The top business issue in spine today + how established practices can continue to grow

Practice Management

Adam Bruggeman, MD, is an orthopedic surgeon at San Antonio-based Texas Spine Care Center. He spoke with Becker's ASC Review on establishing sustainable success in orthopedic practices.

Dr. Bruggeman 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 or Kristelle Khazzaka at for further information about sponsorship and exhibitor opportunities.


Question: If a practice is established and relatively successful, what can be done to shake things up and promote growth?


Adam Bruggeman: Each market is different, so a detailed SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis is necessary to evaluate the individual market. That being said, healthcare is increasingly becoming local, and as such, patients are frequently going to the nearest spine surgeon as opposed to driving. Providing a closer, more convenient location for patients, even if once per week, can open up new referral patterns from physicians as well as increase the likelihood of patients coming to see you on a self-referral.  


Q: What would you say is the most important business issue in spine surgery today?


AB: I think it is clear that public and private insurers are increasingly interested in quality over quantity, but they pay based on quantity. With the transition to [the Merit-based Incentive Payment System] and the significant cost pressures, the treatment (operative and nonoperative) of spinal issues will be required to show value for the services provided.  


The easiest way surgeons will be able to show value is through partnering with CMS and private insurers through bundling in a way that financially incentivizes the physician significantly and also provides the insurance company with cost savings.  


Fortunately, the spine surgery community will be able to learn from the [Comprehensive Care for Joint Replacement Model] and [Bundled Payments for Care Improvement] experience of our colleagues that perform total joint surgery.  


Ultimately, I see a significant shift towards ambulatory surgery centers as a result of these partnerships.

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