Five spine surgeons discuss the impact of COVID-19 on consolidation in the spine field.
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.
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Note: The following responses were lightly edited for style and clarity.
Question: Will consolidation continue to be a trend in spine post-pandemic?
Brent Kimball, MD. CarePoint Neurosurgery (Lone Tree, Colo.): I expect to see consolidation to not only continue to be a trend, but to accelerate post-pandemic. Most smaller spine or orthopedic practices experienced disruption in practice and were introduced to complicated and time-consuming administrative tasks, including Payment Protection Program loans and the Medicare Advanced Payment Program. Many experienced a reduction in volume and a fear of what would happen to practice operations if one or more surgeons could not be productive.
The pandemic serves as a wakeup call to the smaller businesses as they end up bearing a high degree of marginal risk due to such disruptions. Without scale in the business, there is less elasticity to modify the work environment and the number of staff. If one or two surgeons in a small practice are sick or out of commission, the practice may suffer cash flow and payroll problems. As physicians have a new awareness of the risks and tangible reality that external forces can create unpredictably, this will push physicians and businesses to consolidate for the protection found in a practice at a larger scale. In my opinion, the most powerful forces driving the consolidation are:
1. The need to reduce/limit overhead and administrative costs that have increased due to COVID-19.
2. More valuable payer contracts and insurance negotiation found in larger groups.
3. Having more partners to share risk and unpredictable expenses related to future disruptions in practice, such as another pandemic or economic/healthcare slowdowns.
Richard Kube, MD. Prairie Spine (Peoria, Ill.): Consolidation will continue to be a trend due to insurance and large hospital forces. The financial advantages these groups experience through creating quasi monopolistic business scenarios are still as profitable for them now as they were prior to the pandemic. I believe these forces will attempt to seize the opportunity created by the financial squeeze the shutdown caused many small independent practices to forward their agenda of consolidation. Sadly, the government is also driving things in this direction as well. Limiting choices/competition does not improve the products and services provided in any industry. Medicine is much the same. Given that, the small and nimble practices that provide great value should survive and thrive through this time.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Consolidation will behave much like gravity. My hope is that surgeons will partner with each other, rather than relying on a hospital or health system partner. We have always had the ability to coexist with comrades/competitors. Smart surgeons will be seeking other capable surgeons to share space and cost with and to build a collaborative partnership. We can also act as support systems, as we can always sympathize with what we are going through. If you decide to be employed or partner with a larger group, learn the lessons the pandemic has taught us:
1. Everything is negotiable and can/will change.
2. Knowing No. 1: Get everything in writing.
3. Think about what happens when your contract ends.
4. Understand what your leverage and position are before walking into negotiations.
5. Trust but verify.
John Liu, MD. USC Spine Center (Los Angeles): In academic medicine, consolidation has been occurring for the last few years. In Southern California, all the major academic centers are buying other hospitals and absorbing practices to help compete with other conglomerate healthcare corporations. I think consolidation will be the key to survive and cut costs in the future.
Issada Thongtrangan, MD. Microspine (Phoenix): I predict that this trend will continue after the pandemic. The first question that I always ask myself if I am thinking about consolidation is "why?" For me, I will be looking at the partner who has the same visions and work ethics. I also look at their track records of success. I am also looking to partner with an organization or a company, so we can all share data in a fast, reliable and HIPAA-compliant manner. Another important aspect is how we can lower the cost or expenses without compromising the quality of care.