A spine surgeon can generate millions of dollars for a hospital and still cost it more than they bring in.
The difference lies in what happens beyond the operating room. Complications, prolonged hospitalizations and repeat procedures can quickly erase the financial returns of even the most lucrative surgeries. And as healthier patients move to outpatient settings, hospitals are increasingly left with the cases that demand the most resources.
Daniel Sciubba, MD, chair of neurosurgery at Manhasset, N.Y.-based North Shore University Hospital and Long Island Jewish Medical Center, both part of New Hyde Park, N.Y.-based Northwell Health, said health systems need to rethink what makes a complex spine program successful.
“I always hear people say, ‘Look what I did,’ and I go, ‘Let me remind you how expensive you are,'” Dr. Sciubba told Becker’s.
For him, the challenge is not simply making complex surgery more efficient. It is understanding which patients should undergo surgery, what they need to recover and whether hospitals are investing in the systems that make good outcomes possible.
When easier cases leave
Advances in surgical care have expanded treatment options for patients once considered too old or medically fragile for major procedures.
“Where we used to say someone was elderly after 65, now we’re saying it’s after 80,” Dr. Sciubba said
But operating on older, sicker patients introduces greater complexity. At the same time, less invasive procedures and healthier patients are increasingly shifting to outpatient surgery centers.
“If we keep going in this direction, outpatient surgery centers are going to do the discectomies and maybe even the one-level fusions, while hospitals are going to do the cancer, deformity, revision and medically complex cases,” he said.
The result, he predicts, is a hospital case mix increasingly concentrated among patients with cancer, severe spinal deformities, complex revisions and significant medical conditions. Those patients may require longer stays, intensive care and extensive rehabilitation. Without corresponding changes in how hospitals deliver care, margins could narrow even as surgical complexity increases.
The cost of getting it wrong
Dr. Sciubba sees a direct connection between clinical quality and financial sustainability.
“Good medicine is good business,” he said.
Investments in experienced staff, multidisciplinary reviews and enhanced recovery protocols may increase up-front expenses. But a major complication, readmission or return to surgery can cost substantially more.
He also cautioned against measuring surgeons’ value solely through revenue generation.
A surgeon associated with $20 million in revenue, for example, could generate $22 million in expenses. The hypothetical situation illustrates why downstream revenue and procedural volume tell an incomplete story.
The surgeries that shouldn’t happen
Preventing complications starts with identifying risks before surgery. Dr. Sciubba emphasized optimizing patients with poorly controlled diabetes, compromised bone quality, malnutrition or other conditions that could jeopardize recovery. Rather than treating adverse outcomes as unavoidable surprises, he believes hospitals should use available evidence to anticipate and prevent them.
That approach sometimes means recommending against an operation. Dr. Sciubba said predictive analytics are helping surgeons move beyond vague discussions of surgical risk toward more individualized estimates of potential benefits and complications.
He described a hypothetical patient with only a 5% chance of meaningful improvement but a 50% risk of a major complication.
“I can’t take you,” he said, explaining how he would approach such a case.
Instead, he would discuss the unfavorable odds and recommend considering nonoperative alternatives. He believes these conversations are essential to protecting patients from procedures unlikely to improve their lives.
Looking ahead, he expects predictive risk indicators to become more integrated into EHRs, potentially flagging patients who require medical optimization before elective surgery.
But he warned that the same data could be misused to restrict care if insurers or administrators apply rigid criteria without physician involvement. The goal, he said, should be better clinical decisions, not automated denials.
Defining successful surgery
Dr. Sciubba’s definition of successful surgery extends beyond the procedure itself. A patient may undergo technically successful surgery for a spinal tumor but lack transportation for necessary chemotherapy. Another may remain hospitalized because there is no support at home.
Such circumstances can undermine outcomes while increasing costs. He said transportation, financial resources and other social factors may sometimes influence a patient’s recovery or survival more than the operation itself.
For patients with rare tumors such as chordoma, Dr. Sciubba also sees value in connecting people with others who have undergone similar treatment, creating a support network that extends beyond the hospital.
Addressing these needs through social work, transportation assistance and discharge planning can help prevent avoidable hospital stays and emergency visits, he said.
A more precise future for spine care
Dr. Sciubba said predictive analytics and AI could fundamentally change how surgeons select and treat patients.
In spinal deformity surgery, patient-specific data are helping surgeons plan alignment goals and evaluate whether they achieve them during procedures.
In spinal oncology, increasingly detailed tumor classifications are informing decisions about surgery, radiation and systemic treatments.
Some patients may benefit from aggressive surgical intervention. Others may achieve better outcomes without an operation. AI could accelerate these decisions by processing information across the preoperative, intraoperative and postoperative stages, while wearable technology and other tools offer opportunities to monitor recovery beyond clinic visits.
But the technology’s value ultimately depends on how physicians use it. Dr. Sciubba said clinicians must help develop and interpret these systems to ensure predictive models support individualized care rather than become barriers to treatment.
Why hospitals need to rethink spine programs
For Dr. Sciubba, the greatest mistake health systems can make is assuming that hiring talented surgeons is enough.
“Healthcare leaders sometimes think that spine surgery is plug and play,” he said.
Complex programs also require experienced nursing teams, intensive care resources, rehabilitation services, multidisciplinary conferences and timely outcomes data.
Those investments become more important as hospitals take on patients whose needs extend beyond the operation.
Surgeons, meanwhile, must understand how complications, length of stay and resource utilization affect the sustainability of their programs. Administrators must provide the infrastructure needed to improve those outcomes, Dr. Sciubba said.
He added that he believes partnership, supported by continuous data and shared accountability, will be essential to the next generation of complex spine care.
As outpatient surgery absorbs more routine procedures, hospitals may increasingly be defined by their ability to treat the patients who cannot safely go elsewhere.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
