Where does spine need a disruptor most?

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The spine surgery industry has seen major shifts through the years. But some areas may be due for a serious shakeup.

Here are the areas where six spine surgeons told Becker's that change needs to happen.

Note: These conversations were edited for clarity.

Question: What area of spine surgery is in most need of a disruptor?

Scott Blumenthal, MD. Texas Back Institute (Plano): I think there's a huge pendulum to doing these scoliosis fusions, at many levels fusing to the sacroiliac joint, and we're overtreating in that realm. We're treating 80-year-old patients with back pain, which everybody has when they're 80 anyway, and a little bit of deformity based on numerical scales, which they call sagittal parameters. I think there will be a disruptor because I think there's just too much of that going on right now.

Ernest Braxton, MD. Vail-Summit Orthopaedics and Neurosurgery (Vail, Colo.): I think the area that is in most need of disruption is not necessarily with an implant or a device. It is a method to keep up with the Herculean task of keeping up with preauthorization. So having more tools and equipment to access the available literature quickly, accessing insurance indications more quickly, and getting an ability to do an automated response. So it's more along the preauthorization, getting people through the system, through the operator to the operating room. I think that the preauthorization process is in line for disruption because we're using antiquated equipment, we're sending faxes and trying to find old patient records. It should be a much more automated, unified system to get across our indications of reasons for doing surgeries that we do.

Daniel Choi, MD. Spine Medicine & Surgery of Long Island (Patchogue, N.Y.): We need a disruptor in the payment space, and that's where I've been working a lot with advocacy. I think that things like Medicare payment fee schedule reform right now, it's horrendous. The government will reimburse all other parts of Medicare, including hospitals and DME and all other sections. But physician professional fees continue to decline, which causes access issues for patients seeking spine care. It's hard for them to access the physicians that they need and that kind of system.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We need a lot of disruption in the payment space. I think we need to re-approach and rethink the way surgeons are remunerated. We're all doing a very good job and taking care of patients and concentrating hard on the outcome. But the reimbursements continue to get cut as if it's getting easier to take good care of patients on less money. It's actually getting much harder. So a discussion has to be had between the stakeholders about what is reasonable reimbursement and how it cannot continue to go down. We have to change how we reimburse for surgeries.

Theresa Pazionis, MD. Temple Health (Philadelphia): Spinal deformity surgery is definitely in need of a disruptor because right now we have a lot of patients who could benefit from the surgery. But some of the techniques are more invasive than many patients are willing to undergo, and development of more minimally invasive techniques using either navigation or robotics I think is going to revolutionize the field where we're able to offer more patient surgery with better outcomes, shorter lengths of stay and enhanced recovery pathways.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): There are tons of areas for disruption, innovation and spine, and we're seeing that. Our surgeries are becoming less invasive and more effective, but all of that is being hampered by refusal of insurance companies to pay for things. You can figure out ways to combat it through some kind of artificial intelligence and use something to help you fight a prior authorization. The problem with that is the insurance company will have their own artificial intelligence fighting your artificial intelligence. I think it needs to be more of forcing insurance companies to actually follow their contracts because the contract they signed with the patient or with the employer was to take care of the patient and provide healthcare, and they failed to do that.

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