How Walmart, CVS Health will affect spine care: 4 surgeon insights


Retail giants such as Walmart and CVS Health are continuing their push into healthcare, offering cost-friendly and convenient care close to patients' homes, and more providers are taking notice.

Four surgeons reflect on these market disruptors and predict how they could influence spine care in the coming years.

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. Becker's invites all spine surgeon and specialist responses.

Next week's question: Private equity continues to make inroads in orthopedics. What questions has this rising trend yet to answer?

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, May 11.

Editor's note: Responses were lightly edited for clarity and length.

Question: How will retail giants like Walmart and CVS Health affect healthcare in the U.S.? 

Alexander Vaccaro, MD, PhD. Rothman Orthopaedic Institute (Philadelphia): The ability to provide access at an individual's convenience at an appropriate price point with high quality is key to remaining relevant in healthcare. With Walmart and CVS Health further integrating into the market by providing direct patient care via their Center of Excellence collaboration models and hiring providers on staff of their own, this places increased pressure on traditional care providers to innovate or risk a reduction in their patient volumes.

More specifically, they are changing the landscape of where and how care is provided, within the lens that people want, such as the place, time and affordable price point; including where they shop for everyday items and within the comforts of their home. CVS, for example, has applied for a patent in the metaverse for virtual shopping and remote care. Traditional care providers should take notice of these market disruptors as they have the ability to impact supply and demand, which in turn can directly impact volume, pricing and reimbursement for care. As Walmart and CVS seek to reinvent patient expectations and experience, so must current healthcare providers.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The Walmart Center of Excellence program has made a large impact on quality in spine and total joint care. The reality is that we have a lot of variability in spine care today. Indications for interventions and surgeries remain subjective, and the literature suggests that patients may get different treatment recommendations based on the provider they see (physiatrist, pain specialist, surgeon). Center of Excellence programs require the use of standardized care pathways and often mandate multidisciplinary decision making. We published a paper in 2017 that showed that multidisciplinary decision making can actually reduce surgical utilization in favor of nonoperative strategies like physical therapy. Large employers have the ability to mandate such care and therefore have the potential to lead the healthcare system in ways that will improve outcomes, cost and ultimately the value of care delivered.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: My prediction is that cost will go down. Inevitably [Walmart and CVS Health] will be able to deliver it much more cheaply. I do not think better quality will necessarily follow. Cookbook medicine will be practiced and things will get missed. Ultimately, patients will likely do worse but the spend will be less. Healthcare quality has always been — and always will be — you get what you pay for. The only way forward is not cheaper; it's better. We have spent 10 years under the threat of underperformance from various organizations under the umbrella of HHS.

I would wager we have gotten better, and perhaps cheaper, but healthcare costs continue to go up. I am not sure when someone at that organization will decide to read the writing on the wall that allowing unchecked profiteering by for-profit insurance, drugstores or retail stores is not going to drive down costs until you stop letting them gouge patients. Physician fees continue to be less than 6 percent of the healthcare spend. The free market, which is the current "gold standard" for driving down costs, is farcical when it comes to healthcare as the deck is stacked against patients and physicians.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The current state of healthcare delivery has been measurably shaken and disaffected by recent events that the "disruptive innovation" of de novo corporate oversight may be a welcome play. Consumerism and accountability are factored entities to large and small businesses alike, and further awareness of these workings could be made more efficient. EMRs are diverse, and digital enhancements will only improve. The positives of employee health and maintaining that outlook outweigh the negatives of brand disruption.

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