Management service organizations are emerging among spine practices and promise support while maintaining physician autonomy.
Four spine surgeons discuss how MSOs will be involved in the future of the specialty.
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 question: What’s the biggest disruptor in spine today, and how is it impacting your own work?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, May 20.
Editor’s note: Responses were lightly edited for clarity and length.
Question: Are spine-focused MSOs or supergroups the future of the specialty?
Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): From my perspective, we are seeing the emergence of a new and thriving avenue for spine and complex orthopedics like joint replacement. This is a sustainable business model that has evolved as high-acuity cases have migrated from hospitals to ASCs thanks to “minimally invasive” technologies and approaches (i.e., robotics, micro and endoscopic surgeries).
Such a model is supported by the fact that there is little enterprise value in a single practice or small group. With at least 40 surgeons and a group of high-acuity ASC centers, you have a different story.
Emerging MSOs or super groups have provided a new and exciting pathway that maintains physician autonomy. They are also able to better control quality, recapture negotiating power with the insurers, and share business expenses such as marketing, which is necessary these days.
These MSOs are here to stay, with rapid expansion inevitable, though how each ultimately merges into the medical system is a question. Our goal remains to provide best-in-class care that is cost-effective, data-driven and with excellent patient experiences and outcomes. Times are changing, I believe for the better.
Brian Gantwerker, MD. President of the Craniospinal Center of Los Angeles: MSOs offer a very attractive blend of autonomy and support for many practices. In a carefully crafted agreement, all parties can stand to gain. While they seem to be increasing in popularity in some markets, they have yet to prove their longevity. Most surgeons join MSOs to maintain their independence, but what is to stop the MSO from being acquired by a system and the train of inevitability to run over the group? I think MSOs sound great, but I am not sure they have the moxie to stick around long term.
Pierce Nunley, MD. Spine Institute of Louisiana (Shreveport): MSOs are often exploited by private equity for acquisitions, tainting their reputation among physicians. Yet, MSOs are exceptionally powerful tools for building robust, self-sustaining physician supergroups when fully owned and controlled by physicians, not private equity investors. By eliminating private equity physicians avoid the pitfalls and profiteering of PE-driven deals, ensuring patient-focused care. We are launching a 100% physician-owned MSO and strongly encourage other groups nationwide to follow suit. United, these MSOs could transform healthcare by prioritizing patients and physicians over corporate interests.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Most large surgical practices or multispecialty groups utilize (in one form or another) a focused MSO to manage practice growth, patients’ retention and improve administrative operations. The varietals circumnavigating coding, billing and the other regulatory morass are persuasive and constantly warrant expert attention. Business maneuvering and remaining savvy in the field of medicine is a full-time job within itself. The complexities of healthcare mandate the expertise of such an oversight administrative adjunct, allowing for the focus of medicine and patient delivery to be the top priority.
