Vladimir Sinkov, MD, of Manchester-based New Hampshire Orthopaedic Center, highlights reimbursements, regulations and lawsuits as the three greatest obstacles currently impacting independent spine surgeons. He also considers whether independent spine surgeons will be able to remain so moving forward.
Dr. Sinkov will be speaking at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference. To learn more and register, click here. Contact Maura Jodoin at mjodoin@beckershealthcare.com or Kristelle Khazzaka at Kkhazzaka@beckershealthcare.com for further information about sponsorship and exhibitor opportunities.
Question: What are the greatest challenges independent spine surgeons are facing today?
Dr. Vladimir Sinkov: By far the greatest challenge is financial; it is the persistent decline in reimbursements in the face of increasing costs of running a practice. In no other industry that I know of a professional gets paid less every year to do the same job, while doing it better, with more experience. Just this year the major insurance companies decided that they will no longer pay spine surgeons for nerve decompression when it is done with a transforaminal lumbar interbody fusion. Those are two separate procedures and both benefit the patient. We will, of course, still continue doing the surgery that is right for the patient, but will get paid less to do it.
At the same time, the wages we have to pay our employees and costs of supplies are getting higher every year. If the trend continues, it will eventually be impossible to run an independent medical practice as a business or we will have to stop accepting insurance contracts and go out-of-network, which will limit patients' access to care.
The second challenge is the ever-increasing burden of government and insurance regulations that require an independent surgeon to spend more time on clerical duties (instead of taking care of patients) and to hire more staff to deal with complexities of documentation, compliance and pre-certification requirements, none of which have been shown to be of any benefit to our patients. To make it worse, the rules and regulations are constantly changing based on current political whims and not medical science, requiring independent practices to scramble every January to revamp their office procedures and policies just to keep up.
And of course, there is an ever-present threat of a frivolous lawsuit. While sometimes true medical malpractice is committed, the majority of malpractice lawsuits in the U.S. are eventually dismissed or won by the defendant. This means that the current system fails to identify if there is merit in a suit most of the time and does not protect patients. It forces physicians to order more unnecessary tests (significantly increasing the costs of healthcare) and degrades doctor-patient trust. Such lawsuits, no matter how "winnable" and frivolous, still take away a lot of physician's time from running a practice and providing care to patients.
Q: Do you think independent physicians will be able to remain so as competition escalates in the industry?
VS: Innovative and entrepreneurial physicians who value their independence will continue to thrive and adapt to the ever-changing landscape of medicine in the U.S. If things continue as they are, however, and if the government passes more laws that are aimed at destroying private practices (such as "Obamacare"), less and less physicians are going to be willing to keep up the fight.
Ironically, the demise of private practice will not be due to competition; it will be due to the reasons listed above. Competition is actually good, and makes everyone try harder and be better at what they do. This ultimately provides better care for patients and more efficient healthcare with fewer costs. The current system is anti-competitive. It provides an unfair legal and financial advantage for non-for-profit tax-exempt large hospital systems and insurance companies.