Dr. Greg Gullung: Commercial payers' approval process is biggest barrier to spine care

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Greg Gullung, MD, an orthopedic spine surgeon at Birmingham-based OrthoAlabama, discusses the biggest barrier for spine providers and how medical practices can help one another push through the COVID-19 crisis.

Question: How has your practice navigated the challenges brought by the COVID-19 pandemic? What have been your keys to success?

Dr. Greg Gullung: Like almost every industry we have been impacted by the pandemic. Many of our challenges relate to protecting the public while still providing the best possible care.   Fortunately, we transitioned to social distancing, personal protective equipment and screening early in the process. We screened staff and patients prior to entering the clinic, used masks, provided hand sanitizer and limited the number of patients seen per day. This created a bottleneck for patients, but almost everyone understood the need for increased caution given the uncertainties present during the early stages of the pandemic. This allowed us to continue providing patient care with the least amount of risk.

Q: What is the biggest obstacle facing spine providers in the modern landscape?

GG: From personal experience and discussions with colleagues, it seems to be the approval environment from commercial insurance. Many of the advancements in technology, techniques and training have produced competent and caring surgeons, but their decisions for care are often guided by the local insurance providers. Fortunately, many of the treatment guidelines follow the guidelines of our professional societies, but not everyone fits neatly into a predetermined treatment algorithm — that is where the individual physician must provide detailed and research-backed explanations for their treatment plan. It has also been my experience that most companies are willing to provide approval for various treatment options given sound clinical decision-making.

Q: How can spine practices help one another during this turbulent period?

GG: Medicine in general has always had a tradition of cooperation and sharing of information, and I think this must continue now and in the future. Due to the current medical climate, many practices are forced to evaluate daily operations with a more business-minded approach, but we must remember to continue sharing knowledge, tips and personal assistance to colleagues locally and internationally. This way the maximum number of patients can have access to the highest quality of care. One must also be open to taking on extra patient care responsibility; be it clinical, emergency or consultations, given the probability that physician availability may be limited during the current crisis.

Q: What will the spine field look like one year from now? What do you see being different and what will remain the same?  

GG: Given that one year is a relatively short period of time, I do not see any significant leaps forward in terms of technology or technique. I do not say this to mean there will be a standstill in advancement of these means of care. On the contrary, I fully expect the release of new helpful products, improvements in intraoperative imaging and continued modification of surgical techniques to improve patient outcomes. But I wonder if the most impactful change will be a decrease in infection rates. 

The reason behind this is the higher quality of sterilization procedures, more rigorous screening of patients and increased attention to sterile technique by all OR and clinical staff, as well as patients themselves. While not all infections are preventable, there is a subset that can be avoided, and given the high cost of spine infections to the patients themselves, as well as the overall monetary cost to the system, any decrease in infection rate provides a positive boost for the field.

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