How spine private practice will change in the next 3 years

Laura Dyrda -   Print  |

The healthcare landscape is changing quickly for private practice physicians, including orthopedic spine surgeons.

Consolidation over the past decade has led to more physicians becoming hospital employed, and large orthopedic and spine groups growing even larger. New regulations, aggressive payer reimbursement changes, advancements in minimally invasive technology and the shift to value-based care are current trends affecting how spine surgeons prepare for the future.

Six spine surgeons outline the steps they are taking to prepare for key changes in the future.

Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute: I feel private practice physicians like myself will be burdened even more by increasing government regulation, drug prescription monitoring requirements, and increased costs associated with staffing to address these regulations. We try to tackle these head-on as they arise so that we don't have to spend even more time trying to 'catch up' as the regulations become more complicated and restrictive to patient care. Over the next three years we are expecting this to increase unless much-needed deregulation is enacted by our government.

Mick Perez-Cruet, MD. Michigan Head & Spine Institute (Southfield, Mich.): There are certainly increasing administrative burdens. We need to prepare for this and improve our practice's ancillary services and efficiency to defray the added practice cost.

Kevin Foley, MD. Semmes-Murphey Clinic (Memphis, Tenn.): Over the next year or two, my practice will likely change incrementally. Already, for example, the majority of my spinal surgery cases are performed minimally invasively and over half are performed in our surgery center. This trend will continue and slowly increase. Beyond that near term, I expect to see more significant changes in reimbursement, continued pressures on providers to lower costs and risk-share, the adoption of the above and other new technologies, especially if they improve the value of care and/or address previously unmet clinical needs, and increasing involvement of physicians in managing the healthcare system. We are the key drivers of improved value.

We are doing several things at Semmes-Murphey Clinic to prepare for the future. We have entered into co-management agreements with the two largest regional healthcare systems, we are constructing a prospective bundle of our services to market to businesses, and we continue to emphasize and measure quality. In that regard, we have been major contributors to the Quality Outcomes Database and will be a vanguard site for the newly organized AANS-AAOS American Spine Registry.

Peter Derman, MD. Texas Back Institute (Plano): I find it imperative to constantly update my practice and thoughtfully incorporate to the latest knowledge and techniques. One of my mentors during training used to say, 'If you come back five years from now and I'm still doing things the same way, you can consider me a failure.' I embrace this sentiment as well. From a knowledge perspective, I stay up to date by reading the latest journals, participating in society meetings, and producing original research of my own. From a technical standpoint, I seek out additional opportunities to hone my skills and broaden my repertoire, whether that be cadaver labs, courses, or even co-scrubbing with my partners on interesting cases. My goal is always to be able to offer my patients the optimal treatment for their unique pathology, not just a standard 'go to.' This requires comfort with the entire spectrum of spinal procedures.

I believe that the next wave of innovation in spine surgery is in the endoscopic space, and I anticipate that this will become an increasingly significant component of my practice in the coming years. I also think we're going to see a major shift away from fusion and toward motion preserving techniques such as disc replacement, both in the cervical and lumbar spine. It seems absurd to me that spine surgeons are routinely fusing motion segments. Where else in the body is this a standard practice? Hip and knee surgeons do not spend their days fusing joints for degenerative conditions. While the biomechanics of the spine are more complex, we will be performing arthroplasty in more and more instances that previously would have required fusion as motion preserving devices and our comfort with them improve.

Gregory Lekovic, MD. California Hospital and Medical Center (Los Angeles): It is more important now than ever before to pick your friends wisely by seeking alignment with a health system or other institutional partner that understand your culture of excellence and can help you grow. Nevertheless, the more things change, the more they stay the same: the key to a 'destination' practice such as the House Clinic in LA remains excellence in clinical outcomes, high volume, assiduous commitment to detail, and communication with patients through their whole treatment journey.

Kristopher Kimmell, MD. Neurosurgeon (Rochester, N.Y.): It is clear that the trend of the last few years has been driving physicians to do more with less. Reimbursement rates are falling, indications for surgeries are tightening, and many surgeons are finding themselves beholden to larger and larger institutions and stakeholders. Surgeons must find ways to work smarter, not harder, by familiarizing themselves with rapidly evolving healthcare policy as well as digital technologies.

I subscribe to a wide variety of outlets reporting on changes in healthcare technology and policy and am actively involved in my specialties societies in order to 'keep my ear to ground' on policies coming down the pipeline that affect my patients. The only way for physicians to combat policies that are unfriendly to our patients is to be informed and speak up.

To participate in future Becker's thought leadership articles, contact Laura Dyrda at

More articles on spine surgery:
The most dangerous trend in spine surgery
Dr. Christopher Kager, angel venture capital firm eye innovation in healthcare technology
How Beacon Orthopaedics plans to grow after taking on a private equity investor

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