1. Providing appropriate care. Jeffrey A. Goldstein, MD, is a clinical professor and director of spine service, Department of Orthopaedic Surgery at NYU Langone Medical Center and sits on the Board of Directors for the International Society for the Advancement of Spine Surgery.
He believes one of the biggest challenges next year will be to provide the right treatments for patients, based on appropriate guidelines and protocols. Transparency with patients will be crucial.
"The onus is on the spine surgeon to maintain an open and honest relationship with the patient to include them in the decision process and develop the best treatment for that particular patient," he said. "These decisions need to be based on what we as surgeons know, and not on what we believe. While our knowledge comes from the sum total of our experience combined with the evidence, which includes understanding the lifestyle and goals of the patient as well, surgeons continue to be challenged by limitations of resources which are real in addition to those limits placed by payors."
2. Improving quality while lowering cost of care. In today's healthcare environment, the emphasis is placed on providing high quality care for the lowest cost possible. Providers are incentivized to improve efficiencies and cut costs to lower the overall price for care as payors lower reimbursement rates and direct their members to providers with the highest quality reports.
"Spine surgeons have the challenges of improving quality, lowering cost and providing access to the older population," said Andrew Cordover, MD, a spine surgeon with Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala. "There will be changing technology in the coming years and we have to implement it in our practice."
In some cases, payors have stopped covering previously approved procedures, citing a lack of data supporting its effectiveness. As a result, spine surgeons and researchers are engaging in high-level studies to show surgery's effectiveness among appropriately selected patients.
"It's important for me as a spine surgeon to stay involved with the continued development of outcomes measures that are appropriate for our specialty," Dr. Cordover said. "We also must have a voice in new technology because if it doesn't improve quality, limits will be placed on us due to cost cutting measures."
3. Dealing with regional differences in spine care. The perception of too much spine surgery has been propagated by several sources, including statistics showing rates of spine surgery are higher in some parts of the country than others. Frank Cammisa, MD, is chief of spine service at the Hospital for Special Surgery in New York City. He said there are several factors contributing to this difference, including:
• How quickly new procedures are introduced
• When spine surgeons are willing to adopt new procedures
• Demographics — percentage of the population who are likely candidates for spine surgery
"It may be that one area is treating spinal conditions more aggressively, but another area might not have the resources available to perform the same procedures on their patients," Dr. Cammisa said. "There may be just as many patients needing surgery in both areas in terms of population percentage, but the care isn't as advanced. From the statistics, it's hard to tell whether surgery is being overused or underused in different regions of the country."
4. Adjusting to the medical device tax. Beginning in January, a 2.3 percent tax will go into effect for gross medical device sales, which equates to a 15 percent tax on profits from medical devices. The tax was put into place because government officials believed the Patient Protection and Affordable Care Act would create an influx of new patients which would offset the tax's burden to companies while creating additional federal revenue, said Payal Keshvani, an associate with McGuireWoods LLP law firm in Chicago.
However, it could potentially be a barrier to device companies, particularly start-ups, because even an increase in patient volume would leave companies struggling to comply with such a high tax rate.
This new source of government income is being challenged by lawmakers from both parties who don't believe the theory of untapped volume of customers will hold up in practice.
Device tax implementation also creates an uncalculated transaction cost of understanding what the tax means for the entire industry, said McGuireWoods Associate Katherine Lin. The language of the law is very broad and does not make it clear exactly to whom or what the tax will be applied.
"A company may not have somebody in house exclusively to deal with cutting edge regulatory problems," she said. "It's an additional cost that maybe the people who supported the law didn't account for."
5. Dealing with Medicaid expansions and retractions. Earlier this year, the Supreme Court upheld the Patient Protection and Affordable Care Act, but struck down its Medicaid expansion in favor of allowing each state to provide Medicaid individually. For some states, this will still mean including more people in Medicaid while others will lead to fewer enrollees. Either way, surgeons who provide care for Medicaid patients will receive very little reimbursement.
"In Illinois, the problem is that Medicaid pays a third of Medicare rates, and often takes 180 days to send payment," said Anthony Rinella, MD, a spine surgeon with Illinois Spine & Scoliosis Center in Homer Glen and co-founder of SpineHope. "No industry can survive receiving 10 percent of billed charges six months after a service is provided."
He also noted a disproportionate payment model between hospitals and independent professionals. Hospitals receive substantially higher rates than physicians, and eliminating that discrepancy could lead to a more synchronistic system, he said.
"Raising Medicaid to Medicare reimbursement rates would make Medicaid expansion more viable," he said. "When the government pays hospitals very well for Medicaid services and pays surgeons very poorly, the hospital endorsement of Medicaid expansion creates a financial disaster for physicians. If we balance the physician and hospital payment formulas at a reasonable level, and adjust each side of the equation equally over time, we could align our interests and balance the overall federal healthcare initiative."
6. Providing access to care for the older population. As baby boomers age, spine surgeons are seeing an influx of patients with back pain. Caring for these patients has become even harder as the number of young surgeons hasn't kept up with the number of surgeons retiring.
"There is a challenge we'll need to define with the aging population because as technology advances, we are able to treat them, but they may not have access to care or the ability to pay for their care," Dr. Cordover said. "With more educated patients, the demands on the system are going to reach new heights. New technologies and the cost of research and development will add additional strains. We are going to have to make some tough decisions with regard to how many resources we want to put into healthcare as a country."
More Articles on Spine Surgery:
8 Steps to Optimize Spine Practice Revenue in 2013
NASS Honors Outstanding Paper Award Winners
8 Experts on Most Important Areas for Spine Research
6 Ongoing Challenges for Spine Surgeons and Innovators FeaturedWritten by Heather Linder | Monday, 24 December 2012 16:57
As the New Year draws nearer, it will bring new challenges for spine surgeons and industry innovators. Several experts weigh in on six pressing spine challenges and how professionals can cope with these challenges.
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies here.
Most Read - Spine
- Dr. Robert Blok joins Laser Spine Institute — 4 key points
- Orthopedics and spine — 6 trends for 2016
- Does workers' compensation matter for cervical disc arthroplasty outcomes? 6 key notes
- NY spine surgeries migrating to high-volume centers — 5 key points
- 8 things for spine surgeons to know for Thursday — Jan. 14, 2016
Top 40 Articles from the Past 6 Months
- Cleveland Clinic standardizes to 2 implant vendors, at least one orthopedic surgeon out
- 22 minimally invasive spine devices to know
- 5 things to know about physician assistant pay
- Becker's Spine Review Channels
- Did this orthopedic surgeon let his PA perform surgery? Dr. Munir Uwaydah faces conspiracy, $150M fraud & aggravated mayhem charges: 6 key notes
- Surface technology for spine devices: Key trends & concepts
- Orthopedic surgeon Dr. Michael Reilly's whistleblower lawsuit results in $69M+ penalty for Broward Health — 7 things to know
- 15 things to know about physician shortages
- Current annual & hourly salary rates for orthopedic surgeons: 8 statistics
- 334 spine surgeons to know — 2016
- Dr. Sang-Ho Lee awarded Parviz Kambin award for endoscopic spine surgery at NASS meeting: 5 highlights
- Dr. Richard Rooney pleads guilty to undisclosed financial interest, sentenced to prison: 5 things to know
- Physician stabbed in Virginia leaving clinic — Attacker wanted more pain meds
- Rumors of a Stryker acquisition of Smith & Nephew swirl once again: 6 key notes
- Stryker recalls 16k+ units of orthopedic products: 5 takeaways
- The future of private practice: Key thoughts from OrthoCarolina CEO Dr. Daniel Murrey
- 5 trends putting the squeeze on surgical practices
- MIS, stem cells, biologics & more: What excites spine surgeons most about the current landscape?
- Transparency in healthcare can work today — Hoag Orthopedic Institute proves it
- Drs. Troy Caron, Raj Kakarlapudi, Jeff Martin join Laser Spine's surgery centers: 5 key points
- Google and Johnson & Johnson to form new surgical company — 4 highlights
- Global spine surgery device market seeing double-digit growth: 5 key points
- The theory behind Geisinger's spine surgery refund
- 8 surprising topics your spine patients are researching
- The ICD-10 deadline is almost upon us — Are spine surgeons ready?
- 5 key trends on Massachusetts physician pay — And what it means for US physicians
- 5 huge reputation management mistakes for surgeons
- Q2 financials: 150 things to know about NuVasive, Stryker, J&J Orthopedics & more
- 5 trends in the medical tourism market
- 10 statistics on neurosurgeon salaries & bonuses
- 10 key notes on the 2016 CMS physician fee schedule
- Stryker director sells 18k shares, following Smith & Nephew acquisition rumors: 7 points
- Intersecting care of spine pain specialists & spine surgeons: Drs. Heidi Prather & Scott Glaser talk pain
- Rothman Institute merges with OrthopaediCare; adds 17 physicians: 4 things to know
- Did Loma Linda's orthopedic device rep-less strategy work? 5 things to know
- Alphatec Spine, LDR, Globus Medical & more — 21 key notes
- Population health on a budget: How one orthopedic surgeon succeeded in Chicago's most impoverished neighborhoods
- Is PEEK cost-effective for spinal surgery? 5 things to know
- 32 hospitals to pay $28M in spine surgery false claims settlement: 5 things to know
- ProDisc-C vs. spinal fusion: Which has better results? 5 key notes