Where do spine surgeons fit in the changing market? Dr. Brian Gantwerker's insight

Written by Megan Wood | May 02, 2016 | Print  |

The spine market evolves as the healthcare industry continues to shift, and successful spine surgeons will face the powerful forces of change with confidence.

Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, offers his thoughts on the market's outlook and how spine surgeons can successfully navigate the shifting industry.BrianGantwerker


Question: What is the outlook for the spine market?


Dr. Gantwerker: The spine market remains a competitive and evolving place. At its very core, there are opposing principles pulling it in several directions.


First, you have the push to codify and unify what it is we do. There are surgeons who are determined to take the "art out of medicine" and create care paths and algorithms to treat spine patients. Then, there is the well-known push of the government and insurers to save money, effectively rationing care. And in the industry's case, do less surgery and really push for non-surgical management.


These two forces intersect in certain areas, for instance, in minimally invasive spine. In the realm of motion preservation technologies, minimally invasive decompression and outpatient surgery centers, is where balance can be found.


What I do not see in the future is large-scale fusion and scoliosis surgery trending lasting. While I admire the exacting measurements angles, sagittal balance, SVAT, pelvic incidence and so on, and the desire to create a large outcomes registry, I think the current trends will not support it in the long term. I think the push to control cost will unfortunately sideline all that great work and they will dismiss it out of hand, saying it is too expensive no matter how good the outcomes look. We should instead focus on smaller surgeries, small gains, and prevention of adjacent level disease and restoration of comfort.


Q: Which factors are shifting the spine industry and healthcare in general?


BG: The consolidation for larger, regionalized healthcare continues to push patients and surgeries into systems. These systems, for better or worse, will control the flow of patients into most practices.


Medical schools are being established by insurance companies.


There is a general shift toward data-driven care, sterilizing the relationship between physician and patient. Volume-driven care is being forced onto our colleagues in primary care. None of us will be immune to the change, but as physicians we must remain true to our patients and do what is best for them and their particular problems.


Q: How do spine surgeons fit into this future and how do they prepare for the shifting market?


BG: Spine surgeons should fit into this by creating their niche and continuing to do a good job taking care of their patients. The way they can fit in and survive is to resist the temptation of cookbook medicine. Read journals, learn new techniques and fight for your patients. Remember to treat your patients and not their films.


If you exist already within a system, remain true to your principles. Take responsibility for your outcomes and follow your patients. Your reputation will grow along with your good outcomes. Be honest with patients in their expectations.


Q: Which strategies would you suggest spine surgeons in ASCs utilize when approaching the changing market?


BG: I advocate for a direct relationship with patients and their employers. By putting the insurance companies in the back seat, where they belong, we can bring power back to the patients. Instruct your office staff on keeping the patients informed of the goings on with their cases. Get comfortable in the ASC setting and work with your anesthesia and nursing team about common goals in patient satisfaction.


Ultimately, we would all like to keep making honest money for good work. I think playing the game of the insurances is ultimately a losing battle, as they continue to move the goal posts. I think when doing ASC cases, giving patients fair "all-in" prices for their surgeries, then helping them get their fair out-of-network benefits.


If the insurance companies balk at their own contracted reimbursements, utilize organizations such as your state medical association, your state insurance commissioner, and healthcare advocate attorneys to create a no-nonsense environment that shows we, as the doctors, mean business. They will see eventually, it will be cheaper to just let us do our jobs.


Q: What have you found to be your greatest concern so far this year?


BG: The demand for data-driven choices in healthcare. I fear this will spur unnecessarily complex surgeries, treatments for patients that will fail and further problems in healthcare costs.


Cookie cutter medicine will create patients that will be further confused, disenchanted and mistrusting of surgery. In order to restore faith in spine surgery, we must evolve, beyond the confines of the insurance market and their desire to limit access to care. We are playing a game to which only they know the rules — and they are ever-changing.


More articles on spine:
Treating the elite of the elite — Dr. Robert S. Bray, Jr. on using an integrative approach in sports medicine
How should spine surgeons approach a shifting landscape?
Zimmer Biomet, NuVasive, Wenzel Spine & more: 21 key notes

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