Reducing the cost of spine care: Key thoughts from 4 spine surgeons


Treating back pain and other spinal conditions can cost more than $200 billion annually in the United States, with $90 billion in direct costs. There are several factors contributing to the ever-increasing cost of care, including hospital costs, device costs, pharmaceuticals and post-surgical care.

"We have a larger aging population now which requires more care, and in spine surgery we are able to treat a much wider range of patients than in the past," says Glenn R. Buttermann, MD, an orthopedic spine surgeon at Midwest Spine & Brain Institute in Minnesota. "Anesthesia is better and our technology for monitoring and performing surgery with new biologics and instrumentation allows us to perform surgery on patients we wouldn’t have selected 20 years ago."


Physician reimbursement is a relatively small portion of the overall healthcare speeding, and until there is transparent pricing for each aspect of care, the hidden costs will likely continue to drive up the ticket price.


"Physicians need to be aware of the true cost of procedures and choice of equipment," says Jason Datta, MD, an orthopedic spine surgeon with Sonoran Spine in Mesa, Ariz. "When true pricing is known, choices can be made for non-essential expenditures and cheaper alternatives that don’t compromise quality for our patients."


Patient health also makes a difference; obesity is on the rise and can increase postoperative complications that drive costs higher. "Anything we can do as a society to increase awareness of the impact comorbid conditions such as obesity can have on health will go a long way to address some of the real economic factors driving the cost of spine care in our country," says Eubulus Kerr, MD, an orthopedic spine surgeon at The Spine Institute of Louisiana in Shreveport.


Surgeons can influence the cost in several ways, including:


• Device and technology choice
• Using less invasive procedures to reduce the length of hospital stay
• Perform efficient procedures for decreased operating room and anesthesia time
• Focus on procedures with less blood loss
• Appropriate patient and procedure selection to reduce complications and revision surgeries


For years the traditional orthopedic device company giants were able to charge high costs without push-back. However, with a renewed focus on cost control at many institutions there is an opportunity for other companies, such as GS Medical, to bring new innovation to the table.


"GS Medical went beyond our expectations by engaging surgeons and not trying to sell them more products, but instead to figure out how they could make our cases easier and more efficient," says Dr. Datta. "When they can, there is new equipment for performing cases. This is why a majority of surgeons at our facility prefer GS Medical products."


The GS Medical product line is designed for surgeons to control costs and improve outcomes that lower overall costs.


"I have a quality product from a more nimble company that responds to our needs intraoperatively without compromising quality and the hospital is extremely happy because of the significant cost reduction," says Dr. Datta. "GS Medical has proven itself as an engaged partner in providing specific equipment that each surgeon prefers and improving sets to be more efficient for the surgeons and patients to which they are providing the products."


All across healthcare, physicians and hospitals are dealing with similar cost issues. A November 2013 JAMA issue was dedicated to the increasing healthcare costs, with pharmaceuticals, medical devices and hospital care driving the lion’s share of the costs.


"Medical device costs have increased due in part to increased regulations and the 2.3 percent medical device excise tax," says Dr. Kerr. "Though they’ve decreased some of the morbidity risks associated with traditional bone grafting, biologics have also played a role in increasing surgical costs associated with spine care. Certainly, surgeons need to be very mindful of the cost-effectiveness of the products they are choosing and the market will naturally adjust as companies find ways to become more cost-competitive."


Many in the industry are also concerned about new research and development; the past decade brought an innovation boom to spine that will take considerable capital to continue. "Research and development is a major driver of the cost for bringing new products to market," says Gregory Hoffman, MD, an orthopedic spine surgeon at Orthopaedics Northeast in Fort Wayne, Ind. "Up until the last decade, there were only a handful of companies that produced spinal implants. Due to the lack of competition, these companies were able to set a high price point for their implants. With the introduction into this market by innovative companies like GS Medical, the cost of implants has dropped dramatically. Because of this phenomenon, hospitals, surgery centers and patients have directly benefited by lowering their cost of medical care, without sacrificing the quality of care."


There are some who worry the focus on lower costs will stifle future innovation, but that fear hasn’t come to fruition.


"Innovation will not be jeopardized with focused development and budget cuts on non-essentials," says Dr. Datta. "Many companies may learn that it’s more effective to specialize in certain treatment options and do those extremely well. We may not require a complete ‘toolbox’ for every need."


With his training in pediatric and adult deformity, Dr. Buttermann focuses his practice on anterior procedures, including anterior lumbar interbody fusion. His training was in pediatric and adult deformity and he uses GS Medical devices with both his deformity and degenerative cases.


The GS Medical technology provides a large array of lumbar interbody PEEK device sizes to fill the interbody space giving rigidity to promote fusion.


"They have the largest number of footprints with available sizes in height and I can position the implants wherever I need for deformity correction," Dr. Buttermann says. "This allows me to use facet screws posteriorly to achieve the goal of minimal muscle damage giving better outcomes in the short and long term. With these types of minimally invasive procedures, we can perform one- and two-level cases as outpatient. That’s really revolutionized my practice."


Functionality is another factor changing spine practices today. Historically, when patients achieved fusion and reported less pain, surgeons considered the procedure a success. Now, success hinges on the patient’s ability to return to work and resume the activities of daily living, as well as achieve a desired range of motion postoperatively.


"Unlike hip and knee outcome measures, spine doesn’t include range of motion or function. Our outcomes are based on pain and we can improve pain, but we still need to make sure patients can highly function, such as participate in sports or do all the necessary chores at their house," says Dr. Buttermann.


Timing is also important in the operating room to deliver quality care. "GS Medical has been very responsive if and when we needed something changed or adjusted," says Dr. Hoffman. "This responsiveness to the requests from surgeons makes it easier for us to complete our surgical cases and thereby positively affects the outcome for the patients. The quality of their implants is exceptional. I have been using GS Medical implants and instruments for a number of years, even in very complex degenerative cases, and have been completely satisfied with the product portfolio."


Dr. Hoffman feels comfortable scheduling cases knowing the implants will arrive on time, and a knowledgeable company representative will be present for the case. This confidence is important, especially for surgeons who are collecting data and publishing their results for clinical outcome studies or data registries. Hoffman concludes, "GS Medical exemplifies the successful integration of product engineers, research and development scientists and innovative leadership to create economically-conscious, high-quality spinal implants."


This article is sponsored by GS Medical.


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