Fighting for the approval of minimally invasive alternatives to spinal fusion; non-surgeons performing certain spine procedures; and insurers too often dictating care decisions are some of the biggest threats to spine surgeons today, three specialists told Becker's.
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: What's one healthcare trend that you feel isn't getting as much attention as it should?
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Editor's note: Responses were lightly edited for clarity and length.
Question: What is the biggest threat to spine surgeons today?
Colin Haines, MD. Virginia Spine Institute (Reston, Va.): Spine surgeons today are faced with a huge challenge to maintain the ability to care for their patients as they see fit. Too often, payers dictate care based on either archaic literature or cost-cutting measures. I am concerned that the biggest threat to our patients is that, as spine surgeons, we lose ground in appropriately treating our patients. While evidence-based medicine is a cornerstone by which we all practice, large-scale population-based medical systems often leave the patient in the dust. In ideal medical care, each of my patients needs an individualized diagnosis and treatment plan. This level of customization is lost if we plug everyone into the same treatment algorithm. Big data and unilateral decisions by payers risk further loss of control over appropriately treating our patients.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Healthcare consolidation continues to run counter to the free market narrative many use to say the entry of corporations into medicine will bring. Again, not sure who is not paying attention right now, but it's apparent with less and less competition, costs are going to jump. The exhaustion of this cycle and those who are in charge of the narrative saying, "we need to keep cutting costs" and the American people's health and well-being are the grist for the mill.
Outstanding spine surgeons who have good results, provide a good patient experience and can effectively market themselves will remain a viable alternative. There will be more threats down the pike, for instance non-surgeons fusing the spine together or even non-physicians doing spine surgery in some form or another, portend a serious abyss to which we should all be aware of. Only by protecting patients and working with lawmakers can we stem the bleeding.
Todd Lanman, MD. Lanman Spinal Neurosurgery and the Advanced Disc Replacement Spinal Restoration Center (Beverly Hills, Calif.): The biggest threats to spinal surgeons who perform motion-preservation surgery are the insurance companies themselves. They routinely use third-party administrators to review authorization, and predictably, artificial disc replacement procedures are frequently denied reimbursement. Our practice finds it difficult to get approvals for even simple disc replacement surgeries that should be authorized without question.
My hope is that insurers will soon come to realize that ADR is actually better for their customers — my patients — and will be less expensive for them in the long run. Despite overwhelming evidence demonstrating disc replacement is superior to spinal fusion in the cervical spine and lumbar spine, ADR procedures are often denied. Data gathered on ADR are one of the largest datasets on any type of operation in history — more than hip or knee replacement.
Disc replacement is as good as or better than fusion in terms of pain relief and maintaining motion. When you consider the risk of adjacent-level surgery after ADR is 20 percent to 30 percent lower than fusion, the cost savings in avoided spine surgeries is enormous. Nevertheless, we continually fight with insurers and get denials for ADR surgeries. If spine surgeons don't win this battle, patients are going to end up resorting to motion-limiting spinal fusion when they could have enjoyed the benefits of motion-preserving disc replacement.