1. Surgery approval is becoming a hindrance. The approval and pre-authorization process for spine surgery continues to immensely burden spine surgeons.
"It hasn't gotten better and it continues to get worse and worse for spine surgery, spine interventions and spine injections," Dr. Bono says. "It's becoming also prohibitive [due to] the hoops that we have to jump through."
2. MACRA still causes much uncertainty. Causing a lot of anxiety among healthcare providers, the Medicare Access and CHIP Reauthorization Act of 2015's Quality Payment Program is set to commence Jan. 1 for the performance calendar year 2017.
"What's giving a lot of spine surgeons a lot of unease is how it's going to affect day-to-day-practice," says Dr. Bono.
Under MACRA, facilities will choose the Merit-based Incentive Payment System pathway or participate in the Advanced Alternative Payment Models by 2017 or 2018.
Dr. Bono thinks those choosing MIPS will not necessarily need to shift their algorithms much to comply.
However, bundling will change everything for those centers going the APM route. Instead of negotiating for reimbursements, the payer will pay a lump sum of money for the episode of care. Then, it will be up to the facility to decide how to disperse the money amongst the providers.
"We won't be fighting with the insurance companies anymore; we will be fighting internally and with each other," says Dr. Bono.
3. Data analytics market is going strong. It's all about data, offering insight into complications and outcome predictions. The healthcare analytics market is expected to reach an $18.7 billion value by 2020, according to MarketsandMarkets report.
"[The technology trend] is not necessarily new technology like intervention; it's really been on analysis of big data," Dr. Bono says.
4. Care delivery technology will enhance risk stratification. The industry has witnessed a slowdown of new surgical technology, opening the door for a "blossoming of care delivery technology."
Currently, many patients are receiving procedures from which they will likely benefit, but many patients are undergoing surgeries from which they will not see improvement, thus creating poor outcomes.
"With better analysis of big data, we are going to be able to risk stratify those patients much better," explains Dr. Bono. "It will take a lot of restraint and bravery when dealing with patients."
The vignette of a patient undergoing a procedure because they want to, despite the high likelihood for unfavorable outcomes, is common and only increases medical care costs.
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