How the spine field is evolving with price transparency, robotics and value-based care — key thoughts from Dr. Peter Passias

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Peter Passias, MD, is an orthopedic spine surgeon with NYU Langone Health in New York City.

Dr. Passias has been a board-certified orthopedic surgeon since 2012 and completed his fellowship in spine surgery at Hospital for Special Surgery. Here, Dr. Passias shares his thoughts on robotic technology as well as the business and economic impact of healthcare trends affecting spine.

Question: What do you think about robotic technology in the spine field?

Dr. Peter Passias: I view robotics as an evolving technology with tremendous potential for creating dramatic changes in our field. At this point the inception of robotic assisted spinal surgery has taken a dramatic turn in the past year after years of struggling to assimilate. Despite this, the challenges and progressions in efficiency that are required are great. In ideal circumstances with efficient operating room theatres and staff and optimal preoperative or intraoperative 3D images robotics has allowed even minimally trained surgeons to place pedicle fixation with relative ease.

However, these circumstances are not always routine, and inefficient utilization of operative time and efforts can be quite frustrating. In addition, this single application changes the workflow of the surgical procedures and requires even the most experienced of surgeons to change very refined practices. Training has also been affected, with residents and fellows being exposed less to traditional and varying techniques. Lastly, cases which would benefit from robotics the most, such as complex revision or uncommon fixation points, are at this time too complex to allow for current algorithms to reliably and safely improve upon surgical results.

Overall, this remains a very key area of development and research and will have an increasing impact in the coming years.

Q: Where do you see the biggest need for improvement in spine patient care?

PP: There is certainly much room for improvement in what we do. Perhaps the largest room for improvement lies filling the void in treatment options for patients that do not respond favorably to nonoperative options while at the same time are not ideal surgical candidates. Given the magnitude of mechanical spine related pain from a public health perspective, expanding upon treatment potentials for this grey zone from both the operative and nonoperative arms would be tremendously impactful. Aside from this large gap in care, from a surgical perspective there is certainly room to uniformly standardize the amount of improvement achieved from our procedures. This entails a critical assessment of risk and benefit, our surgical indications and technical components.

Q: How do you see trends toward price transparency and value-based care affecting spine?

PP: While there is opportunity to improve our care in terms of price transparency and value-based care evaluations, unfortunately, there is also much potential for the level and availability of care to be negatively affected. Value-based care based on the current systems in place inherently implies cutting services. We need to be absolutely certain that we thoroughly assess the impact of such retractions on an individual, as well as from a general population basis, prior to implementation.

Q: What is the smartest thing you've done in the past 12 months to prepare your practice for the future?

PP: Success in the current spine marketplace necessitates well designed growth, and proper alignment with affiliated healthcare networks, in order to allow for competitive negotiation of reimbursement for services provided and access to referral networks. This has been a focus of our group, as well as continuously improving the care that is provided. Patients no longer look at healthcare as a luxury, they demand services as an inherent right. While this sounds like a respectable ideology, treating larger numbers of patients at lower cost points requires a streamlined office system. This has also been our focus in recent times.

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