The top industry worries for spine surgeons: 4 insights

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A lack of access to innovative technology, mounting pressures from health systems and payer denials are among some of the top worries for spine surgeons today. 

Four surgeons recently spoke with Becker's about their industry worries and what they think these issues will mean for spine care.

Editor's note: Responses were lightly edited for length and clarity.

Stephen Tolhurst, MD. President of the Texas Back Institute (Plano): My biggest industry worry is physician access to innovative and beneficial treatments for patients. Some large health systems and hospitals have consolidated their spine implant purchasing, with physicians only able to use implants offered by a few large companies. While this simplifies purchasing to some degree, in these arrangements it limits surgeon access to new and innovative products from smaller companies, which is frequently where we see novel treatments emerge. It also has the potential to limit surgeon access to the implants with which they feel most comfortable and most beneficial for their patients.

Philip Louie, MD. Spine surgeon at Virginia Mason Franciscan Health (Seattle): We are seeing major health systems publishing enormous losses in the first half of 2022. Short staffing, burnout and hospital capacity are compounding the stressors related to production targets that will be set to chip away at these heavy losses. With mounting pressures to produce financial and volume targets with limited resources (and temporary resources at many locations), there will be an enormous focus on producing quantity of work. I worry that all the work that we have accomplished in building value-based care pathways, developing quality-based programs and academic pursuits to innovate will take a back seat to providing the greatest volume of care to "catch up." We are all facing the same pressures, so we must all continue to find opportunities to innovate, invest and collaborate in areas that support quality of care — knowing that best care will also work out in the end. The journey toward addressing pandemic-related losses will be a marathon — and you never want to start that race in a full sprint.

Kenneth Nwosu, MD. Spine surgeon at NeoSpine (Burien and Puyallup, Wash.): My biggest industry concern is the ever increasing barriers by payers to provide high value care to our most vulnerable patients in a timely fashion. Over time, it appears that the default decision for procedures needing prior authorization is a denial, as indicated by a rising number of peer-to-peer reviews where the reviewing physician openly states that the ordered surgery should not have been denied. Alternatively, I am seeing more denials where a peer-to-peer review time is dictated by the payer, which is often in conflict with the treating physician's availability. In some instances, there is not an option to partake in a peer-to-peer review following a denial. 

These increasing denials have had a net negative impact on patients' health and are more burdensome to the healthcare and economic system (directly and indirectly) as a result of patients not receiving appropriate treatment in a timely fashion. The issue is further exacerbating the high burnout rates being experienced by surgeons and their staff. I believe this is the primary contributor to the sentiments expressed by many of my colleagues regarding leaving the field altogether. Continuing down this trajectory will likely contribute to further corporatization of healthcare, reduced competition, increased costs and ultimately reduce the value of healthcare that we provide.   

Issada Thongtrangan, MD. Spine surgeon at Microspine (Scottsdale, Ariz.): My biggest concerns are:

1. The CMS pay cut in the time that we just came out of the COVID-19 pandemic, making it harder financially, especially with an independent practitioner. I have to find strategies to cope with this pay cut while maintaining the quality of care. Not to mention how many hours physicians have to spend to comply with the rules and regulations.

2. The pre-authorization process has been more difficult and consumes so much time. My biggest concern is that this will delay the patients' care. Every one of us who deals with it is so frustrated with this process. Many times, the wait time to talk to someone was ridiculous. The time we spent with an appeal process should have been the time we provide quality care to our patients.

3. Private equity investment. With the ongoing private equity investments that bought the practice left and right, I am concerned for the patients that they may not get the quality care they deserve. The physicians lost their autonomy and ultimately some of their decision making. The first goal of the investors is to make money. Quality is not equal to the cheapest product, procedures, etc. Think about it in our daily life. Excellent-quality products are not cheap unless you lower your expectations or you use the similar, AKA low quality product.

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