Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What aspect of healthcare reform do you think will have the biggest impact on the spinal field this year?
Please send responses to Heather Linder at firstname.lastname@example.org by Wednesday, Jan. 30, at 5 p.m. CST.
Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland, Washington: Most of them have no track records and are promoted by the industry.
Their rationale, their safety and advantages, benefits and or potential have yet to be proven.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: Simply put, "not enough of them." Research in medicine (and hence progress) is clearly on the "down swing" due to lack of private and government funding as well as a clear lack of support by powerful health insurance companies that indiscriminately label ALL new R&D as "experimental" and hence not reimbursable. How are we to bring new technology to patients when it won't be paid for? Each new technology costs millions of dollars to develop and bring to the market only to be thwarted by insurance companies that inevitably refuse to pay for any of the care a patient receives when a new technology is introduced. Doctors and the great institute of medicine has never before faced this challenge in such immense and eclipsing proportions.
For the last 200 years-plus doctors have conducted research and tried new ways of treating patients. Insurance companies were required to pay for the care patients received and they would never think of challenging a doctor's care of their patient. However over the last 25 years, health insurance companies have become greedy beyond all reason and the laws and codes of ethics that bound them in the past to conduct themselves professionally have been shed much like a snake looses its old skin to rid itself of parasites, only in this case the parasites are the health insurance companies themselves and those that are under their control. Any and all new technology being developed or having been developed in the last 10 years has been classified by insurers as "experimental" and they refuse to pay for any of the services to patients receiving care related to the new technology.
For example, a life saving new technology may be developed to heal the spinal disc without fusion and with a recovery time of 10 percent of that of spinal fusion and the patient may go to the hospital to receive care with this new technology and have an excellent outcome but the insurance company will deny paying for the treatment even though the patient's life is given back to them in "spades" and the patient and their family are eternally grateful. The bill in the tens of thousands of dollars will go unpaid by the insurer. This is happening all over the country right now, everyday, every minute and it has been happening for the last five years in spine but its the severity and scope of the problem has grown out of control and is pushing medicine to the brink of total collapse in this country. Sadly, almost no one knows about this. We all must work to bring the "ART" back into medicine. I am afraid the insurance companies are too powerful for anything to change the course of our desperate plight as we prepare to once again enter the "Dark Ages" of medicine.
Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center's Hospital for Joint Diseases: In order to advance our healthcare system and improve patient care and outcomes, we need to continue to foster new technologies to satisfy any deficits in our treatment options. My concern relates to our ability to prove the long-term benefits are cost effective, affordable and improve outcomes. Further, those who develop new technologies need to be encouraged to improve patient care. Device taxes, insurance restrictions and approval processes need to be considered with respect to how they may either inhibit or encourage the advances in healthcare, which we have all come to enjoy and anticipate.
William Taylor, MD, Spine Surgeon, University of California San Diego Health System: Emerging spine technologies are concerning for a variety of reasons. The major concern falls around marketing of these technologies as either faster, easier, improved outcomes and, specifically, a new push towards minimally invasive technology. Minimally invasive spine technology has the opportunity to reform the way we are doing spine surgery. However, it is a new field which is being slowly adopted due to numerous issues. The number one concern for spine surgeons adopting new technology is the lack of monitored, uniform, CME and certification programs in training surgeons for these procedures.
As new data becomes available revealing improved outcomes and decreased complications, the adoption of this technology is going to increasingly rely on appropriate methods of training and education. As our ability to perform and complete clinical trials due to rising expense [decreases], the utility of new procedures is going to be difficult to establish. Even in the face of level one, data pairs have been reluctant to proceed with coverage and will often brand new operating room procedures experimental inappropriately. As finances become tighter, the ability of outside entities to find research and outcome data and our ability to bring these procedures and products to a general population will decrease.
Jeffrey Wang, MD, UCLA Spine Center: My biggest concerns are the stunting of the growth of technology of the spine. With the hurdles of the FDA and the insurance reimbursement issues, we have seen a decline in newer technology due to these concerns about approvals and eventually reimbursements for these technologies. This is in stark contrast to the recent past where we saw newer technologies trying to push for better ways to make our patients better. Now, granted, there were perhaps too many new technologies, and many of them did not really develop. Many were probably not needed, and some did not really make our outcomes better. There may have been too many new technologies.
However, being in the field, there was a feeling that everyone was trying to find better technologies. Perhaps this is just a phase, but now, there is a scant amount of newer technologies. My concern is that there are advancements that need to be made. I just hope that the environment has not stunted that particular technology from coming into fruition. I would hope that if a newer technology does develop, that it will be supported.
Christian Zimmerman, MD, Neurosurgeon, Idaho Neurological Institute, Boise: The biggest collective concern about emerging spine technologies that all spinal surgeons should possess is the cost to the patient and the cost to one's parent organization. With time and experience, all of us have witnessed the latest and greatest in orthobiologics,
only for the end result to be less than optimal. Many large health systems are presently acting upon observational data as a means to lower costs by no longer renewing contracts.
In our community, the days of an "unbridle cost per unit case" type practice is on a slow march to an eventual demise. My discussions with a number of biomedical companies are strategies circumnavigating around the premise of cost containment and value.
More Articles on Spine:
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6 Spine Surgeons on Concerns About Emerging Technologies FeaturedWritten by Heather Linder | Thursday, 24 January 2013 17:05
Six spine surgeons discuss their biggest concerns about emerging spine technologies.Last modified on Monday, 04 February 2013 22:33
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