Rising overheads, decreasing reimbursements: Dr. Martin Quirno on the biggest challenge for spine surgeons today

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Martin Quirno, MD, is a fellowship-trained spine surgeon and clinical assistant professor of orthopedic surgery at New York University Hospital for Joint Diseases in New York City.

SpineLine, the main publication for North American Spine Society members, recognized Dr. Quirno in its '20 Under 40' list of top spine surgeons for 2019 in August.

Here, Dr. Quirno discusses the impact a single-payer system would have on spine and the biggest challenge facing spine surgeons today.

Note: Responses are lightly edited for style and for clarity.

Question: What do you think is the biggest obstacle facing spine surgeons today?

Dr. Martin Quirno: As a young spine surgeon in private practice I realize it's becoming harder to reconcile rising overhead costs with the constant decrease in surgical reimbursements. We need more staff in our office to help deal with the increasing amount of logistics and paperwork. However, in order to have competent staff we have to provide a competitive salary, while our own reimbursements are actually decreasing.  

We are expected to provide flawless care. Patients' expectations are very high. Therefore, it's very important to have a strong internet presence detailing your expertise and experience, to help accurately portray your practice with surgical reviews and patient experiences. This also costs money and time. 

Q: Do you think a single-payer insurance system help or harm spine practice? 

MQ: I believe a single-payer insurance would harm spine practice. By creating one single payer funded by the government with absolute control over pricing, the one thing that is guaranteed is that the reimbursements would significantly decrease and there would be nothing physicians could do about it. This would help dissolve the already disappearing private practice world. There would be a small percentage that would remain outside of the system by charging cash for surgeries. But most of us would have to join large hospital networks. The physician and hospital systems would also make less and have to make significant cutbacks in staff and resources. Ultimately this would drive down the quality of services provided and significantly increase the cost to the American taxpayers. 

Q: What spine research are you currently engaging in? Is there anything you see as particularly innovative on the horizon in the field?

MQ: I've always been involved with research and had the opportunity to complete two postdoctoral research fellowships during training. I'm currently involved in studying the effects of minimally invasive spine surgery on different clinical, financial and radiological outcomes. 

I'm interested in seeing the long term clinical advantages of utilizing new navigated robotic devices, especially ones that will prevail and what the best utilities are for these new technologies.

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