In an ever evolving healthcare landscape, spine surgeons discuss the key factors driving change at their practices.
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. Becker’s invites all spine surgeon and specialist responses.
Next question: What spine condition do you believe is most commonly overtreated today? Why is it so hard to reverse that trend?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Jan. 6.
Editor’s note: Responses were lightly edited for clarity.
Question: Which factor is driving the most change in your practice today — reimbursement, regulation, technology or patient demand?
Jordan Iordanou, MD, PhD. McHugh Neurosurgery (West Islip, N.Y.): Technology is driving the most change in my practice, with innovations like robotic-assisted surgery and advanced imaging improving precision and outcomes. Patient demand for minimally invasive options further accelerates this shift. While reimbursement and regulation pose challenges, technology’s transformative impact is reshaping how we deliver care.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Multiple factors interact to drive change, making it difficult to isolate single drivers. Reimbursement pressures push toward efficiency and value-based models. Technology offers new capabilities but requires significant investment and learning curves. Patient expectations, influenced by information access and consumerization of healthcare, demand more transparency and involvement in decision-making. Regulatory changes affect everything from opioid prescribing to quality reporting requirements.
Jacky Yeung, MD. Yale School of Medicine (New Haven, Conn.): Reimbursement, without question, drives much of the behavior we see in spine surgery today and not always in the best interests of patients. Smaller, more targeted surgeries like endoscopic decompressions are technically complex, require specialized training, and often deliver faster recovery and better long-term outcomes. Yet they’re reimbursed at a fraction of large, instrumented fusion procedures and in some cases, there’s no wRVU assigned at all.
Meanwhile, large multi-level fusions are reimbursed very well, even though they’re not always the most appropriate or personalized option for every patient. When the economic structure rewards magnitude over precision, it inevitably shapes surgeon behavior. Until reimbursement models evolve to value minimally invasive and patient-centered care equally, focusing on outcomes rather than volume, we won’t fully realize the potential of personalized spine surgery.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): From my perspective, the dual augur of change and repeated excitant in complex spinal management is both demand and regulation.
Current trends regionally and nationally have shifted the higher acuity, more co-morbid patient and diagnosis to larger institutions for opinion, surgery and post-operative management. This increscent populace has grown in size and demand, while the caregiver in this class and willingness to manage has depreciated. This may reflect training essentials, deference in choices or worse yet, financial discretion. Albeit obvious to the mature surgeon, the furtherance and acquiescence of robotic surgery complement some surgical approaches, the failed back syndrome such as adjacent level failure and unyielding stenosis remain relieving challenges especially for those so reliant on technology rather than experience. Time will be the ultimate arbiter.
