NASS Next Year: Dr. Michael Heggeness on Goals & Challenges for 2012


Michael Heggeness, MD, director of the spine surgery fellowship program at Baylor Clinic in Houston, was recently named the 2011-2012 president of the North American Spine Society. In this role, he will be building upon the efforts of previous leaders to strengthen NASS's mission of fostering advancement in spine care and advocating for the interests of spine specialists and patients in Washington, D.C.

"Right now, NASS is a place where one goes to teach and learn about things in spine," says Dr. Heggeness. "We have our annual meeting where people want to present their research and hear about cutting-edge opportunities in spine care. We also have The Spine Journal and Spine Line as a medium for the exchange of information. I'm interested in seeing that these things grow over the next few years. We're lucky to have an absolutely astonishing group of people donating a huge amount of time and energy to keep NASS going forward."

During his time as president of NASS, Dr. Heggeness will focus on promoting two major goals:
•    More basic science studies in spine
•    Larger international focus

"I want to promote NASS as the primary place where we can exchange basic science about the spine. I'd like to see more discussion and research on topics such as molecular genetics and bioengineering," he says. "I'm also looking for more collaborative efforts with spine specialists and societies abroad. Those initiatives include co-sponsored meetings and other activities that involve our international colleagues."

Looking into the future, Dr. Heggeness sees biology becoming a bigger part of treating spine patients. "In the next five years, some of the new biology will eventually have a much larger influence in the way we treat patients," he says. "We'll be using new molecular techniques to help our patients get better."

However, there are still several challenges spine surgeons will face over the next year in both clinical practice and research. Dr. Heggeness discusses three major challenges and how they will impact spine care going forward.

1. Paying for healthcare.
One of the biggest current challenges for medical professionals is figuring out how people are going to pay for their healthcare. Uncertainty with the Patient Protection and Affordable Care Act — what parts will be repealed and implemented — makes it difficult to predict what the future holds for healthcare providers. Reimbursement is declining for all specialists, and spine surgeons are no exception. However, with the healthcare landscape in flux, surgeons and professional organizations have the opportunity to contribute to the new emerging healthcare structure.

"Right now, we are looking at how the diminishing pieces of the healthcare pie are going to be distributed among the different parties involved," says Dr. Heggeness. "NASS will continue to try to contribute thoughtfully and reasonably as arguments come along."

2. Implementing evidence-based medicine.
As with all medical specialties, spine research is now focused more on providing strong evidence-based research for the development of treatment guidelines and justifying reimbursement. Unlike some other specialties, spine research hasn't been well-funded. Therefore, strong evidence-based studies are lacking. "Evidence-based medicine means a very structured look at the research and creating definitive guidelines," says Dr. Heggeness. "We have the challenge of obtaining the evidence to guide our treatments."

He notes that in the past, one of the biggest challenges was disseminating the information associated with new research. Technology such as the Internet and online professional journals has fixed that problem, but the research still needs to be stronger. "Research could be a lot better if we had more funding from impartial sources," Dr. Heggeness says.

3. Funding research.
Research has always been an important part of spine care, but is even more important now in finding and defending appropriate treatment pathways. While the depth of spine research is beginning to broaden, surgeons struggle to find non-industry funding for their projects. "Those of us who devote time to clinical research are suffering, like all musculoskeletal specialists are suffering, from a lack of research funding," Dr. Heggeness says. "If you look at the frequency and the amount of human suffering and disability due to musculoskeletal injury and disease, the amount of funding provided by the National Institute of Health is ridiculously low."

As a result, many spine surgeons have accepting funding from spine device companies to conduct research trials, and when industry members sponsor research there is the potential for bias in outcomes reporting. "There are good reasons to be alert to bias from industry-sponsored studies, but in many cases industry is the only funding source for spine research," he says. "We have huge problems finding money to fund the very important research projects that are taking place, and that is a real concern for us because the opportunity to actually study effective treatment for back pain or fracture healing too often just isn't there."

Related Articles on Spine Surgery:

10 Cost Benchmarks for Outpatient Cervical Spine Surgery

Where Spine Research is Headed: 5 Points From Dr. Frank Phillips

Building a Foundation for Scoliosis Treatment: 3 Important Studies

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