What are the biggest factors adversely affecting independent spine practices today?

Written by Anuja Vaidya | April 29, 2015 | Print  |

Here seven spine surgeons discuss the challenges standing in the way of maintaining independence.

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. We invite all spine surgeon and specialist responses.


Next week's question: Who would you say is/was your mentor?


Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, May 6, at 5 p.m. CST.


Question: What is the most challenging aspect of independent practice in spine today?

Walter Eckman

Walter Eckman, MD, Aurora Spine Center (Tupelo, Miss.): Competition for surgeons employed by hospitals, insurance companies resistance to spine surgery and poor reimbursement.


Fred Sweet, MD, Co-Founder, Rockford (Ill.) Spine Center: The most challenging aspect of spinal surgery today is negotiating the rapid changes in healthcare. It has become increasingly difficult to get necessary surgeries authorized by insurance companies. In addition, patients have higher deductibles that they cannot afford, so practices are absorbing those losses or patients are not getting the necessary treatment.  


Hospital administrators are overwhelmed with the government mandates and requirements to the extent they are not able to adequately anticipate and collaborate well with independent surgeons to make timely decisions that could ameliorate the impending financial and patient care crisis that is rapidly evolving.


There are many innovative surgeons and professionals that work jointly with health systems on improving quality and significantly reducing costs. Lower cost implants, outpatient surgeries, and quality care initiatives are available, but underutilized primarily due to the size and cumbersome nature of health systems. Surgeons as well as hospitals need to more quickly adapt to this tsunami of healthcare change. Rockford Spine Center continuously looks for ways to partner with hospitals and health Liebreman Headshotsystems to ensure the best possible quality of care for patients.


Isador Lieberman, MD, MBA, Director, Scoliosis & Spine Tumor Center, Texas Back Institute (Plano): Staying up to date with all the regulatory, credentialing and billing and coding changes.



KubeRichard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute (Peoria, Ill.): That is tough seeing as there are so many. I think in general it is the trend towards consolidated medicine. While an independent practice can be nimble and evolve rapidly, the size of the bureaucracy is placing an increasingly untenable financial strain on smaller practices.  The infrastructure required to meet all of the guidelines and mandates is increasingly difficult to afford in independent practice. The consolidation is also making it increasingly difficult for smaller independent groups to maintain payer contracts.


Neel Anand

Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center (Los Angeles): Insurance regulations. Surgeons cannot do what is appropriate for patients because of these regulations. It is choking healthcare right now and raising costs and making it difficult to provide optimal care.


Brian GantwerkerBrian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Besides the obvious things like competition from the "big box" hospitals and clinics, and climbing overhead, it is dealing with the payers. Filing appeals and lawsuits to combat obvious delay tactics and capricious refusals to not pay for preauthorized surgeries seem to be the only way to force change in their behavior.  



I foresee a tipping point, when some independent practitioners might consider a direct-pay system and billing the insurance out of courtesy. They would have to offer superior outcomes, more personalized service and a more welcoming atmosphere. That is the distinct advantage of private practice — to provide that customized, patient-centered feeling. It is challenging to replicate in the larger hospital or clinic setting.   

Ty Photo


Gowriharan "Ty" Thaiyananthan, founder of BASIC (Newport Beach, Calif.): The most challenging part of practicingspine surgery today is actually being able to practice the art of medicine in the setting of today's managed care and medical economics/regulations. The amount of regulations and restrictions placed on surgeons, the requirements for paperwork and documentation associated with EMR systems for example, and countless hours advocating for patients through a peer-to-peer system distract doctors from the actual task of caring for patients.


Less of the physician's time is spent with actual patient care in today's system. Also, once a doctor prescribes a set course of treatment often times they have to actively defend and justify them to insurance companies simply looking to cut costs rather than actually providing services for patient care. For independent practitioners this difficulty, combined with declining reimbursements, creates a challenging environment for practice. Often times, large well established systems and numerous employees are necessary to adequately deal with this tasks without compromising patient care. The challenge that independent practitioners face is to stay true to their patients while competently dealing with the business of medicine.


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