How hospital, spine practice competition is playing out in 4 regions


Four spine surgeons discuss the competition between private practices and hospitals in their markets.

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 thing you would change about the spine surgery industry?

Please send responses to Carly Behm at by 5 p.m. CDT Wednesday, Aug. 16.

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

Question: How is competition between hospitals and private spine practices evolving in your market?

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Private practice physicians and hospitals are increasingly forming alliances to work collaboratively instead of competing with each other. This shift in the healthcare industry is driven by several factors. First and foremost, collaboration allows for better coordination of care and improved patient outcomes. By working together, private practice physicians and hospitals can share resources, expertise, and technologies, leading to more comprehensive and effective treatment options for patients. This collaborative approach also promotes a sense of continuity in patient care, as physicians and hospitals work hand in hand to provide seamless and integrated services.

Another key benefit of forming alliances is the potential for cost savings. By sharing resources, such as medical equipment and administrative staff, private practice physicians and hospitals can reduce overhead costs and improve efficiency. This, in turn, can lead to more affordable healthcare services for patients. Additionally, through collaboration, physicians and hospitals can leverage their collective bargaining power when negotiating with insurance companies and suppliers, resulting in better reimbursement rates and access to necessary resources.

Overall, the trend of private practice physicians and hospitals forming alliances reflects a shift towards a more patient-centered approach in healthcare. By coming together, these entities can combine their strengths and expertise to deliver high-quality and coordinated care to patients. This collaborative model not only benefits patients by providing them with comprehensive and cost-effective care but also strengthens the overall healthcare system as a whole.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There are increasing amounts of consolidation in the marketplace. Private practice still exists in several forms. Some are coalescing into "groups of groups" while others I suspect are being backed by large health systems while appearing to be independent. We have several large academic systems in the area, constantly hiring and jostling for patients. There are various niches and opportunities, but with reimbursement cuts and increasing burden of prior authorization hurdles, we might be headed for a house of cards moment. Certainly, we will see continued push for single payer and that will be an interesting moment when we truly see how we will not have learned the lessons of our cousins across the pond who are facing their own crisis despite a single-payer model.  

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): The hospital systems are gradually eliminating independent spine surgery in our market. They have effectively acquired more than 95 percent of all primary care and control the referrals from those physicians. I regularly see patients who tell me they had to argue with their primary doctor to be referred to our practice. Thankfully, our brand and reputation have created an environment where we are requested by name. While I do not see anything changing in my practice for quite a long time, I believe the final remaining independent spine providers in our region are selling to one of the local hospital systems. The hospitals are frankly eliminating competition in every manner they can.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Like other markets nationally, the competition for privatized hospitals versus regional medical centers has devolved into two obvious differences in healthcare delivery: reimbursements and complexity. The former obviates the underinsured and more morbidly challenged patients usually managed in larger facilities where more clinically complex capabilities and willingness is available. The private surgical institutions deviate care of certain patients through physician-choice preferences yet banner-like their practices as community providers. Locally, it is also common knowledge that these facilities lack clinical scrutiny and data collection of acuity-based metrics like larger health systems, making comparisons difficult.

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