Dr. Anthony Yeung: What surgeons need to know about reimbursement, training in endoscopic spine surgery

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Spine surgeon Anthony Yeung, MD, recently retired from Phoenix-based Desert Institute Spine Care, where his son Chris Yeung, MD, is spearheading the practice.

In the 1990s, he developed the Yeung Endoscopic Spine System, which has continued to evolve as an outpatient procedure. Now, Dr. Yeung is focusing on publishing details of his experience in more than 11,000 spine cases since he began his career in 1991.

Here, Dr. Yeung discusses the development of endoscopic spine surgery, the importance of surgical training and reimbursement shackles associated with the technique.

Note: Responses are lightly edited for style and clarity.

Q: What is your opinion of pain management physicians performing endoscopic spine surgery?

Dr. Anthony Yeung: Pain management physicians can be qualified if they work with and are trained by endoscopic spine surgeons. This is a disruptive and disparate part of surgical pain care that traditional spine surgeon leaders and pain management physicians do not fully understand. It is recommended that physicians interested in this technique — pain management physicians as well as traditional open-oriented surgeons — take up endoscopic surgical training, which is needed for recognizing potential and actual complication risks in this litigious environment. 

Multiple pitfalls face those who take on endoscopic procedures without training or being mentored by experienced endoscopic spine surgeons or working in a multidisciplinary environment with similarly-trained pain management physicians. I think eventually endoscopic spine surgery will need to be a cooperative effort between pain management and nonsurgeons who understand each other's skills. Knowledge of the patio-anatomy of pain will complement each other's skills in a multidisciplinary cooperative effort.

Q: What is the best way for spine surgeons to approach endoscopic training? How did your approach evolve over the years?

AY: Spine surgeons will need additional training in endoscopic techniques in the rapidly evolving subspecialty for the sake of safety, efficacy and cost-effective care. Traditional surgeons should have an endoscopic surgeon on their surgical team. In my spine group, DISC, I dedicated myself to MIS endoscopic spine surgery and to the treatment of pain generators correlating the path-physiology of care with endoscopic documentation of intradiscal path-anatomy. I then evolved my technique to add extradiscal therapy of patio-anatomy in the foramen as well as the epidural space.

Q: How can endoscopic spine surgery become as popular in the U.S. as it is in Europe and parts of Asia?

AY: The healthcare environment is different in Asia, which has thousands of years in healthcare evolution, acceptance of traditional medicine and naturopathic alternatives. Eastern traditional medicine is married with 'modern' advancements from the West and is what fuels the acceptance of endoscopic spine surgery as an alternative to open spine surgery. The East looks to the West for modern advancements and innovations.

Q: How has reimbursement changed in endoscopic spine surgery changed throughout your career? Is reimbursement the primary shackle preventing further adoption of this technique?

AY: A resounding yes is the answer. Reimbursement in today's capitalistic world has gone amok. There are too many stakeholders trying for maximum reimbursement and striving for procedural reimbursement codes without some accountability. I was fortunate to have finished my medical training in 1970, where Medicare reimbursement was not a problem. Medicare then paid 80 percent of private billings, which provided enough reimbursement for physicians to use knowledge from their training for their patients without restriction.

Not every payer is trying to reduce cost. The practitioner, especially successful surgeons, use vertical integration supporting their treatment philosophy and technique. Currently, reimbursement is falling behind the actual cost of care when unlimited healthcare is 'guaranteed' and there are no limits to healthcare access and treatment. There is now a need for all physicians to be more aware of their treatment recommendations. Today's physicians must depend on their calculators as well as their stethoscopes. Returning to treating the pain generator with safe and cost-effective staged options, rather than just treating the imaging, is what endoscopic spine surgery is all about.

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