Value-Based Fellowship in Spine and Musculoskeletal Medicine

OVERVIEW

Program Director: Christopher Standaert, MD
Current Fellow: Joseph Shivers, MD
 
The goal of this unique fellowship is to train physiatrists in the advanced management of spine and musculoskeletal conditions and to develop leaders in value-driven care. Clinical expertise is honed through work in novel interdisciplinary PM&R outpatient clinics and rotations with multiple other specialties. The fellow is actively engaged in the growth of alternative payment and care structures and meets regularly with leaders from the UPMC Health Plan to gain a working knowledge of value-based care, payment structures, coverage policy, and health plan operations. 
The core clinical training experiences occur within the Program for Spine Health and the Musculoskeletal Total Home, both of which are patient-centered, physiatry-led, interdisciplinary teams designed to help patients with back and joint pain achieve better function and greater autonomy. Through these programs, patients have access to expert physical therapists, a pain psychologist, a nutritionist, and a health coach. The Program for Spine Health is community-based, with multiple locations in greater Pittsburgh. The Musculoskeletal Total Home is on the campus of UPMC’s flagship Presbyterian Hospital.
 
A unique aspect of this fellowship is payer and provider collaboration within UPMC, a $23 billion system whose Insurance Services Division offers a full range of products and services to more than 3.9 million members. Through real-life care models, leaders from the Insurance Services Division teach the fellow about health systems, payment policy, benchmarking, value-based payments, and health care transformation. The opportunities to work in alternative payment and delivery structures, and to use this knowledge to develop care teams such as the Program for Spine Health, provide one-of-kind training for success in our rapidly evolving health care environment.
 
This type of training is not available anywhere else within the US, and fellows will have a unique capacity to develop and work in value-based care structures. They also will have the ability to work across departments and service lines to help deliver and define optimal care. Procedural skills are not a primary focus of this fellowship. However, as this is not an ACGME accredited fellowship, there is the capacity to address individual priorities or skills of interest. Additional training and development in electrodiagnosis are both available and encouraged. 
 
The fellowship also involves direct clinical learning from faculty in other disciplines of spine and musculoskeletal care, including:
  • Neuroradiology
  • Musculoskeletal Radiology
  • Neurosurgery
  • Orthopedic Surgery
  • Physical Therapy
  • Rheumatology
  • Pain Medicine
  • Addiction Medicine
  • Neurology

CORE COMPETENCIES

  • Diagnosis, prognosis, and clinical reasoning across the range of acute and chronic conditions in ambulatory spine and musculoskeletal care, with an understanding of the natural history of those conditions, built on a foundation of anatomy, biomechanics, and psychology
  • Communication with patients that is empathetic, curious, honest, knowledgeable, confident, nuanced, motivational, and framed around each patient’s own goals and values
  • Communication with staff and interdisciplinary colleagues that is respectful, collaborative, and geared toward the shared aim of providing better and better patient care
  • Interpretation of relevant diagnostic studies including plain films, computed tomography, magnetic resonance imaging, and nerve conduction studies / electromyography
  • Interpretation of scientific literature with appreciation of both internal and external validity, familiarity with key clinical trials, awareness of common cognitive bias, alertness to conflicts of interest, and a passion for translating data into clinical shared decision-making
  • Working knowledge of value-based care models and other alternative payment structures, as well as traditional insurance models, strategies, and practices
 
EDUCATIONAL OPPORTUNIES
 
Structured educational opportunities include:
  • Weekly journal review with Dr. Standaert
  • Weekly interdisciplinary meetings within the Program for Spine Health
  • Weekly orthopedic spine didactics
  • Neurosurgical spine case conferences, twice per month
  • Bi-monthly neuroradiology spine case conferences
  • Department of PM&R grand rounds (Panther Rehab Rounds)
  • Participation in the University of Pittsburgh’s intensive training program for physical therapists and chiropractors to become Primary Spine Practitioners, with sessions held four weekends per year
  • Primary Spine Practitioner Grand Rounds
The weekly schedule includes 1.5 days of protected non-clinical time, to allow for participation in relevant meetings, reading, writing, and research. There is encouragement and support to attend national conferences and to seek ongoing instruction beyond UPMC.