Where will spine patients come from? Key trends in the North American spine surgery market

Laura Dyrda -   Print  |

The spine field landscape is changing in many ways, including patient demographics and how surgeons are reaching those patients.


"[There are] more older patients, more deformity due to aging (degenerative scoliosis) and more patients who remain functional in their 80s and 90s who will want to be 'fixed' instead of living with their degenerative conditions," says Alan Hilibrand, MD, The Joseph and Marie Field Professor of Spinal Surgery, Vice Chair of Academic Affairs and Faculty Development, Co-Chief of Spine Surgery and Director of Orthopaedic Medical Education for Jefferson Medical College / The Rothman Institute. "[These] patients are looking for someone who will listen to them and be honest and help address their pain."


At the same time, there is an expected physician shortage in the United States, which will have the biggest imipact on primary care physicians. The impact is less for specialists, and may not have an impact on spine surgeons.


"I do not think the anticipated physician shortage will affect spine care," says John C. Liu, MD, co-director of the USC Spine Center, Keck Medicine of USC in Los Angeles. "As the healthcare market continues to change, spine care practitioners will need to adapt because patients and payers will demand appropriate, high-quality care no matter what. A movement away from procedural, volume-driven spine care to more preventative and conservative care will likely decrease the number of spine surgeons required in the future. Improvements in quality and technical precision in diagnosis and surgery will reduce failed spine surgeries and unnecessary surgical interventions, while much of the current care provided by spine surgeons will likely be supported by other specialists or physician extenders."


The North American spine surgery market is expected to grow at a compound annual growth rate of 7.5 percent through 2019, according to a report from Research and Markets. The United States is expected to have the maximum market share through the next few years. Spinal fusion is the largest segment in the market and the spinal fixation is the fastest-growing segment. Contributing factors include the increased aging population and more people with access to health insurance.


But even as the spine market grows, there is more emphasis on lowering the cost of care while improving quality which can have an impact on providers. Payers and providers are entering into risk-sharing agreements like accountable care organiztions, narrow networks and bundled payments to reach these goals. Some of the traditional referral systems, including primary care physicians and word-of-mouth, are becoming more scarce as independent physicians sign employment contracts. So, how will they arrive at the spine surgeon's office?


"Many [patients] will go through ACOs and medical homes," says Dr. Hilibrand. "Some will come through networks of musculoskeletal providers."



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