Spine Surgeon Roundtable: Biggest Industry Concerns, ACOs & Goals

Here three spine surgeons weigh in on their most pressing industry concerns, including how spine surgeons will fit into accountable care organizations. Question: What is your biggest concern about the field of spine surgery?

Brian Gantwerker, MD, Neurosurgeon, The Craniospinal Center of Los Angeles: I'm most concerned about lack of innovation from industry, denial of payments and non-approval of the correct surgery for my patients.

Brian Subach, MD, The Virginia Spine Institute, Reston, Va.: As a practicing spine surgeon, I have three major concerns about the field in the upcoming years. I am concerned about the denial of service, patient access to care and the patient's increased responsibility in bearing the burden of cost for their healthcare.

Specifically in my practice, I have noticed a dramatic increase in the denial of surgical and interventional procedures by insurers. I frequently have to speak with an insurance company physician trying to justify the need for a surgical procedure or intervention which has been denied. In general, the physicians are patient and they listen quietly, but then they refer to company policy or lack of evidence to support my approach to dealing with the problem. In summary, the increased denial of service, which I believe has a financial motivation, is impairing my ability to care for patients, particularly ones who have failed conservative management.

Additionally, I am very much concerned that patients will not be able to access spinal healthcare in the future. Given the restrictions imposed by insurance networks as well as government regulations, patients will find it increasingly difficult to continue to be treated by a physician who they know and trust. Patients will be directed to providers which are in network and are therefore preferred, essentially denying patient access to competent, respected, and trusted physicians who have earned their trust.

Although the cost of healthcare in the United States is high, the costs are related to the advanced technologies and medical care available. With a recent push to lower the costs associated with healthcare primarily by reducing the physician fees paid by insurance companies, this will shift the burden of payment from the healthcare insurer to the patient himself. So, the healthcare insurer pays less money in an attempt to lower cost; however, since there are certain fixed costs which cannot be lowered (physician overhead), the burden of payment will be shifted to the patient, placing many interventions out of their financial reach.

Kenneth Pettine, MD, Spine Surgeon, The Spine Institute, Johnstown, Colo.: My biggest concern is the impact of cost containment and moving everything toward generic care. I think the future will be a two-tier system with more spine surgery being performed on a cash basis.

Q: Can spine surgeons participate and thrive in accountable care organizations?

Dr. Gantwerker: By their very design, ACOs discourage individual excellence. I believe spine surgeons and pain providers should form local organizations to capitalize market share and consolidate bargaining power with carriers.

Q: What are the long or short-term goals you've set for your practice?

Dr. Pettine: The long and short-term goals for our practice are to emphasize biologic treatment of spine problems. I would encourage everyone to go to our Orthopedic Stem Cell Institute website. I think biologics have a potential tremendous future for the treatment for spine care.

Dr. Gantwerker: My goals are increasing the quality of care delivery and minimizing my number of contracts with carriers.