Sep 19th 2022

Q&A with Chief of Musculoskeletal Programs

Q&A: eviCore’s Chief of Musculoskeletal Programs on the Need for Evidence-Based Care for Muscles, Bones & Joints

Dr. Robert Westergan, a board-certified orthopedic surgeon, is Associate Chief Medical Officer of Connected Musculoskeletal (MSK) Solutions at eviCore. His team of 100+ surgeons, physicians, chiropractors and therapists makes sure patients get care for their muscles, bones and joints that aligns with the latest medical science. Dr. Westergan has more than 27 years of practice experience in both academic and community settings. We sat down with him to learn more about the MSK program.

Why is eviCore’s MSK Solution Important?

MSK disorders impact muscles, bones, and joints. Every year, more than half of adults – and nearly three-quarters of people over 65 – are impacted by MSK conditions.  Unfortunately, though, 25% to 40% of the care people get for MSK conditions is wasteful or ineffective.  That means the treatment doesn’t follow current evidence-based medical guidelines, and it’s unlikely to help them get better. That’s where we come in. We apply evidence-based guidelines to make sure patients get MSK care that matches up with the latest medical science.

What Kind of MSK Care is eviCore Focused on?

We focus on four main categories of MSK care: therapies, pain management, surgery and implants. Therapies include massage, acupuncture, chiropractic, physical/occupational and speech therapy. The pain management piece helps people suffering from chronic pain. Surgery includes joint and spine procedures, and implant management is around procedures like knee and hip replacements.

What Can Happen to Patients if They Don’t Get MSK Care That’s Evidence-Based?

When a patient doesn’t get the treatment they need, they’re in pain longer, and it costs them time and money – in unnecessary co-pays and other medical expenses, as well as time away from work and family. In fact, people living with MSK conditions lose an average of 10 workdays every year, which is more than for any other major health condition. 

For example, back problems are the third most common reason people go to the doctor.  Many providers jump straight to imaging like an MRI, but evidence-based guidance from the American Academy of Family Physicians, North American Spine Society and other medical societies all say to wait six weeks.  When conservative care is used to treat lower back pain before imaging, the patient is three times less likely to have surgery and the cost is six times lower. 

Our team also looks at the whole patient to understand any medical or behavioral health challenges that might need to be addressed before undergoing an MSK procedure. For example, if a patient’s diabetes is unmanaged, we’ll alert their physician so the patient can receive important diabetes care before surgery. When necessary, we’ll help enroll patients in a disease management program to address other health needs.  

Doesn’t the Doctor Know What Care is Needed for Their Patient? 

The truth is that medical knowledge is exploding so fast that it’s impossible for providers to keep up with all the new information. In 1950, it took 50 years to double medical knowledge. In 2010, it took 3.5 years. In 2020, it was estimated to be 73 days. On top of that, a study found that physicians only retained about 50% of basic science just two years after medical school. This creates knowledge gaps for even the most talented physicians.

An initiative called Choosing Wisely was launched launched in 2012 to try to address this problem by educating providers and patients about avoiding unnecessary tests, treatments, and procedures through educational efforts. Unfortunately, though, Choosing Wisely hasn’t put a meaningful dent in reducing the number of low-value health services.  That’s why the work we do is so important. Our evidence-based clinical guidelines are used to help ensure that the MSK care patients receive is evidence-based, which means they get better outcomes, including reduced pain and increased function and mobility.

How Does eviCore Make Decisions That Align With Medical Best Practices?

I’ve referenced our guidelines a few times. They’re based on information from numerous medical societies like the American College of Radiology, as well as recently published, peer-reviewed medical studies. The guidelines are created by physicians who are appropriately specialized, and they’re reviewed by external experts. Our guidelines are updated at least twice a year and are available to anyone by visiting eviCore’s website

We use the guidelines to help determine the appropriateness of a requested MSK test or treatment or, in many cases, whether there’s a more fitting alternative recommendation. For example, for a patient with back pain, the evidence may not recommend an MRI, but it might suggest physical therapy.

Who Makes Decisions at eviCore?

eviCore has a team of more than 450 board-certified physicians and over 1,000 nurses with experience across multiple specialties. Our MSK team alone has more than 100 surgeons, physicians, chiropractors and therapists Their job is to help ensure better outcomes for patients. Only a physician can make the determination that a request does not meet the evidence-based guidelines. 

How Are You Helping Make Sure Patients Get the Care They Need Quickly?

We’ve invested a lot of time and resources in streamlining and automating our processes to help make the role we play as seamless as possible. Specifically for our MSK programs, we’ve implemented a program called corePath, which has increased the number of visits that are pre-approved for an initial physical or occupational therapy request. This improvement reduces the number of times the provider’s office needs to interact with eviCore and ensures the patient gets quicker access to care.

You can learn more about eviCore’s Musculoskeletal solution on our website.

 

 

References 

[1] Orthopaedic Research Society, “Burden of Musculoskeletal Disease,” https://www.ors.org/burden-of-disease/. Accessed 15 Jul 2022.

[2] Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, García L, Herrera-Espiñeira C. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010 Oct 26;11:249. doi: 10.1186/1471-2474-11-249. PMID: 20977745; PMCID: PMC2987974.

[3] United States Bone and Joint Initiative, “The Burden of Musculoskeletal Disease in the United States,” https://www.boneandjointburden.org/fourth-edition/id2/lost-work-days. Accessed 22 Jul 2022.

[4] St Sauver JL, Warner DO, Yawn BP, Jacobson DJ, McGree ME, Pankratz JJ, Melton LJ 3rd, Roger VL, Ebbert JO, Rocca WA. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013 Jan;88(1):56-67. doi: 10.1016/j.mayocp.2012.08.020. PMID: 23274019; PMCID: PMC3564521.

[5] Choosing Wisely, “Imaging for Nonspecific Low Back Pain,” https://www.choosingwisely.org/wp-content/uploads/2015/05/ICER_Low-Back-Pain.pdf. Accessed 15 Jul 2022.

[6] eviCore analysis of blinded payer-based medical claims data source

[7] Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.

[8] K2P, “How Much Knowledge Do Physicians Lose over Time?, https://k2p.com/posts/medical-knowledge-lost-over-time/. Accessed 1 Sept 2022.

[9] Cliff BQ, Avanceña ALV, Hirth RA, Lee SD. The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review. Milbank Q. 2021 Dec;99(4):1024-1058. doi: 10.1111/1468-0009.12531. Epub 2021 Aug 17. PMID: 34402553; PMCID: PMC8718584.