Dr. Jonathan Carmouche: Key thoughts on robotics and value-based care in spine

Laura Dyrda -   Print  |

Jonathan Carmouche, MD, is section chief of scoliosis and pediatric orthopedics at Roanoke, Va.-based Carilion Clinic and director of the Musculoskeletal Education and Research Center at Virginia Tech Carilion School of Medicine.

Here, Dr. Carmouche discusses the big trends in spine technology and how to prepare for value-based care.

Question: What do you think about robotic technology in the spine field?

Dr. Jonathan Carmouche: With increased interest in 1) minimizing radiation to patient, surgeon and staff, 2) precise and accurate implant placement and 3) minimally invasive technologies, spine robotics are here to stay. Though the technology may not yet be optimal, it has reached a point where it is reasonable and available. Surgeons are and will increasingly continue to be pressured to decrease hospital length of stay, to decrease reoperation rates. Robotics can help the surgeon community safely transition to more minimally invasive surgical instrumentation procedures while decreasing radiation exposure and maintaining low implant malposition rates.

Q: Where do you see the biggest need for improvement in spine patient care?

JC: Consistency of decision making. Spine pathology is quite heterogeneous and it is therefore a challenge to standardize care. However, just because this is a daunting task does not mean that we should shy away from trying to decrease some of the variability and therefore reduce healthcare expenditure on spine care and procedures.

Q: How do you see trends toward price transparency and value-based care affecting spine?

JC: There will be more drive towards minimally invasive procedures to shorten length of stay and therefor decrease cost. Aggressive implant negotiations will be necessary to decrease implant-related costs. I also see continued optimization of patient-specific case packs to minimize sterilization of many trays and decreased fusions for axial pain.

Q: What is the smartest thing you've done in the past 12 months to prepare your practice for the future?

JC: Surgeons need to prepare for value-based outcomes now before it is forced upon us. Learn the value-based care lexicon and implement changes to improve value. Keep pace with new technologies; you may not need to adopt all of them but learn about them all.

To participate in future Becker's Q&As or speak at Becker's events, contact Laura Dyrda at ldyrda@beckershealthcare.com.

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