'The most effective compromise to optimize VBC will have to come from payers': What we heard in May

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During the month of May, spine and orthopedic experts spoke with Becker's about topics from value-based care to surgeon training.

Here are some of their key insights: 

"Our teaching methods have definitely evolved over the past 10 years. For one thing, our fellows tend to come into fellowship with much more first-hand experience in basic spine techniques than we used to see 10 to 20 years ago. At one time it was common that incoming fellows hadn't put in a pedicle screw or performed a lumbar decompression, but now our incoming fellows almost always have experience with basic techniques such as these. Another thing that has really transformed teaching is the use of navigation. With the use of navigation, we can see directly where a trainee is putting an implant, and this allows us to have confidence in their placement of screws as we can directly visualize what is happening on a screen. This allows us to be less "handsy" during a case as we can see early on if there is a problem with a screw trajectory.  Finally, members of our faculty have made a very conscious effort to give our trainees lectures on "real-world" topics (eg. finding a job, negotiating a contract, how to succeed in their first years in practice, etc.). This is information that they often haven't heard before in an organized formal setting and they really appreciate learning about these topics." — Mladen Djurasovic, MD, of Louisville, Ky.-based Norton Leatherman Spine Center, on the evolution of spine teaching.

"We're not taught how to speak business or sit in a room with administrators and convince them financially that something makes sense. We only see the clinical side of things. But the reality is many administrators don't have a surgical background and they don't know these things. You have to be able to speak their language and communicate in their terms why these things are potentially beneficial." — Andrew Chung, MD, of Sun City West, Ariz.-based Banner Del Webb Medical Center on working with leaders to grow a spine program.


"At this point in time, the most tangible and effective compromise to optimize VBC will have to come from payers, large healthcare systems and hospitals. This does not preclude the responsibility of physicians and multi-specialty practices, such as my own (CAO), which have the responsibility of managing ancillary use and expenses. However the majority of money spent on healthcare is consumed by payers, large healthcare systems and hospitals. Rather than continuing to decrease reimbursements to physicians and medical staff responsible for direct patient care, our society must recognize where most expenses are consumed — and those parties have to be accountable with controlling their consumption. This is not to demonize payers, large healthcare systems or hospitals as their good will and participation are paramount to establishing true value-based care. One of the first steps, and what I believe is the most important, is to establish trust amongst all parties involved, including patients, providers, medical staff, payers, healthcare systems and hospitals. I believe compromise would soon follow." — Emeka Nwodim, MD, of Bethesda, Md.-based Centers for Advanced Orthopaedics, on what's next for value-based care in spine.

"​​The acceptance of intraoperative fluoro images being shared on social media and the surgeon posting that the surgery was a 'complete success,' this lack of follow up should be phased out. It would be equivalent to showing me the halftime score of a football game and saying the team is going to win, that doesn't usually happen, and there is still more to the story ... Look, I am not against intraoperative images being shared, just wary of surgeons also claiming what this surgery did for the patient, that day. Heck, sometimes the physician is posting the images at 1 p.m. the day of surgery, and the patient possibly hasn't even ambulated yet! I just think we should expect actual follow-up in these case examples such as standing images (for alignment), and comparative ODIs, to then claim how great a certain procedure or product is at helping patients. Follow-up with post op radiographs tells a different story in terms of success!" — Chester Donnally, MD, Dallas-based Texas Spine Consultants, on an industry trend that should be let go.

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