Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, shared his expertise with Becker’s on topics including cost monitoring, a partnership with NYU Langone and AI.
Here are five key quotes:
On AI’s potential: The potential for AI to substantially impact spine surgery, and frankly the entire field of medicine, is essentially limitless. We are already seeing some of it in action, including electronic medical record alerts, surgical navigation, and robotics. However, I think an area where it can truly transform the way surgeons practice is revenue cycle management. Billing in healthcare is complex and requires navigating contracts and government payer regulations. Manually doing so is inefficient, but I envision AI-driven systems will be able to cross reference between patient records, surgeon billing, and payer contracts to ensure accurate reimbursement.
AI will and is streamlining the payer denial and appeals process. By analyzing and identifying trends in denial patterns, it will provide solutions for how visits and procedures should be billed appropriately. In addition, AI systems will be able to seamlessly follow-up on payer denials to confirm whether payment was accurate and initiate appeals processes when necessary. Overall, automating these processes through AI would significantly reduce the administrative burden on a surgeon’s staff and ultimately result in greater revenue for the practice.
On tech investments: You could look at Rothman as a business, and you could look at Rothman when it comes to treatment of patients. I think the most important [investment] is artificial intelligence. The one thing that we get hung up on when we do a procedure is with so many check boxes for prior authorization, then you have to get an explanation of benefits, then you have to send it to the insurance company, and the insurance company sends it back to you, and then you have to scrub it to make sure that the bill is appropriate. The bill goes to the insurance company and they pay you, but how do you know if you’re being paid according to your contract?
Artificial intelligence can look at a bill and can say if this has been documented appropriately through the medical records because it scanned your preoperative note and it scanned the operative report. It makes sure that the codes are appropriate. It understands what the insurance company wants to see. If the insurance company sends it back, it develops an instantaneous appeal to send it back again, and then it tells you if you were paid according to your contract. That is the most important technological investment that we have, and it’s not just not for private practice. This is for any private equity, hospital system, university system, just to make sure that everyone’s in compliance with the contracts you have.
You could take this technology and you could use it for anything. I would exploit it for patient safety with that concept of checklists. I say to the residents all the time, “go slow to go fast.” I love the checklist concept that pilots use. Do a briefing before you begin the operation. You do the operation, and read the checklist off before you begin the closure. When the case is complete, run the checklist again. Exploiting technology to help us do that is phenomenal.
On the next decade of spine practices: Current day spine surgery primarily relies on preoperative and/or intraoperative fluoroscopy and CT imaging, which can be associated with substantial radiation and increase the lifetime risk of malignancies. However, there are several enabling technologies that are already in use and will transform spine surgery practice over the next 10 years. For instance, with the push to perform more minimally invasive surgery, navigated/robotic decompression and instrumentation and advances in anesthesia techniques enabling expanded awake surgery indications are quickly gaining popularity. Augmented and virtual reality are also on the horizon with the promise of increased precision, reduced complications, and enhanced patient safety. This will require a migration from ergonomically awkward head mounted devices, steep learning curves, and lack of ability to simulate physical touch. While much of the progress in spine surgery over the last century has revolved around hardware innovations, the next century will be dominated by software innovations. Patient engagement through telemedicine and remote patient monitoring skyrocketed during the COVID-19 pandemic and are now part of standard practice for a sizeable number of spine surgeons. Ease of obtaining telehealth privileges in multiple states through initiatives such as the Interstate Medical Licensure Compact has also elevated its appeal. Predictive analytics and technologies such as AI and machine learning have emerged as tools positioned to produce a paradigm shift in multiple aspects of care. This includes patient selection for specific spinal procedures, preoperative workup, outcome prediction, as well assisting in the detection of difficult to visualize spinal fractures and malignancies.
On tracking cost and outcomes data: From a cost monitoring perspective Rothman Orthopaedics, like similar medical practices, develops an annual budget for the practice, academic department, ambulatory surgical centers and specialty hospitals monitoring medical and administrative supplies usage, staffing, benefit costs, facilities and equipment maintenance and replacement costs. Cost budgets are based on projected patient volumes for all areas. Actual costs vs. budgeted costs are reviewed monthly with variance explanations provided by the department leads. Actual data is then used to prepare subsequent budgets and actual costs.
When it comes to outcome data, outcomes are monitored and reviewed at numerous levels. Patient surgical outcomes are monitored and reported by the facilities where the procedures take place such as an academic hospital, ASC, specialty hospital or office facilities. Rothman has a team of nurse navigators that follow patients from preoperative care, through surgical planning, surgery, and post-surgery care. To optimize patient outcomes communication is key. In the case of a perioperative concern our nurse navigators will assess the patient needs and get them to the appropriate site of care such as the office, urgent care or emergency department. Rothman also tracks outcomes on a longitudinal basis with a very robust research department which monitors patient outcomes to develop improved care protocols for future patient care as well as knowledge dissemination through peer reviewed medical journals, and seminars.
On practice partnership strategy: When we were looking for a partner in the New York metropolitan area, we wanted to work with the partner who was invested in the success of improving orthopedic care in the Westchester region through excellence in clinical care, patient centric research, education and innovation. NYU Langone offered all those possibilities. We viewed private equity as a funding source, which wasn’t necessary due to the ample financial support provided by NYU Langone. NYU Langone, through excellence in business management, provided the appropriate amount of capitalization to develop a thriving Rothman Orthopaedic practice in Manhattan and Westchester. NYU Langone allowed Rothman to continue with its patient centric research, developing clinical pathways and most importantly providing excellence in patient care. When it was the right moment strategically for more rapid expansion in the Westchester region, NYU Langone was the preferred candidate to acquire the practice, allowing its footprint to expand dramatically within a short period of time through Rothman’s large patient population, multiple offices and first-class surgeon personnel.
