatory surgery and should consider a hospital setting where I can be carefully monitored.

I have to tell you that I am in extreme pain, so I was very disappointed with the news. But I have a lot of respect for your facility and the doctors who put my best interest first.  They did not try to do surgery in a situation that could have put me in a lot of
danger.

So I just wanted to tell you how impressed I am with your facility, the physicians who made the decision, Casey Sanders and Dee, my nurse.  I wish the Laser Spine Institute the best in the opening of their new facilities and would recommend them to anyone.

Sincerely,
Crystal R.