Dr. Thomas Schuler: Key challenges for spine surgeons and how to ensure success in the future

Written by Laura Dyrda | May 16, 2017 | Print  |

Thomas Schuler, MD, founded Reston-based Virginia Spine Institute in 1992 and has grown the practice to one of the largest multidisciplinary spinal groups in the region. As CEO, he leads the group through changes in healthcare and continues to succeed in providing cutting-edge treatment options for his patients.


Dr. Schuler is speaking on a panel titled "How Can Spine Surgeons, Orthopedic Surgeons and Pain Management Physicians Thrive in a Changing Market?" at the Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference on June 22-24 in Chicago. Learn more and register here.


Question: What are the biggest challenges for spine surgeons running their own practices today?

Dr. Thomas Schuler: First and foremost, the biggest challenge is keeping on top of the requirements and regulations from the government and insurers. They are continuously moving their requirements and I believe they are doing it intentionally to decrease payments and/or access to care for patients. One example is with partial corpectomy. Insurance companies used to accept documentation for a partial or complete corpectomies and then they required us to identify partial corpectomies, with some requiring one-third while others required one-half, and the numbers keep changing to benefit the payers.


Another area they focus on is spondylolisthesis. You can't just say spondylolisthesis; they want clarification of 3 mm of flexion/extension on the X-ray while another company might want 4 mm. They are constantly moving their requirements, not based on scientific findings but in order to promote their financial agenda. The same is true for many other codes. Payers are either bundling or excluding codes from the payments and making it hard for surgeons to collect.


If surgeons are in-network, complying with the rules is important. If they are out-of-network, it's a challenge to attract patients to your practice when they have high deductibles. If you're providing the out-of-network model, you have to provide a superior product in terms of clinical quality and patient experience, and make sure your product is communicated.


Q: What are the top practices doing today to ensure success going forward?


TS: The answer is quality medicine and customer care. Individualized treatment for patients that will best solve their problems and provide the safest and simplest way to get back to their lives. To me, this is best done as an out-of-network provider because you don't have your hands tied by the insurance company's regulations. You can do what the patient wants when the patient wants it. You can provide care in a timely fashion with the patient driving that conversation and timeline.


You also have to stay current and constantly innovate. You have to improve quality and services as new technologies become available. If you believe in the technologies and they will improve care, implement them in your practice. Some of the new technology our group is working with includes robotic surgery, which allows for even more minimally invasive operations. We also use stem cell therapies and regenerative therapies which allow for nonoperative treatments to improve patient outcomes.


There are many things that can be done to enhance patient results. Artificial discs allow for less degeneration and breakdown. Patients expect high quality outcomes. You can't stay in the training you received during your residency and fellowship. You have to constantly innovate as technology allows us to do better things for our patients.


More articles on spine surgery:
5 key points on robotic spine surgery: pedicle screw placement, radiation, learning curve & more
Bullish on spine: 5 surgeons on why they recommend the specialty for young physicians
Lumbar fusion patients taking preop opioids experience worse outcomes—5 observations

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