Where can spine surgeons reduce costs?


Amid economic headwinds, spine surgeons are exploring different ways to reduce costs in their practices.

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 innovative ways can spine practices increase their revenue in the current economic climate?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Wednesday, Oct. 11.

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

Question: Where are the biggest opportunities for spine surgeons to reduce costs?

Chester Donnally, MD. Texas Spine Consultants (Dallas): Biologics. Unfortunately, insurance carriers are making this decision for us and often I have to do peer-to-peer approval to justify even using (cheap) DBM putty. That said, when I get a spine fusion, I definitely will want significant allograft use in my surgery!

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Some of the biggest opportunities for spine surgeons to reduce costs include:

1. Minimally invasive procedures: Minimally invasive techniques can reduce the length of hospital stays, decrease postoperative pain and limit the need for additional resources like blood transfusions. This can lead to lower overall costs for both patients and healthcare systems.

2. Improved patient selection: Identifying patients who are most likely to benefit from surgery and have positive outcomes can help reduce unnecessary procedures and associated costs. Additionally, identifying patients who may be better suited for nonsurgical treatments can also help avoid unnecessary expenses.

3. Enhanced surgical planning and precision: Utilizing advanced imaging technologies and computer-assisted navigation during surgeries can help improve accuracy and reduce the risk of complications. This can lead to better outcomes, fewer revisions and ultimately lower costs.

4. Optimized perioperative care: Implementing enhanced recovery protocols and standardized care pathways can help minimize variations in postoperative care and improve patient outcomes. This can potentially shorten hospital stays, reduce complications and lower costs.

5. Strategic purchasing and resource allocation: Collaborating with healthcare supply chain experts and negotiating favorable contracts with suppliers can help reduce the cost of surgical equipment, implants and other necessary resources.

6. Value-based reimbursement models: Emphasizing quality outcomes and value-based reimbursement models can incentivize spine surgeons to focus on improving patient outcomes while reducing unnecessary costs.

It's important to note that while cost reduction is crucial, it should not compromise patient safety or the quality of care provided. Each patient's unique circumstances and needs should always be considered when making treatment decisions. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: At this point, we are all working harder for less. The line needs to be drawn. Spine surgeons should be remunerated commensurate with their care, training, experience and outcomes. Otherwise, it's an interminable race to the bottom. 

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): In those areas of the country where direct contracting is growing, there is enormous ability to cut overhead. Virtually all of the struggle for payment is eliminated. Time spent doing useless utilization reviews is gone. Staff time billing and then following up with untold numbers of appeals is gone. Staff overhead drops per case, as does personal time that can be redirected toward patient care, thus decreasing the amount of unbillable time spent by the physician.

Scott Raffa, MD. Cantor Spine Center at the Paley Orthopedic & Spine Institute (West Palm Beach, Fla.): Spine surgeons can reduce costs in different ways.

For hospitals, healthcare systems and individual spine surgeons, costs may be reduced by employing any one of the following initiatives:

1. Enhanced recovery after surgery protocols: These recovery strategies can help reduce length of stay and improve speed of patient recovery, leading to a reduction in length of stay.

2. Standard procedures and instruments: By reducing the variation in the surgical technologist's back table and reduction of disposable items, excessive costs may be reduced. 

3. Careful selection of spinal implant equipment: Spine implants can account for a significant portion of hospital costs. Surgeons can work with healthcare systems to negotiate prices, considerable purchasing agreements, and reduce costs through usage agreements.

4. Telemedicine: For surgeons or their private practices, use of telemedicine has exploded and has now become mainstream. Considering which patient interactions are and need face-to-face conversations, and others that may only be in need of direct communication but not in person, may lead to reduction in unnecessary patient travel and unnecessary use of staff and overhead costs. 

5. Improved implant inventory management: Healthcare systems and the spine industry may benefit from improved logistics, such as implant tray consignments on long-term loan/lease agreements. These agreements may reduce unnecessary transfers of implant trays in/out of the healthcare system, and into the exposed natural environment. Unnecessary transfers may lead to reduced risks of infection and better availability due to consigned hardware.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): The biggest opportunity to reduce the immediate costs of surgical procedures is to move the surgery from a hospital to an ASC setting (when safe and appropriate). Being considerate with the choice of implants and bone grafting materials could also have a significant effect on the overall cost of the procedure (whenever safe and clinically appropriate). 

Performing a spine surgery in a minimally invasive fashion can also substantially reduce the cost of care by significantly reducing the length of hospital stay, the risk of complications such as infection, and the duration of time the patient will need to take prescription pain medications after the surgery. The patients also typically return to full function and work significantly faster after a minimally invasive procedure. This will reduce the nonclinical and societal costs associated with the loss of productivity.  

Another great opportunity is to provide timely and appropriate care. Sometimes delaying medically necessary surgery by trying additional physical therapy or injections only delays the "inevitable," increases the overall cost of care for this diagnosis and prolongs the duration of time the patient is not back to full function or work.

Hao-Hua Wu, MD. UCI Health (Orange, Calif.): As someone who has been involved in multiple cost-effectiveness studies, including one that won the NASS Value Abstract Award in 2021, I have found that one of the biggest drivers of healthcare cost is the inpatient stay. Every night spent in the hospital is costly, and certain spine procedures require patients to stay in the hospital longer. Patients who undergo minimally invasive surgery for their spine, however, have the potential to recover faster. In my practice, when possible, I perform MIS procedures, such as motion-preserving cervical laminoplasty and tubular decompression, to minimize recovery time needed in a hospital setting.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Cost reduction (per unit case) is best managed for all complex spinal practices by negotiating implant costs and orthobiologic usage. Our health system has a corporate-wide committee that works closely with physicians and the private sector to manage, regulate and intercede when contracts become due. Conservative mindsets and applied measures can also serve this cause. Reimbursements continue to falter, and this will indirectly affect surgeons nationally.

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