How Apple, Amazon & price transparency will affect spine: 3 Qs with Dr. Alok Sharan

Laura Dyrda -   Print  |

Alok Sharan, MD, co-director of Yonkers, N.Y.-based Westmed Spine Center has been successful in building a spine practice and performing awake spinal fusions.

He also has a keen interest in the business of healthcare and serves as deputy editor of digital health transformation for Clinical Spine Surgery. Here, Dr. Sharan discusses the big trends in healthcare today and how technology will affect the spine field in the future.

Question: Do you think the future is bright or dark for spine surgery? What are the biggest factors driving decision-making about your practice?

Dr. Alok Sharan: The future is bright for spine surgery. As the population ages I predict there will be a greater need for appropriate spine surgery in the elderly population. As the research on who benefits from spine surgery becomes clearer, it will become easier to direct patients toward surgery sooner. So many times I have seen an elderly patient come to me with symptomatic spinal stenosis. They are in reasonable physical condition. We send them for pain management/epidural injections and due to their pain, they become deconditioned over time. For an individual like that, as long as we could do surgery safely, taking them to the operating room sooner rather than later would result in a greater overall outcome and perhaps prevent them from becoming deconditioned. From a resource perspective, preventing that elderly individual from becoming deconditioned would lead to decreased utilization of resources over the entire episode of care.

In our practice, while we are focused on performing appropriate spine surgery and achieving the best outcomes for our patients, we do keep an eye on the overall utilization of resources to ensure that we are being efficient in how we deliver overall spine care.

Q: What do you think about technology companies such as Apple, Microsoft and Amazon moving into the healthcare space? Is this a positive or negative trend for spine and healthcare overall?

AS: The tech companies have done a good job disrupting other traditional industries (communication, retail, etc.). There is no doubt that they will do the same in healthcare. When Clayton Christenson talks about disruptive innovation, he talks about nonconsumption and jobs-to-be-done.

Nonconsumption as a business strategy is creating a product or service that helps a customer complete a job-to-be-done that is normally inconvenient or high cost. People want to have more control of their health (job-to-be-done). Currently they do not have the proper tools to do it (nonconsumption). Applying Christenson's theory, the tech companies will succeed by developing products that help the ordinary consumer manage their own health. Currently, patients defer management of their health problems to physicians; this will change over time as new tech products enter the industry. To some degree physicians will have to rethink their role as the traditional paternalistic model of the provider will diminish over time.

I had a chance to work with some folks at Apple Health where I heard some of these discussions happening. It is clear that they want to build a suite of services/products that will allow the patient to manage their own health. For physicians, this will mean less office visits and more e-visits or perhaps even more virtual care coordination.

Q: How do you feel about the move toward increased price transparency? Will this have an impact on spine?

AS: Increased price transparency will force providers to scrutinize their activities and ensure that they are truly delivering good quality care at a reasonable cost. Unfortunately, price transparency will lead to the commoditization of a lot of the services that a physician offers. Patients/consumers are very cost sensitive; providers should be aware of their costs as compared to relative benchmarks and should be able to justify their prices. While most patients do not want to shop for care I do think patients will want to understand why one provider charges more than another.

As services become more commoditized, physicians should really rethink their strategy, and more importantly, understand how they can deliver a unique value proposition. If you can not differentiate yourself from the next provider, then you will have to compete on price, which is never a good strategy.

To participate in future Becker's Q&As, contact Laura Dyrda at

For a deeper dive into the future of spine, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-5, 2019. Click here to learn more and register.

More articles on spine surgery:
Where spine reimbursement is headed—Key thoughts from 4 spine surgeons
Effective political advocacy—Key thoughts from orthopedic surgeon Dr. Chip Hummer
3 core business concepts for successful practice from Dr. Alpesh Patel

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