What changes Dr. Oren Gottfried expects to see in spine in 2020

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Oren Gottfried, MD, is president of the North Carolina Spine Society as well as professor of neurosurgery and clinical vice chair of quality in the department of neurosurgery at Duke University School of Medicine in Durham, N.C.

Here, Dr. Gottfried discusses what changes he expects to see in the spine field in 2020 and what strategies spine surgeons can implement to tackle declining reimbursements.

Question: What area of spine do you expect to see the most change in 2020? 

Dr. Oren Gottfried: I expect to see predictive analytic tools helping guide spine surgeons with regard to who will benefit most from surgery; appropriate preoperative health optimization; achieving ideal spinal alignment with reduced need for return to the OR; details of the surgery or approach best suited to the individual patients; informed decision making for patients with knowledge of potential outcomes based on their individual risk factors and helping surgeons promote value, efficiency of healing and reduced costs with our complex patient population. 

I appreciate that there is significant innovation and exciting new spine technology, and I would like to see all surgeons guided by concrete data that shows maximal value with great outcomes at the lowest expense. I think in a population health observant model we need to put technology forward to reduce the overall episode of care costs. I think surgeons will be even more aware in the future of their outcomes and costs of their care. I think surgeon dashboards will help push this effort. At Duke University, I send this data out to each surgeon on a regular basis to compare data to national and institutional benchmarks. 

Q: What are your plans for your practice next year? What strategies or initiatives are you implementing?

OG: I keep all of the spine surgeons at my institution updated with their quality and safety outcomes, patient satisfaction in the clinic and hospital as well as many value based metrics. I think surgeon report cards are key to improving quality of our care and reducing costs. 

Q: How do you see the emerging trend of price transparency affecting spine?

OG: I think every surgeon should see the costs of what they do in and out of surgery on a regular basis. I suggest surgeons think about every item they use in the OR — including what it costs — and if there are cheaper, as effective alternatives. As a group, we need to take a spinal pathology and look at surgery outcomes and costs, and assess the reasons and drivers for such variability in overall costs and outcomes. If someone is using more expensive materials and not providing a proportional improvement in care and longevity of outcomes, we need to reconsider their approach. 

Q: What are some strategies that spine surgeons can implement to deal with declining reimbursements?

OG: I would argue in a population health value-based care model, reducing the costs of our surgeries while providing great outcomes can only lead to spine surgeon's maintaining a greater amount of the reimbursements of the overall care. If we spend extensively on the surgery itself, we will continue to see declines. 

More articles on spine:
Dr. Sergiy Nesterenko opens spine clinic in Texas
California hospital adds 7 neurosurgeons to curb patient leakage
Drs. Nic Gay, Kerisimasi Reynolds team to form Silicon Valley Orthopaedics 

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