Value-based care in spine and where device companies should focus next: Key concepts from Dr. Frank Phillips


Frank Phillips, MD, is the director of the division of spine surgery at Rush University Medical Center and practices with Midwest Orthopaedics at Rush in Chicago.

He is also president of the International Society for the Advancement of Spine Surgery and has been a leader in the spine field for decades. Dr. Phillips participated in a fireside chat during the Becker's Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Virtual Event on June 17 to discuss topics such as resuming practice after the pandemic, technology innovations, payer trends and where the spine field is headed in the future.

Below is a brief excerpt from the discussion.

Click here to view the full interview on-demand as well as access several other fireside chats, panels and workshops during the event. Be the first to know about the major trends in spine and hear from leaders during sessions that will stream on June 18 and 19 by registering here. Upcoming sessions feature Alexander Vaccaro, MD, Richard Wohns, MD, Cynthia Emory, MD, Evalina Burger, MD, Thomas Schuler, MD, Scott Blumenthal, MD, and more.

Question: What technology will be most essential for spine surgeons in the future?

Dr. Frank Phillips: COVID is really accelerating the push toward outpatient surgery centers. I was already there. I've done lumbar fusions for a number of years in the surgery center. But I think it's relatively slow in spine when compared with even in our own practice, to joints and sports and other areas of orthopedics. The COVID situation has accelerated that. It's more efficient and hospitals have to deal with COVID and there is a real patient fear about going into hospitals for COVID. ASCs offer a good alternative for both the surgeons and the patients, and we have had no pushback from patients coming to the ASCs, but we have had patients nervous going to the hospital. COVID-19 will accelerate spine going to the ASC.

Companies and manufacturers need to put their efforts behind technologies that play to the surgery center because I think we're migrating there anyway and this is really going to accelerate. There aren't specific widgets that we are going to point to in that space. But it will really be procedure innovation in the outpatient space. Part of that is the widget, part of that is the overall pain management, which is one of the biggest barriers to doing [more spinal surgery] in the ASC.

Q: How do you see value-based care in the spine field evolving? What are the most important investments for surgeons to make to prepare?

FP: I've gone back and forth on this. At one point, I thought this was the future, we were all in; we have to measure and get our metrics prepared for this. In spine, it has been a lot fits and starts, it hasn't really panned out. Total joints are pretty uniform; every total hip replacement looks about the same. Spine is just a different animal like a bundle for a lumbar fusion up to five levels, it encompasses so many different pathologies and the economics of those procedures are so different.

We have tried within our group to be part of Medicare bundles and accept different types of care, and that has been difficult to do in spine. It hasn't really taken off like it has in joints and other areas of orthopedics. I still think the principle of value-based care will stay, there is no doubt, but it's a tough thing in spine to execute. Obviously payers want to move away from fee for service and we at the same time have to prove the value of what we do. But formal value-based programs have been very elusive in spine.

I think we should collect data and it's important that all practices do it; if you don't you'll be in trouble. But is it going to be the way of the future that people have talked about? I'm less certain of that than I might have been three or four years ago.


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