What is a Spine Center of Excellence?

Introduction: Spine center of excellence (COE) designation is not uncommon; however, there are no
standardized regulations governing their designation. Formal accreditation is not required and
may be provided by multiple independent organizations. This heterogeneity generates confusion
for both patients and insurance providers, as COEs may differ significantly in their
qualifications, quality of care, and services provided.

Methods: Accreditation requirements were compared across four spine COE-certifying organizations: The
Joint Commission (TJC), Det Norske Veritas (DNV), Aetna, and Blue Cross Blue Shield
(BCBS). 194 COEs in Northeast America were identified via online search and compared based
on accreditations held (if any), services provided, and characteristics.

Results: Numerous similarities exist between accreditation requirements, although DNV required more
thorough data reporting overall. Aetna and BCBS built upon existing requirements of TJC or
DNV to varying degrees (with BCBS being more comprehensive) and reserved accreditation for
facilities within their respective networks. Of all COEs, 56% were accredited, primarily by
BCBS; however, many COEs reported more than one accreditation. Accredited centers involved
neurological surgeons, offered multidisciplinary care, and were affiliated with academic centers
at a significantly higher rate than non-accredited centers. Additionally, accredited centers were
closer to metropolitan centers and employed a larger number of providers. COEs, regardless of
accreditation, reported providing non-surgical treatment, minimally invasive surgery, and
physical therapy at similar rates. In a logistic regression model, employing neurosurgeons and
affiliation with academic medical centers were predictive of formal accreditation.

Conclusion : Although accredited centers reported certain characteristics at higher rates than non-accredited
centers, variability between accreditation requirements and similarity between COEs, regardless
of formal accreditation status, serve as potential points of confusion for prospective
patients. While this study generates a preliminary profile of the Northeast spine COE, our
findings reinforce the need for a standardized set of guidelines for spine COE designation.