Payer relationships and physician autonomy are two things that need to be improved in the orthopedic and spine surgery industries, according to three surgeons.
These surgeons recently shared with Becker's the changes they would make to the industry if they could.
Editor's note: Responses were lightly edited for clarity and length.
Brian Perri, DO. Spine Surgeon and Founding Partner at DOCS Spine + Orthopedics (Los Angeles): If I could change one thing about the spine surgery industry, it would be [for] payers to look more favorably at cervical and lumbar arthroplasty authorization. Maintaining motion in the spine is more natural than fusing spine segments. The safety and efficacy of spine arthroplasty has been proven now in many different FDA-approved, randomized, prospective, multi-center studies. These are lengthy and costly studies. The spine industry is never going to be able to complete similar arthroplasty studies on more than two levels, hybrid or non-contiguous level cases. There are too many variables and it would cost and take too long. Similar studies were never required of fusion surgeries, yet they are more universally approved by the payers. It's time for the insurance industry to step up and do the right thing for insured patients who are routinely denied arthroplasty spine surgery. Denying arthroplasty based upon the technology being "investigational" or "not clinically proven" is wrong. It is not accurate or consistent with the literature.
Issada Thongtrangan, MD. Spine Surgeon at Microspine (Scottsdale, Ariz.): I would like to change the insurance authorization process and payment. The authorization process has been ridiculously terrible and getting much worse in the past two to three years. This causes delays in patients' care. I have to spend two to three hours cumulatively each week just for the peer-to-peer and appeal process if they overturn it. I also feel their guidelines are not up to date with the advanced technologies even with supportive level one studies. It kept getting worse that some of the [insurance companies] even dictated what type of implants or hardware the surgeons would like to use. Sadly, the best implant in their guidelines is the cheapest. Moreover, they delay the payments by requesting "additional" documents so many times.
Ramy Elias, MD. Orthopedic Surgeon and Medical Director for the Center for Advanced Orthopedics & Sports Medicine at Cerritos (Calif.) Surgery Center: I would put patient care back in the hands of the physician. Too many healthcare decisions are being made by administrators that don't prioritize the doctor-patient relationship. Each patient is unique and the treating doctor is best suited to address the healthcare needs of that patient. We have moved from providing individualized healthcare to population health where the needs of an individual don't matter anymore. Physicians are called providers not doctors, and the quality and access to healthcare has declined. We have increased the burden on physicians by adding bureaucratic roadblocks. We spend more time documenting and doing peer reviews than we do taking care of patients. In the end, the patient suffers the most.