How to grow a successful independent spine practice: 4 key questions

Practice Management

Four spine surgeons answer tough questions on how to build and sustain a successful practice in today's changing healthcare environment.

All surgeons participating in this article are featured speakers at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 14-16. Click here to register. 

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

Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): 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: Where do you see the biggest opportunities for independent physicians to build their businesses?

Stephen Hochschuler, MD. Texas Back Institute (Plano): Becker's Healthcare is a great resource. Surgeons can get their name published and thoughts out there proactively. When I started working with Becker's, I didn't know the publication's reputation. But I contributed. The leader always takes arrows in their back, but then everyone wonders what they are doing and tries to get involved. Spine Health and SpineUniverse are also great resources, especially if you're looking to grow on nickels rather than $100 bills.

Telehealth is another expandable area that allows you to cover your patients more efficiently. All the rules of telehealth are changing, so you have to learn what they are. Another area I'm looking at is pain management for spine surgeons; you need a multimodal approach to prepare the patient for pre-op and then what to expect without opioids. Finally, I'm looking at regenerative medicine for spinal procedures to address anti-inflammatory issues, which all spine surgeons should be interested in.

Q: Do you think independent physicians will be able to remain so as competition escalates in the industry?

Vladimir Sinkov, MD. New Hampshire Orthopaedic Center (Manchester): 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.

Q: How do you expect the value equation to change the practice of spine surgery over the next decade?

Frank Phillips, MD. Midwest Orthopaedics at Rush (Chicago): Bundled payments will continue to evolve with the inevitable march away from a fee-for-service model. Bundles are readily managed for spinal procedures with reproducible and predictable outcomes, such as ACDF. More complex treatments, such as surgery for advanced spinal deformity, will remain a challenge in a value based purchasing system. With increased emphasis on value and transparency, practices and practitioners' outcomes will become increasing available to the public who will become much more sophisticated healthcare shoppers.


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