The biggest obstacle facing spine providers: 4 spine surgeons share insights

Written by Alan Condon | August 07, 2019 | Print  |

Four spine, neurosurgeons offer their opinions on the biggest obstacle facing spine providers today.

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: How do you see spinal fusions evolving in the future?

Please send responses to Alan Condon at by Wednesday, August 14, 5 p.m. CST.

Note: The following responses were edited for length and clarity.

Question: What do you think is the biggest obstacle facing spine providers in the modern landscape?

Issada Thongtrangan, MD. Microspine (Phoenix): Dealing with payers, data overload and unrealistic patient expectations are the biggest obstacles for me.

Payers nowadays rely on outdated data and guidelines for surgery approval. In addition, some of the carriers even have strict rules on what type of implants and biologics that surgeons can use for certain types of surgeries, which is not always good for surgeons or the patients.

We are in the era of social media and direct consumer marketing. Many patients come with self-diagnosis from internet searching. They often want unrealistic outcomes and sometimes want certain types of surgery that may not be appropriate for them. I spend more time educating and guiding them during their visits.

Data overload for surgeons. There are many studies on new technology that published "superior" results; however, the majority of them were sponsored by the company so I have to be cautious looking at those studies. Unfortunately, it is very expensive and time consuming to conduct a level 1 study.

Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In my opinion, the largest hurdle facing all specialty spinal surgeons is the insurance approval process and escalating denial rhetoric, which in most instances, is baseless. When surgical decisions and discernments are based on physical and radiologic findings, most submissions are honored for their presentation and thoughts. Hopefully these trends are changing.

John Spitalieri, DO. The Spine Center at Yavapai Medical Center (Prescott, Ariz.): All the usual suspects: payer denials, declining reimbursements, commodification of our profession and misinformation online. However, at the end of the day, it's our patients who suffer most. We need to be adaptable, caring and focused on our mission: managing and removing these obstacles (as best we can) for our patients so they can get the care they deserve. 

Eugene Carragee, MD. Stanford University Medical Center (Palo Alto, Calif.): The current spine provider is overwhelmed by the quantity yet dubious quality of literature purporting various therapeutic options and innovations. There is little time to thoroughly examine the literature in detail and many of the groups providing guidelines or systematic reviews have various agendas. The most prudent clinician is often unable to decipher what entities are promoting a product based on information readily available. 

In the past few years there have been the largest litigations against drug and device manufactures for false promotion of products — including some of the largest indictments and cash settlements ever in U.S. history. The largest pharmaceutical and device corporations have been implicated in underreporting complications, duplicate publications, ghost writing and misleading promotion of products in the market. 

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