What should change in spine care over the next 5 years? 6 spine, neurosurgeons discuss

Written by Alan Condon | October 02, 2019 | Print  |

Six spine and neurosurgeons describe what drives them to make their practice the best it can be.

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 new payment models such as bundled payments and value-based care developing in spine?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CST Wednesday, Oct. 9.

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

Question: What changes would you like to see in spine care over the next five to 10 years?

Issada Thongtrangan, MD. Microspine (Phoenix): I would like to see:

1. Less involvement of payers and hospitals in directing spine care. This should be directed by physicians and experts, not by the insurance carriers.

2. Fair reimbursement models as we as surgeons have been increasingly dealing with the high complexity of cases and patients but the reimbursement for our service has been continuously decreasing.

3. Clinical outcomes of evolving technologies as I predict there will be evolving technologies around stem cell, endoscopic technique, artificial intelligence, robotics, 3D printing, and more in spine care.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: In a perfect world, private insurers see the light and start playing by the rules, and we fix the current healthcare system.  Prior authorization is now linked to payment — gone will be the days when you do the case you get authorization for and instead we will have to go through an entire new and frustrating process, and then get paid 6 months later. Physicians are paid for both being good doctors and by being reasonably good postoperative managers as well. We are listened to when it comes to policy. Bundling falls flat and implodes. Remuneration stops shrinking and grows, albeit slowly.  

Scott Russo, MD. Orthopaedic Associates of Michigan (Grand Rapids): I would like to see more patient optimization, cost conscientious care, and guideline driven care. 

William Taylor, MD. University of California San Diego Health System: I would like to see the continued push toward minimally invasive spine. This can be a technique driven area such as the use of lateral approach surgery. This will continue to improve complications and length of stays with the cost savings clearly documented, and minimally invasive surgery from transforaminal lumbar interbody fusion to long term outcomes with endoscopic surgery.

Mark M. Mikhael, MD. NorthShore Orthopaedic & Spine Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): I would like to see a continued push toward improving value-based care. We need more advancements in that area to safely decrease the length of stay for spine patients post-surgery. This will also help us move toward more outpatient surgeries. There's an exciting future with outpatient spine surgery, but right now we need to be cognizant of patient selection. I am very careful with the patients I choose for outpatient surgeries. They must be otherwise healthy people and motivated to endure intense postoperative rehab. As we push the envelope of innovation, we need to prioritize the safety of our patients. If we do, we will realize shorter hospital stays and better patient outcomes.

Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): I would like to see effective and responsible uses of technology. As we have seen in the past, numerous procedures, devices, technologies and ideas have not provided the results initially promised. Avoiding this and being introspective with our outcomes needs to be paramount.

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