As various factors in the healthcare landscape push many groups to consolidate, spine surgeons have to remain nimble.
Three spine surgeons discuss how changes in the market affect their regions.
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: How should spine groups evaluate the trade-offs between liquidity, growth, capital and long-term autonomy when considering a PE deal?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Sept. 23.
Editor’s note: Responses were lightly edited for clarity.
Question: As consolidation accelerates across orthopedics and spine, are you seeing new competitive threats — or openings — in your local and regional markets?
Jeffrey Carlson MD. Coastal Virginia Surgery Center (Newport News): With hospitals and venture capital firms wanting to purchase and control more orthopaedic and spine practices, we are seeing younger surgeons wanting to get out of the employed model. Surgeons that may be getting more toward retirement will use a buy-out as a means to slow down and eventually retire. Younger surgeons who are still idealistic and willing to work hard want to have the rewards associated with a busy practice. These surgeons see our independent practices as a method to provide them with ownership in a practice which allows autonomy in the practice of medicine but also ownership in real estate and surgery centers that can provide them with long-term stability. Smaller independent practices can be more nimble in the marketplace to provide the patient-centric care that we all envision.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: In regional markets, as hospitals try to drive out private practice doctors, we will see unusual alliances of otherwise competitive surgeons. I think the very consolidation hospitals are driving, and effectively want, will create opportunities for nimble and smart surgeons to offer better patient experiences. Many of us do not enjoy this trend but will ultimately adapt as we can and let the hospitals bloat and keep patients waiting, while we can do a better job more efficiently and have good quality without all the metric, check-box driven administrative bloat that now plagues their overgrown systems.
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): There has been increasing pressure to consolidate within orthopaedics and spine, and I think there are both advantages and disadvantages to this. As a benefit, practice consolidation can lead to improved access to advanced technology, better resource allocation, and enhanced collaborative care that fosters multidisciplinary approaches to complex cases, ultimately benefiting patient outcomes and satisfaction. The drawbacks, however, include potential erosion of personalized care, increased administrative burden, and the risk of prioritizing profitability over patient outcomes, which can diminish the patient experience.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Growing numbers of physician-providers are ‘opting out’ of Medicare Supplemental plans and turning these patients away to manage their care elsewhere. Choosing a concierge primary care plan or specialty provider usually spells exorbitant out of pocket or balance billed payments, which most seniors and the underserved become quickly excluded. The complex spinal patient or less-than-marginal result is also shifted to a more well equipped, higher acuity facility. This growing phenomenon has created pressures on employed physician practices and already burdened health systems. This consolidation/competition also extends between larger hospitals, whereby mission-based care with its non-exclusionary models is routinely negatively impacted.
