The best advice for spine surgeons for 2019

Anuja Vaidya -   Print  |

Two spine surgeons discuss strategies for this year.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What health IT innovations should spine surgeons keep an eye out for in 2019?

Please send responses to Anuja Vaidya at by Wednesday, Feb. 20, at 5 p.m. CST.

Question: What strategies do you plan on implementing in the coming year?

Brian Su, MD. Medical Director of Spine Surgery at Marin General Hospital (Greenbrae, Calif.): Rarely does doing spine surgery alone lead to surgeons being able to make it in private practice. Being a spine surgeon gives you the ability to take part in alternative sources of income.

Participation in BPCI-A is critical because it forces surgeons to be responsible for cost of care. Emphasis on reducing days in rehabilitation, hospital readmissions and emergency room visits continues to drive savings. The shared savings of cost reduction will be significant over the next several years and is a win-win both for spine surgeons and patients.

I believe that the transition of Medicare bundled payment to commercial insurance is inevitable. Surgeons who are initial adopters of the bundled payment system will have a significant advantage. Included in BPCI is the ability for surgeons to participate in internal cost savings, allowing surgeons to share in savings related to reduction in implant costs in their hospitals. The natural progression is for the surgeon to not only control 90-day postsurgical care but also to control the hospital-based DRG. In that situation, the hospital or surgery center becomes a cost center since anything left in the bundle would go to the surgeon.

Outpatient spine surgery is on the rise and investment in surgery centers continues to be a great opportunity for spine surgeons. Centers with 23-hour stay capabilities allows for multi-level decompressions, minimally invasive fusions and two-level cervical disc replacements or fusions to be performed. This year, in partnership with Surgical Care Affiliates/Optum, our group is in the process of moving our current center to a 14,000-square-foot surgery center with 23-hour stay. The operating rooms in the new center will be larger than those in our current hospital. Providing lower cost, high-quality care in a non-HOPD setting is the value proposition we will be making to our patients and the future of spine surgery.

Leveraging the in-office ancillary services exception for group practices will be another focus for our group. Having in-house MRI, DME, PT, CT and X-ray services will continue to be developed in our group as it can be up to 33 percent of bottom line revenue for each physician.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: We have changed some of our systems to a cloud-based, more payment-friendly EMR. I have also changed our approach to new patients and implemented some new strategies and helpful subcontractors focused on things like MACRA/MIPS compliance, bookeeping and website/SEO. We basically cleaned house and made some positive changes. Stagnation is the enemy of progress.

More articles on spine:
DePuy Synthes had the highest spine revenue in 2018 at $3.2B—but 2 other companies are gaining ground in 2019
Spinal fusion hospital costs for Medicare patients exceed $40K: 5 things to know
5 big growth opportunities in spine

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