Top 4 challenges for spine surgeons


From tightening cost margins and staffing shortages in the operating room, spine surgeons are facing a number of challenges in 2022.

Here are four of the biggest hurdles:

1. Rising costs and declining reimbursements

Expenses have gone up in the past decade, with overhead costs such as malpractice insurance, IT systems and compliance accounting for a considerable portion of operating costs, rising closer to the cost of quality staff. In addition, the reimbursements surgeons receive have been decreasing. This is shrinking the margins under which independent practices and ASCs operate. 

Efficiency will be crucial to tackling dwindling reimbursements, neurosurgeon Ciro Randazzo, MD, said. 

"Physician reimbursement is the only cost that has not increased, and actually decreased over the last several years," Dr. Randazzo said. "So we're going to have to look for ways to be more efficient in our practice, running our practice and in collecting as we're faced with the same inflation that all other businesses are faced with in the United States and throughout the world."

2. Independent practices maintaining autonomy 

Another major challenge for independent practices is maintaining their autonomy, and this has driven many smaller and medium-size orthopedic practices to band with larger groups. Others are partnering with private equity firms, and some are joining hospitals and health systems. However, this can mean sacrificing autonomy when it comes to patient care, which independent surgeons say they do not want to do. Still, being part of a larger group has advantages such as greater economies of scale, sharing financial risk and a larger seat at the table when negotiating contracts with payers.

Frank Aluisio, MD, orthopedic surgeon and physician president of Durham, N.C.-based EmergeOrtho, said consolidation has helped provide better value-based care.

"When you compare us to the hospitals, as we transition to value-based care, just by definition — with value being quality divided by cost — we feel as a large independent group we can provide higher value care because we can provide equal or better quality at a much lower cost than the hospitals," Dr. Aluisio said. "We're poised to really thrive in a value-based system."

3. Payer battles 

Surgeons are growing increasingly frustrated by insurance companies delaying, deterring or denying certain procedures. The net effect can be delayed or lower quality care for patients, and it also is contributing to burnout among surgeons and their staff and leading to financial stress among independent physicians.

A key insurer battle catching the eyes of spine surgeons relates to Aetna's coverage denials for artificial disc replacement, said Jack Zigler, MD, of Plano-based Texas Back Institute. 

"It's really indefensible at this point for [Aetna] to say that it's experimental and investigational when it's been FDA approved since 2004," Dr. Zigler said. "There have been almost 150,000 to 200,000 or more global implants already. … Other insurance companies have tried to do the same thing, but they've had class-action lawsuits by patients who are more educated than the insurance company 'experts,' and those companies have all capitulated." 

4. Staff shortages

Staff shortages are affecting the entire healthcare industry, and it is a continued concern for spine and orthopedic surgeons. One of the biggest challenges they face is the struggle to recruit and retain quality nurses, many of whom have been taxed physically and mentally by the pandemic. 

Christian Zimmerman, MD, a spine surgeon with St. Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, said staffing pressures could become part of a new normal.

"By and large the attention towards staffing issues, especially in the operating rooms, has been an additional hurdle of late," he said. Between the half dozen surge contentions and subsequent fall out of lassitude, the ability for hospital systems to properly staff and return to some normalcy in practice is affected. Albeit urgent and emergent care has not faltered, there is measurable lagging in both nursing and other ancillary services from the pre-COVID business model. This could represent the new norm."

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