Dr. Kee Kim: the trends that will have the biggest impact on spine in 2020

Alan Condon -   Print  |
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Kee Kim, MD, is chief of spinal neurosurgery at Sacramento-based UC Davis School of Medicine and co-director of the UC Davis Spine Center.

Here, Dr. Kim discusses how price transparency and other emerging trends will affect spine in 2020, and how he plans to enhance UC Davis' clinical trials program.

Note: Responses were lightly edited for style and clarity.

Q: What area of spine do you expect to see the most change in 2020? 

Dr. Kee Kim: Our patients are expecting more from us. Even older patients who in the past were resigned to increasing activity limitations are seeking us out to maintain a certain quality of life. Thus, innovation in our field will continue and accelerate to meet that demand. I expect that we will continue to push the envelope with increasingly less invasive surgeries and non-fusion surgical options in 2020. In addition, better biologics and novel alloy implants will become available. Robotics in spine surgery will be utilized not just for placing screws but will be more versatile. 

Adult spinal deformity surgery will be tailored to individual patients considering not only their age but fragility index, bone quality and other emerging factors. Individual deformity correction will be customized so we do not, for example, end up fusing all patients from T4 to pelvis. Many clinical trials will begin in 2020 to evaluate cutting edge technology that may have significant impact on our patients, including those with spinal cord injury. As a busy Level I Trauma Center, we have participated in all major spinal cord injury clinical trials starting with the National Acute Spinal Cord Injury Study, so UC Davis Health is well-positioned to contribute significantly to the traumatic spinal cord injury field.

Q: What's the most challenging part of your practice at the moment?

KK: Our field was simpler when I began my career in 1998 after a complex spine fellowship. With the rapid pace of innovation and changes in healthcare overall, we face more challenges, which are not unique to my practice. All facets of our clinical practice are evaluated and more demands are placed upon us with 24-7 access to electronic medical records. We are graded by our patients and our outcomes are compared to our peers. With the availability of more surgical and nonsurgical treatment options, determining what is best for our patients can be difficult. 

This challenge is compounded by a lack of good data. In those situations, I try to place myself or my loved ones in my patients' shoes so that I do not recommend a treatment that I would not choose for myself or my loved ones. Despite the challenges, I feel blessed to be doing what I truly enjoy. For those of us in this field and more broadly in healthcare, I think it is truly a privilege to be entrusted with so much by our patients. 

Q: What plans do you have for your practice next year? What strategies or initiatives are you implementing?

KK: When I cofounded the UC Davis Spine Center in 2006, our goal was to have a comprehensive spine center comprised of all the disciplines including nonsurgical spine specialists, physical therapists and a clinical psychologist. Back then, it was rare for our spine patients to be able to go to one place to have all their spine-related issues addressed. Although this model is quite common now, I believe what we offer is a very special working environment resulting from more than a decade of cultivating a collegial and collaborative approach. Just with the word of mouth from our patients and our referring physicians, the demand for our services has grown over the years. 

The plan for 2020 is a smart expansion to better meet the needs of our patients. We are recruiting an additional neurospine surgeon to not only enhance our clinical practice but also strengthen our laboratory to translational spinal research. Over the years, we have built one of the busiest clinical trials in the country. We want to build upon that and further grow our clinical trials program. Patients seek us out to access cutting-edge technology available only in a clinical trial. Even if they do not qualify for the study, they often stay with us for care. We are also taking the initiative to start operating at the UC Davis Same Day Surgery Center to increase our OR access for our expanding minimally invasive spine surgery program.  

Q: How do you see the emerging trend of price transparency affecting spine?

KK: Price transparency in healthcare will be an inevitable reality. However, the dollar figure is helpful only if we know what that number means and understand the relevant factors to consider. For example, teaching hospitals will generally cost more than nonteaching hospitals, but many patients do not know that or the reasons why. An important part of my job is educating our future surgeons. The surgeries will typically take longer in that setting, but we all know that hands-on experience is an essential part of training. If done properly, the patient outcome is not compromised but instead may even be enhanced.

The Journal of the American Medical Association published a paper in 2017 by Laura Burke, MD, et al. on the association between teaching status and mortality in U.S. hospitals. They looked at over 21 million hospital visits paid for by Medicare in 2012 and 2013. Adjusted for all the factors that could have skewed the results, they found that the teaching hospitals saved more lives compared to nonteaching hospitals, including lower mortality for five of six major surgical conditions. This is just one example where the dollar figure alone would be inadequate to determine its true value. If we can implement price transparency in a way that would allow our patients to make a truly informed decision, it will help reduce healthcare costs without compromising quality.

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