How to Reduce Costs & Maintain Quality of Care: 5 Spine Surgeons Weigh In


Five spine surgeons discuss how to reduce healthcare costs without compromising care. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What is your methodology for bringing new techniques or innovation to the operating room?

Please send responses to Heather Linder at by Wednesday, May 1, at 5 p.m. CST.

Dr. Jeffrey Wang of UCLA SpineJeffrey Wang, MD, UCLA Spine Center: Well, tying together reimbursements and payments with the increased quality and better outcomes is the way that the system appears to be going. I do think that this provides motivation for hospital systems to provide support for the administrative personnel we need to track our outcomes, quality and reduce re-admissions and complications. I believe that surgeons have been wanting to do this all the time, but have not had the appropriate resources to be able to create this type of tracking system and maintain a busy clinical practice. The role of electronic medical records is also going to help.

However, the real key will be to try not to overburden the care provider. Most of the guidelines and rules that have been created over the years have placed an increasing burden on the time and efforts of the practicing surgeon. Declining reimbursements, new requirements and other initiatives basically require physicians to jump through more hoops without compensating them for their time. I do believe the key for a sustainable plan will be to help the practitioner and not place the burden of time, liability and work solely on the practitioner, who is providing the actual care. This will allow the practitioner to have the time to provide high quality care. Perhaps more importantly, it will not discourage the brightest people from entering healthcare as a profession.

Dr. Richard Kube of Prairie Spine & Pain InstituteRichard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: Harvard Business Professor Michael Porter authored a book titled "Redefining Health Care." In it he discusses lowering cost through the principles of competition and providing value to the patient and consumer. Forming an Integrated Spine Center would be a great start to accomplish this.

As costs rise, everyone looks for greater value in purchases. If services are truly integrated, then a center operates with the goal of returning the patient as closely to normal function as possible in the most efficient way possible. Coordinating care under one roof helps improve efficiency, and it allows for the appropriate care to be delivered regardless of what is needed every time. Providing surgical services as part of the model also lowers costs as hospitals charge and cost much more than ambulatory surgical facilities.

In addition, the outcomes are just as good if not better and patients have higher satisfaction at these smaller facilities. Unfortunately, many of the current market forces are encouraging hospital mergers and physician practice acquisitions. While these models place the services under one roof, they also create monopolies which will undoubtedly lead to paying more for less. Allowing for smaller physician-run models will provide for competition and allow the medical decisions to be made at a grassroots level. It's the only way to control cost without compromising or rationing care.

Walter Eckman, MD, owner of Aurora Spine Center, Tupelo, Miss.: I think it is critical that surgeons progress as rapidly as possible to nearly 100 percent minimally invasive spine surgery. Reduced length of stay, elimination of transfusions and infections, and early return to activity and work all have major economic impact and potential benefits of reduced disability and would give additional savings.  

One of the biggest cost savings would be focusing on lumbar fusions at only one or two levels. Many surgeons are finding they can address the most serious patient needs in degenerative spine disorders with this approach. Once a surgeon understands this, additional major savings are gained by unilateral surgery with single interbody devices and unilateral pedicle fixation. When surgeons adopt this surgery, they will have an opportunity to send the vast majority of their patients home the same day (to date we have over 800 patients with MITLIF who had same day discharge with 93 of our last 100 lumbar fusion cases home that day).  

Richard Guyer, MD, Spine Surgeon, Texas Back Institute, Plano, Texas: Clearly not what the government is doing!!! It would require a change in the entire paradigm and empowering the people to make medical decisions, that is, consumer-driven healthcare. Stan Feld is a retired endocrinologist writes a weekly blog on repairing the healthcare system. He is very bright and articulate with clear insights to these problems. I would suggest that anyone interested should read his blog. In one of his most recent entries he discusses the fallacies of the new "Obamacare."

Kern Singh, MD, Rush University Medical Center, Chicago: Surgeons and physicians are the keys to delivering efficient and cost-effective healthcare. Unfortunately, physicians tend to be divisive and autonomous leading to large healthcare reforms without physician input. Hospital-physician and physician-physician partnerships through joint ventures in the hospital and surgicenter environment will allow doctors to deliver cost-effective and expeditious healthcare.

More Articles on Spine:
5 Current Healthcare Policy Issues for Orthopedic & Spine Surgeons to Know
Laser Spine Institute Publishes Study of Laser Spine Surgery for Lumbar Stenosis
7 Areas of Underused Potential for Spine Surgeons Online

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