Spine technology adoption in a value-based practice — What's worth the investment? 3 Qs with Dr. Jesse Even


Jesse Even, MD, a spine surgeon with TMI Sports Medicine and Orthopedic Surgery in Arlington, Texas, and a spinal and orthopedic consultant to the Texas Rangers and Dallas Stars, discusses how he examines and selects new technology for his value-based spine practice.

Question: What technology and techniques are most exciting for you in the future?

Dr. Jesse Even: I am excited about several innovations in spine. It is a great time to be a spine surgeon. Our ability to treat patients in a quick, less painful, and efficient manner has never been so available. The spinal technology and innovation over the past 20 years is quite remarkable. There are two technologies that I am very excited about currently. The first one is total disc arthroplasty especially the in cervical spine. I made this procedure a part of my practice from the beginning and have had nothing but positive results for my patients. The FDA approval from a one-level indication to a two-level indication is a game changer because it opens up another set of options. Now young patients can proceed with a total disc option instead having to be forced to proceed with a two-level fusion.

The second technology that I am very excited about is the titanium interbodies. I currently use Stryker Tritanium in my transforaminal interbody fusions and my anterior cervical interbody fusion. There is great data coming out regarding these 3D-printed cages. They have excellent ingrowth of bone due to a design that is similar to the bony ingrowth models that the total hip acetabular cups have been using for the past decade. I think the evolution from polyetheretherketone to 3D-printed interbody cages is going to enhance our patient's ability to fuse and heal their interbody fusions at much quicker and higher rates.

Q: How do you evaluate new technologies and techniques?

JE: I am a reviewer for The Spine Journal so I am exposed to new technologies early in their development during their clinical trial development period. I compare their outcomes to the standards that have been set in our industry, and to historical outcomes. Then I also weigh the cost of the new technology and try to determine if the clinical benefit is worth the cost to the healthcare system.

I had a professor at Vanderbilt tell me you never want to be the first to implement a product, but it is also your duty as a physician to your patient not to be the last to put one in. Essentially saying, consider new technologies and always ask the ultimate question: is this good for my patient? The only thing that should matter is your patient and their outcomes.

Q: Is your practice moving toward value-based care? How does new technology fit in, whether you're taking cases to a hospital or outpatient surgery center?

JE: Yes, my practice is moving forward with value-based care, and [it] is one of the reasons I decided to join this practice. My partners are well-known in the community as conservative, well-trained surgeons who do the right thing for patients.

In addition, I also participate in a spine bundle payment model with my hospital system for value-based care along with performing many of my outpatient cases at an ambulatory surgery center. New technology is something we have to consider in these two situations due to the significant higher costs of the new technology and how they affect the value of the care. If the new technology can prove in a clinical trial that it is providing above and beyond what the standard of care is currently, then I think we must consider the cost of those technologies to get the best outcomes for our patients.

In the ambulatory surgery center, it is a real challenge to incorporate new technologies because most ASC contracts with the insurance companies do not cover the cost of implants. This makes it very difficult to implement new technologies with their much higher costs in this setting. Our goal as surgeons every day should be to get the highest quality patient outcome with the lowest cost to the healthcare system.

To participate in future Q&As with Becker's Spine Review, contact Laura Dyrda at ldyrda@beckershealthcare.com.

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