The toughest challenges facing the spine industry


From an increasingly demanding spine patient population to payers too often dictating care and a potential overreliance on enabling technologies, five spine leaders outline some of the biggest challenges facing the specialty.

Note: Responses were lightly edited for length and clarity.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: A discussion I frequently have with both my reps and those who train residents is there is a genuine concern of the overreliance on tech. Surgeons of a certain vintage who trained on anatomic techniques were slow to adopt them. The next generation seemed more comfortable but were also trained in the backup plan of mapping hardware placement using landmarks and aided by fluoroscopy "just in case." The following generation I hope can still do this. 

My concern is that instead of verifying and then proceeding, some will just charge ahead, assuming the navigation or technology is spot on. It's more concerning when you think about who exactly is liable when the technology is "off." I hope the next set of surgeons can see its shortcomings and that the need for anatomical knowledge is paramount.

Colin Haines, MD. Virginia Spine Institute (Reston): 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.

Hooman Melamed, MD. The Spine Pro (Marina Del Rey, Calif.): Major hospitals and healthcare corporations are acquiring more and more physician practices, especially primary care, which not only is driving the cost of healthcare up but also decreases the referral to the community orthopedic surgeons, and now instead, those primary care practices have to refer to the hospital or that healthcare corporate system.

Insurance companies are further reducing payment and bundling payments together which is putting some practices on a financial strain since average overhead is going up every year. For example, as staff salaries increase every year, yet reimbursement is getting less.

This forces many orthopedic surgeons to work more and increase the volume which causes higher rate of burnouts, dissatisfaction with the job and increased patient care mistakes.

Maurice Goins, MD. Resurgens Orthopaedics (Atlanta): I believe there are many challenges, [including] providing care to an increasingly skeptical and demanding patient population that is continuing to grow in size that ultimately is outpacing the growth of practitioners. Compared to five to 10 years ago, there was a shift in patient care where it became a combined approach involving more of the patient-physician relationship to make a quality decision for patient care going forward. Over the past five years, in particular during the pandemic, our patient population has become ever more knowledgeable and even more demanding of the care provided, which makes it more challenging to meet their expectations. The shift in care is now the patient, who is a consumer along with the insurer, the physician and the internet.

Nick Jain, MD. DISC Sports & Spine Center (Newport Beach, Calif.): While prior authorization for ACDF is an obvious target due to the increased authorization process burden and delay in care, I think the decreasing CMS fee will prove to be the most detrimental recent change to patient care. As reimbursement costs decrease while staffing costs and inflation soar to all-time highs, physicians will be forced to spend less time with patients to make ends meet, resulting in shorter face-to-face visits with an increasingly sicker and older patient population who require our full attention and dedication. This will only lead to the further degradation of the physician-patient relationship and, for that reason, I would eliminate the recent cuts to the CMS fee schedule.

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