Minimally invasive spine surgery, data gathering, value-based care & more: Key thoughts from NuVasive's Spine Summit

Spinal Tech

NuVasive held a Spine Summit on Oct. 13 and 14 in California focused on topics that impact spine surgeon leaders as well as hospital and healthcare executives.

Elizabeth Teisberg, co-author of Redefining Healthcare: Creating Value-based Competitive Results, spoke at the event along with Houston-based Memorial Hermann CEO Dan Wolterman, Las Vegas-based Western Regional Brain & Spine's William Smith, MD, former CMS Administrator Leslie Norwalk and Advisory Board Consultant Emily Brown, among others.


There were more than 100 attendees, primarily hospital administrators, who gathered at the event to learn more about where healthcare and spine are headed and engage in a dialogue with surgeons, CMS and other healthcare thought leaders.


"The days of the surgeon, hospital and industry doing their own thing are over," said Michael Farrington, head of corporate marketing for NuVasive. "Especially given how our financial model is set up, we have to work together. We aren't going to succeed if we don't approach healthcare collaboratively, specifically in spine. There has to be alignment between the patient, surgeon, hospital and device community."


Spine is a particularly complex subspecialty because there are multiple critical systems between the vertebrae, muscles and nerves to navigate during treatment. It's difficult to simplify the service line in the same way orthopedic knee and hip replacements have been streamlined in many hospital departments.


There is also a shift of spine procedures to specialized, high-volume spine hospitals or outpatient surgery centers. "Minimally invasive surgery — that's what really kicked off the latest and greatest outpatient shift," said Ms. Brown.


Ms. Teisberg addressed service line outcomes in her presentation, examining the best outcomes to measure success and how patients and physicians often measure success differently.


"Quality is better health outcomes for individual people," she said in her presentation. Failing to measure the outcomes could lead to slower improvement and higher costs. Measuring the outcomes also expresses empathy and can create a meaningful context for the patient's recovery.


Physicians often measure pain scores, fusion rate and readmissions to declare surgery a success. However, if patients aren't able to return to function, is the procedure still a success?


"ODI and VAS are not a true measurement of outcome," said Dr. Smith. Achieving predictable clinical and economic outcomes will be important for surgeons under new payment models to deliver value for the patient, clinician and industry partner. The outcomes will include some of the traditional measurements in addition to functionality, mobility and patient satisfaction.


Dr. Smith spearheaded efforts to bring new technology into his hospital that would add thousands to the upfront cost of spine cases but could achieve better outcomes and additional revenue. Initially, the hospital's value committee balked at the idea, but armed with data, he was able to show the technology's worth and the value committee changed its tune. Dr. Smith substantiated the technology and expanded the patient population eligible for the procedure.


Ms. Norwalk discussed healthcare spending trends, as the national health expenditure growth rates have been unsustainable. Many Americans, she said, aren't getting the best care possible and readmissions affect the quality and cost of care.


"Focus on the things that reduce overall administrative cost while improving quality," she said. "Innovation in healthcare delivery will be critical in having a sustainable healthcare system."


Mr. Wolterman spoke on identifying an end goal and working backwards to achieve desirable outcomes. He also addressed collaboration and providing the right incentives for clinicians to deliver high quality care.


"No longer can we divide and conquer; we all have to come together and behave as one [and] put the patient at the center of everything we do," said Mr. Wolterman.


In one example discussed at the conference, a small practice decided to change their culture to become more transparent. The surgeons shared cervical outcomes data and reviewed it as a group. The head surgeon found he ranked low on outcomes compared to the junior surgeons. The head surgeon observed how the junior surgeons performed their cases and was able to incorporate their techniques into his practice and deliver better outcomes for his patients as well.


"The culture has to change to become more open and transparent with data outcomes," said Mr. Farrington. "Organizations that are continually learning will deliver better outcomes."


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