Goals & Priorities for Spine Surgeons Post Healthcare Reform: Q&A With NASS President Dr. Charles Mick Featured

Written by  Heather Linder | Friday, 09 November 2012 14:56
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At the North American Spine Society's annual meeting in October, Charles Mick, MD, was named president for the next year. Dr. Mick is a board-certified orthopedic surgeon who has been a member of NASS for 25 years. He practices at Pioneer Spine and Sports Physicians in Northampton, Mass., and is also a member of the Advocacy and Rehabilitation Interventional and Medical Spine Committees.
Dr. Charles Mick, president of the North American Spine SocietyHere Dr. Mick expounds upon his goals and vision for the organization, as well as how NASS will cope with changes in the spinal care industry.

Q: What will be the top priority for NASS next year?

Dr. Charles Mick: There are many important issues facing the spine community. The one we've heard about most strongly from members is defining insurance coverage policies for spine care. NASS will be working this year to define and distribute to the members and insurance carriers reasonable and evidence-based coverage policies for spine care. We've created a task force that will be selecting between 10 and 20 common spine conditions and then developing what we believe are reasonable coverage policies for those conditions, based upon reviews of evidence.

Q: What further goals will your organization pursue?

CM: We also want our members to be able to measure how the treatments that they recommend are doing. We need to start collecting outcome data, not only in research settings, but in daily care. Individual physicians need to be able to track and measure their own outcomes. Then we can set standards, identify shortcomings and develop ways to improve care.

A diagnosis based spine registry has been under development at NASS for the past two years. The pilot program we anticipate will be starting in December or early next year. An important goal is to complete the pilot study and then to expand the registry to the members. Insurance carriers are demanding that physicians demonstrate they can achieve good outcomes for the interventions they are recommending. NASS will work to define top quality high value care, advocate for its coverage and make available to the members a registry to measure the results.

Q: What are some challenges facing NASS and the spine industry?

CM: There are several challenges. One is defining high quality and high value care. We then have to demonstrate which treatments work and that they are cost-effective.

[A second challenge] relates to the recent presidential election. We need to learn how best to coordinate the different aspects of spine care as we create integrated delivery systems. This will require specialists in spine care to increasingly interact with primary care physicians and ancillary providers. We have to discover how best to do this.

Q: What type of advocacy efforts will NASS coordinate?

CM: We will be advocating for coverage from insurance companies for care proven to be effective. We will also be speak out against care for which we don’t have good evidence. An example would be prolonged bed rest for the treatment of back pain. We know that this is poor treatment so we will advocate against this approach and for early mobilization.

Also, consider MRIs or CAT scans inappropriately ordered within the first few weeks of the onset of low back pain in absence of warning signs for dangerous conditions. [Those tests] are important when appropriate, but they can be over used. We want to advocate for appropriate coverage and speak out against inappropriate care. I think the physician community has been hesitant to speak out against [MRI] overuse. We need to do a better job.

For certain tests and therapies for which we have good evidence, we need to work with insurance companies and advocate for coverage and reasonable payment. For example, surgery for spinal stenosis. We know that it is an excellent intervention. We know it works well, and it has good value. We can advocate very strongly for it.

Q: How will President Obama's reelection impact your field?

CM: It is time for all stakeholders in health care to look beyond self interests and to work together and implement the Democratic experiment in healthcare reform. Nobody knows the end result, but all of us know that healthcare reform is needed. We need to improve care coordination and quality, and we need to reduce costs. The Democrats have won, and we have been given a message that the public wants to move forward with their plan.

Some aspects of the ACA are superb. For example, giving insurance to everybody, not being able to take insurance away if you get sick and being able to move from job to job and take your insurance with you. There are other aspects that will need to be modified and improved, for example the Independent Payment Advisory Board.

Q: How will your past experience work toward your new position at NASS?

CM: I've been involved in spine care and in private practice for 25 years and have a tremendous amount of experience with patients, what they need and what is required to deliver high quality care. My expertise at NASS has been in healthcare policy, including coding, insurance coverage, reimbursement, advocacy and defining quality and value-based spine care. These are top priorities for our patients and members.

I'm looking forward to working with the [NASS] staff and volunteer leadership. Everyone at NASS brings a unique perspective to the team. The society by its nature includes spine care professionals from multiple disciplines. Each of these individuals will need increasingly to work together to define, coordinate, deliver, measure and improve care. This is exactly what our patients need us to do.

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