Here are eight predictions from spine surgeons on the healthcare market.
This article is an excerpt from the "50 spine surgeon predictions for 2018" list sponsored by DSM, a biomedical solutions company. Click here to read the full list.
Frank Phillips, MD. Director of Spine Surgery at Rush University Medical Center (Chicago): As we move toward a value-based system, major challenges revolve around defining "value." Value is defined quite differently by the various stakeholders in healthcare. For an insurance company, value is ultimately defined by returns to shareholders and profitability. I believe physicians, with their expertise, are in a unique position to play a pivotal role in defining value. Simply put, value represents outcomes divided by cost. Both numerator and denominator in this equation are challenging to define. Spine surgeons need to engage in this process.
A. Nick Shamie, MD. Chief of Orthopedic Spine Surgery at UCLA School of Medicine: 2018 brings us much change and turmoil in our healthcare delivery systems. It is imperative for us as physician scientists to use the "big data" of population and health records to better understand what's really going on. Clinical trials are an effective way to study certain new treatment modalities, but by using large data that is now available to us, we are increasingly able to see how certain treatments affect certain segments of a population and compare what happens with and without a particular intervention.
Neil Badlani, MD, Chief Medical Officer of Nobilis Health (Houston): Healthcare is becoming an increasingly consumer-driven industry. Patients have access to healthcare information everywhere because of the internet and direct-to-consumer marketing. They are more educated about their healthcare choices and they have higher expectations and want to be active as long as they possibly can.
Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): I think it is clear that public and private insurers are increasingly interested in quality over quantity, but they pay based on quantity. With the transition to [the Merit-based Incentive Payment System] and the significant cost pressures, the treatment (operative and nonoperative) of spinal issues will be required to show value for the services provided. The easiest way surgeons will be able to show value is through partnering with CMS and private insurers through bundling in a way that financially incentivizes the physician significantly and also provides the insurance company with cost savings.
Brian Gill, MD. Nebraska Spine Hospital (Omaha): I think the typical issues of declining reimbursement and increasing expenses are always on the minds of practitioners. There continues to be consolidation in healthcare with various systems merging, which trickles down to individual groups merging. This is being done out of necessity rather than convenience.
Brian Gantwerker, MD. Founder of The Craniospinal Center of Los Angeles: The pressures of increased regulatory requirements are pushing doctors to leave private practice and to seek the (possibly) safe umbrella of employment. Of those coming out of residency or training, they seem to either not want or cannot function in a private practice situation.
William Tally, MD. Athens (Ga.) Orthopedic Clinic: I think the biggest impact [to the spine field] will be reimbursement and consolidation. Hospitals will continue to use leverage and power to force us into employment models. Those that can navigate the reimbursement changes will be able to stay viably self-employed. My biggest concern is the overall transition to employment-based practice and our subsequent loss of system control; that will not serve our patients well.
Thomas Scully, MD. Northwest NeuroSpecialists (Tucson, Ariz.): Insurance companies' continued lack of authorizations for procedures or imaging and the incessant hoops to jump through to care for patients continues to loom large. I really think the progressively aging community makes it difficult to know how aggressive to be with octogenarians, etc. We need to be good stewards with Medicare dollars, but also not deprive patients of increased quality of life given the right spinal surgical procedure.