Domagoj Coric, MD, is chief of the department of neurosurgery at Carolinas Medical Center and spine division chief of Atrium Musculoskeletal Institute, both of Charlotte, N.C.
Dr. Coric specializes in artificial disc replacement, degenerative spine disease, endoscopic disc surgery, spinal cord injuries as well as spinal trauma and tumors.
Here, Dr. Coric discusses how value-based care and price transparency will affect spine.
Question: Would a single-payer insurance system help or harm spine practice?
Dr. Domagoj Coric: It would almost certainly harm spine practice. If fact, it has the potential to be disastrous to patients with spinal disorders and to the practice of spinal surgery. A single payer system would likely limit patient access to spine specialty care as well as hinder the development and implementation of new technology.
Q: How do you see new payment models such as bundled payments and value-based care developing in spine?
DC: Value-based care is here to stay. Spinal procedures and new technologies will need to have an evidence basis for efficacy as well as value in order to be adopted and widely utilized. The emphasis on value is also reflected in the increasing prevalence of outcome measurements and spine registries. Bundled payments are also here to stay, but not as easily applied to spine as orthopedic procedures such as total joint replacement. More straight forward spine procedures, especially those performed in the outpatient surgery centers such as lumbar discectomy, anterior cervical discectomy and fusion or cervical artificial disc replacement lend themselves to bundling. Conversely, more complex procedures such deformity correction surgery will be difficult — if not impossible — to bundle.
Q: What impact do you think the emerging trend of price transparency will have on the field?
DC: Price transparency is a positive trend in healthcare delivery. It forces healthcare providers to be cognizant of costs and it allows healthcare consumers to comparison shop for cost and quality. The first step in controlling cost is understanding what your actual costs are and how they can be modified. Price transparency also brings market forces to bear, forcing various healthcare delivery entities to be price and quality competitive locally, regionally and nationally. Of course, cost is just one factor to consider and always needs to be considered in the context of quality, which is why we're also seeing such an emphasis on outcome measurement.
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