'It's not an equal back and forth': What we heard in Q2

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Spine and orthopedic experts and leaders spoke with Becker's Spine Review on key topics in the second quarter from Medicare to spine navigation technologies.

1. "The biggest issue with Medicare is the ever-increasing regulatory and documentation burden. It is getting more difficult and requires more practice resources to stay compliant with all of their regulations, most of which do not actually benefit patient care. For example, the recent development of requiring prior authorization for cervical fusion surgery made it much more difficult to get those operations done in a timely manner. A close second issue is declining reimbursements. Medicare keeps cutting reimbursements for all physicians, but even more so for surgical procedures, including spine surgery. With the current levels of inflation, the costs of running a medical practice are going up rapidly, making it very difficult for a spine practice to stay financially solvent on Medicare reimbursements." —Vladimir Sinkov, MD, of Sinkov Spine Center in Las Vegas, on issues with Medicare.

2. "The most important for navigation when you're training is choosing a program that does both navigated and minimally invasive surgeries and a program that has a large open experience. It's much easier to know how to go from big, open insertion of crooked screws to understanding what's under the skin using a robot or navigation, than to just do it blindly always and then have to do it open. That doesn't always work. It's not an equal back and forth. Having a strong foundation of being able to do open surgery and knowing landmarks and then moving to navigation or robotics is better in the long run. Everyone hears the stories about the navigation system breaks and cases get canceled. You just don't want to be like that. If the navigation is down or something's just not right, you need to recognize that and know that we have a very, very powerful biological computer in our skulls." —Michael Kelly, MD, director of scoliosis and spinal deformities at Rady Children's Hospital-San Diego, on robotic assistance in spine surgery.

3. "We see MedVanta as a national symbol of change and the protector of healthcare in the future. Medicine is evolving. It is becoming too costly, and the younger generations — Millennials, Gen Z — don't seem to want the same doctor-patient relationship that older generations value. The digitalization of medicine is very real, and telemedicine and urgent care are becoming the first point of patient care. It is paramount that we adapt and we are excited to embrace change." —Louis Levitt, MD, chief medical officer of MedVanta, on the new MSO's plans.

4. "The most important trend at this time in healthcare saving orthopedics is the transition to outpatient surgical care whenever feasible. Traditionally, open musculoskeletal procedures have been associated with postoperative pain interfering with rehabilitation. Minimally invasive techniques to achieve excellent outcomes are evolving rapidly with an advantage of less surgical morbidity and quicker rehabilitation. Specifically for the spine, endoscopic techniques are appealing. … Outpatient surgery not only can potentially save the hospital setting resources for sicker patients but also has a positive psychological impact on the patients facilitating rehab and return to daily activities." —Niranjan Kavadi, MD, a spine surgeon in Oklahoma City, on healthcare trends saving orthopedics.

5. "I truly recommend all physicians and especially surgeons read Being Mortal by Atul Gawande, MD, a practicing surgeon. In this very important book, he fearlessly discusses the emotional struggles of his profession and the lost art of supporting dying patients. It moved me from tears to enlightenment about the ultimate experience that every patient, friend, family member and one's self will confront eventually." —Anthony Melillo, MD, of Houston-based Bay Oaks Orthopaedics & Sports Medicine, on reading recommendations.

6. "Cost will go down. Inevitably [Walmart and CVS Health] will be able to deliver it much more cheaply. I do not think better quality will necessarily follow. Cookbook medicine will be practiced and things will get missed. Ultimately, patients will likely do worse but the spend will be less. Healthcare quality has always been — and always will be — you get what you pay for. The only way forward is not cheaper; it's better. We have spent 10 years under the threat of underperformance from various organizations under the umbrella of HHS." —Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on his outlook for retail giants in orthopedics.

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