Craniofacial Team of Texas Philosophy

The Craniofacial Center of Texas has a singular focus, provide the highest value craniofacial care available in the US.

Value = Quality/Cost

We do not think it is enough to provide high quality care; it must be affordable as well. Currently, the number one cause of bankruptcy in the United States is related to medical bills. This is a particular concern for families with special needs children. We have made great strides over the last decade to constantly improve the quality and consistency of work that we provide, and more recently we are working hard to untangle the complexities of the financial world of medicine to bring care to our patients in simple-to-understand, transparent, affordable payment systems.

Philosophy of Care

The philosophy of the Craniofacial Team of Texas is based on the old saying, “two heads are better than one.” This means that complex problems are best handled by bringing all the specialists together for diagnosis, treatment planning, and execution of treatment plans . We realize this through our team-based care model and culture. The team believes that the complex functions of the craniofacial region can only be properly diagnosed and treated by the array of specialists that focus on this very complex region of the body. Our team includes specialists in craniofacial surgery, pediatric otorhinolaryngology, pediatric neurosurgery, craniofacial/cleft speech pathology, craniofacial orthodontics, physician assistants, and coordinators. Every patient treated by the Craniofacial Team of Texas has all of these specialists at their disposal. The Craniofacial Team of Texas operates under the tenets of the American Cleft Palate-Cranio facial Association (ACPA), which is the only organization in the US that creates standards and certifies organizations as teams. The ACPA standards are intended to improve care for craniofacial patients through the creation of a platform for coordinated care that strives to maximize outcomes and efficiency by coalescing resources and services into systems of care. There are other specialists in the region and state who provide care and perform procedures for patients with cleft lip and palate, as well as other craniofacial procedures. Few provide team-based care like the Craniofacial Team of Texas.

Our goal is to make our clinics and clinical encounters as efficient and comprehensive as possible. We understand that all families are very busy, and those with a child that needs special medical care are extremely busy. We strive to provide all the specialists that the patient needs at every encounter. The patient and family usually stay in one place and the specialists come to them, avoiding the need to run around to multiple clinics and appointments as much as possible. We also know that medical care is expensive so we make every effort to limit unnecessary care whenever possible. Our multidisciplinary clinics are followed by team conferences where patients are reviewed by all the specialists to ensure comprehensive information gathering, discussion, coordination, and decision-making. The Craniofacial Team of Texas uses multidisciplinary conferences to support decision-making regarding a number of diagnoses (see Multidisciplinary Care). Examples include the cleft conference, craniofacial conference, complex surgical planning conference, complex airway conference, and vascular malformation clinic case conferencing. These conferences ensure that the medical decisions regarding your child’s care are the most advanced and have been validated and coordinated by a number of experts to ensure the best care possible.

Commitment

Our focus is craniofacial and cleft care. Our specialists demonstrate a full time commitment to craniofacial and cleft lip and palate diagnoses. Our craniofacial surgeons do not perform cosmetic surgery or focus on other areas of plastic and reconstructive surgery. They focus their full energies on constantly improving the quality of care they provide and ensuring that the Craniofacial Team of Texas is capable of offering the patients every service needed to live the fullest life possible. They avoid the distractions of running a business in other areas of plastic surgery that draws their attention and focus away from craniofacial and cleft lip and palate. Often craniofacial and cleft diagnoses extend into adulthood; and the Craniofacial Team of Texas remains committed to our patients by providing a seamless transition of care to an adult clinic where again our surgeons and staff are focused on the provision of high quality craniofacial and cleft care.

Our commitment and focus has led to a number of achievements in this very complicated field of medicine. Members of the Craniofacial Team of Texas pioneered the discovery and implementation of “low radiation dose” imaging protocols in the diagnosis and surveillance of craniofacial disorders like craniosynostosis that are now standard of care across the country. Concerned about the high dose of radiation exposure occurring in routine CT imaging, we worked with the radiologists at Austin Radiological Association (ARA) to lower the dose to a range consistent with the dose that a person gets every day from living on the planet Earth. Our team members have also been national pioneers in the development and implementation of virtual surgical planning. This includes clinical transfer of the virtual surgical plan to the operating room to create and refine new strategies to treat very complex craniofacial disorders that have had historically poor solutions. Members of the Craniofacial Team of Texas have performed more virtually-planned congenital cases than any other center in the country through its close collaboration with the Medical Modeling Corp (now 3D systems, Golden Colorado).

Our team members are active within national societies, often serving leadership roles within these organizations (American Cleft Palate-Craniofacial Assoc., American Society of Maxillofacial Surgeons, American Society of Craniofacial Surgeons, American Society of Plastic Surgeons) that are committed to advancing the quality of care offered to this group of patients. We actively attend the meetings where the leading edge of innovation in care and techniques is discussed and debated, keeping our providers on the front edge of delivery. Our providers continue to actively innovate, presenting our discovery and research in the medical literature and at the national forums.

Outcomes

Medicine is one of the few industries where the buyer really has no way of determining the quality of their results of their providers or facilities prior to their care. Providers and hospitals have been completely reluctant to provide patients with even the most basic data for patients to make quality decisions, citing the lack of proper disease-specific outcomes and performance metrics and patient risk factor adjustments. While it is true that many of the diseases, especially those with lower occurrence, lack consensus outcomes metrics, providers and hospitals have hidden behind this and the perverse financial incentives for bad care and complications for too long.

There is a general movement across the country that is changing this, a quality initiative led by pioneering physicians. This effort has been pioneered and championed by organizations like the Society of Thoracic Surgeons (STS), American College of Surgeons (ACS), International Consortium of Health Outcomes Metrics (ICHOMS), among many others. And it is now gaining steam. Medicare is now requiring hospitals that accept Medicare or Medicaid payments to publish on a limited set of performance metrics, and it is planning to expand the list in years to come.

While the above initiatives are important to help determine whether the hospital you are considering is a generally safe place to receive care, it does little to help a patient determine whether a specific doctor, group of doctors, or facility will provide high quality care for their specific condition. Unfortunately, we are still fairly far away from that. So how does a patient get information on the quality of work of their provider?

According to Marty Makary, MD, author of the revolutionary book, “Unaccountable”, there are really only two surrogates in today’s world for quality outcomes. One of the most important indicators of high quality care is teamwork (or team-based care). Team-based care supports a level of collaboration, transparency, and quality improvement superior to the traditional independent physician model. There are tremendous personal and economic disincentives for medical providers to provide care in a team environment. Insurance companies often only allow one provider to bill for services at each visit, so often team visits lose money and teams have to find alternate ways to fund themselves. It takes a strong commitment to the patient to organize and operate in a team environment. Important as well are the opinions of nurses and allied health professionals who work in the operating rooms and clinics with your provider on a daily basis. These frontline providers represent ground zero. They have the true insider’s perspective. Most people don’t have access to the people that doctor’s work with day in and day out, but what may be available are the results of a Safety Culture Survey. Borrowed from the airline industry, this important survey asks providers within a hospital (department, clinic, etc.) a series of questions:

• Is the teamwork good?
• Would you feel comfortable having your own care performed in the unit in which you work?
• Do people work well as a coordinated team?
• Do doctors and nurses do what’s in the best interest of the patient?
• Is communication strong?
• Do you feel comfortable speaking up when you have a safety concern?

Interestingly, there seems to be a positive correlation in emerging hospital data sets between the results of the Safety Culture Surveys (which are, of course, not offered publically) and those of performance metrics (infection rates, 90 day readmissions, etc.). Hospitals with favorable Safety Culture Survey results also happen to be the best performing hospitals. More analysis and transparency need to happen before we fully understand the implications of this, but in other industries, especially the high risk flight industry, the same has born out to be true for a number of years.

Members of the Craniofacial Team of Texas believe that we have been providing superior outcomes consistently in Central Texas over the last 12 years. It all starts with the assembly of an expert team of craniofacial providers, with unique training and focus on craniofacial medicine. Our team members focus their entire practice on craniofacial medicine. We feel that only through intense focus can we consistently produce superior results, keeping our surgeons, physicians, and dentists on the leading edge of the diagnosis and treatment of these complex disorders. Few of today’s care protocols leave a patient without some deformity or disability, so it is important for us to be on the forefront of creating a new and better standard of care for these complex disorders. For example, our orthodontist is committed to craniofacial orthodontics and is capable of combined orthodontic and surgical treatment of the most complex disorders that many orthodontists have never seen in their careers. Our speech pathologist is the only one in the region with formal training in cleft lip/palate, velopharyngeal insufficiency, and pathology specific to craniofacial disorders. Our craniofacial surgeons all completed one year fellowships in Craniofacial and Pediatric Plastic Surgery, a fellowship only available in the USA to individuals who have completed a plastics surgery residency program.

While there is a great deal of variation between and within each craniofacial disorder, there are a number of principles that are consistent. The development of treatment protocols are also key to the Craniofacial Team of Texas producing superior results. Treatment protocols provide a consistent, uniform platform of care that ensures that each patient is afforded the consensus best practices available. Treatment protocols are derived through close collaboration of the providers, where the combined knowledge and experience of the providers are leveraged to derive a consistent and well defined platform for diagnosis and treatment. They are routinely reviewed, questioned, challenged, and amended to improve their performance.

So, this all sounds great, but how does a patient know that the results are truly superior? The long and short of it is that you really don’t. We recommend that you look through our site and others to get yourself educated on your diagnosis. Look at some of the results posted in our Craniofacial Gallery of Photos, which admittedly are biased toward the our successes. The education pages often will talk about what can go wrong with care. If you do this and feel comfortable with us, then make an appointment to come and see us. If you still feel concerned, then get a second opinion. We always freely recommend second opinions, and we can help get you to that second opinion and even put a couple words in our note to help get your insurance company to pay for it!

Going forward, we are committed to the tenets established by ICHOM (International Consortium for Health Outcome Measurement), which has established outcomes measures that are important to patients for 85% of the diseases that affect humans. For those craniofacial diagnoses that ICHOM has not determined measures for, the Craniofacial Team of Texas are in the process of determining a set of measures that are important to patients and employers, not just doctors and hospitals.

Scope of Care

The Craniofacial Team of Texas offers treatment for just about every condition or set of symptoms that can occur to a craniofacial or cleft patient. Over the years we have recruited specialists to the team strategically to make sure that we can take care of every problem possible. While we strive to offer all services, we are also committed to providing them at the highest standard across the country. If there is someone else in the country that performs the procedure better than we do, we do not hesitate to discuss this openly with the family and always encourage a second opinion or visit.

Our team regularly treats congenital disorders, growth disorders like craniosynostosis and malocclusions (overbites, underbites, etc.), and deformity caused by trauma or cancer. Additionally, we perform the surgery to take out complex facial, skull, and skull base tumors with simultaneous reconstruction. Our craniofacial surgeons are capable of microvascular and microneural surgery and perform a number of procedures that require free tissue transfer and peripheral nerve reconstruction.

Quality Improvement

The Craniofacial Team of Texas believes strongly that errors and substandard outcomes should be openly discussed and reviewed to ensure that errors are learned from, not repeated. All providers and allied health providers can refer cases to our peer review system for case evaluation and discussion. The purpose and culture of this process is strictly educational where providers get the opportunity to share thoughts on tough cases and complex situations to ensure delivery of the best care possible and constant self-improvement.

There is a wide range of expression (phenotype) of every disorder, and this range requires versatility in the approach to diagnosis and treatment of the disorders. At the same time, there are many areas where variability is more restricted and offer the opportunity to develop care pathways and protocols. Care protocols help improve the consistency of care and quality of care offered by intentionally coalescing best practices, minimizing variation and missed steps. The Craniofacial Team of Texas uses care protocols wherever possible to improve care and provide a platform of care that can be assessed for quality improvement (QI)opportunities.

Clinic-Specific Conferences, Care Protocols and Pathways Conferences, Complex Treatment Planning Conferences and Case Review/Peer Review Conferences are the cornerstones of our QI processes. A culture of constant improvement and progress provides the foundation. 

If you would like more information about any craniofacial anomaly, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.