Becker's Spine Review

36 PRACTICE MANAGEMENT 8 spine surgeon predictions on the healthcare market: consumerism, reimbursement, big data & more By Laura Dyrda H ere are eight predictions from spine surgeons on the healthcare market. Frank Phillips, MD. Director of Spine Surgery at Rush University Medical Cen- ter (Chicago): As we move toward a val- ue-based system, major challenges revolve around defining "value." Value is defined quite differently by the various stakehold- ers in healthcare. For an insurance compa- ny, 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 de- fining value. Simply put, value represents outcomes divided by cost. Both numerator and denominator in this equation are chal- lenging to define. Spine surgeons need to engage in this process. A. Nick Shamie, MD. Chief of Orthopedic Spine Surgery at UCLA School of Medi- cine: It is imperative for us as physician sci- entists 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 treat- ment modalities, but by using large data that is now available to us, we are increas- ingly able to see how certain treatments af- fect 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 in- ternet and direct-to-consumer marketing. They are more educated about their health- care choices and they have higher expecta- tions 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 Sys- tem] and the significant cost pressures, the treatment (operative and nonoperative) of spinal issues will be required to show val- ue 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 sig- nificantly and also provides the insurance company with cost savings. Brian Gill, MD. Nebraska Spine Hospital (Omaha): I think the typical issues of declin- ing reimbursement and increasing expens- es 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 necessi- ty rather than convenience. Brian Gantwerker, MD. Founder of The Craniospinal Center of Los Angeles: The pressures of increased regulatory require- ments are pushing doctors to leave private practice and to seek the (possibly) safe um- brella 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.) Ortho- pedic 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 em- ployment models. Those that can navigate the reimbursement changes will be able to stay viably self-employed. My biggest concern is the overall transition to employ- ment-based practice and our subsequent loss of system control; that will not serve our patients well. Thomas Scully, MD. Northwest NeuroS- pecialists (Tucson, Ariz.): Insurance com- panies' 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. n Texas hospital lays off 40% of administrative staff amid financial troubles By Ayla Ellison H untsville (Texas) Memorial Hospital is facing financial troubles, but the hospital is taking steps to shore up its finances, according to e Huntsville Item. e hospital has faced financial chal- lenges for months, and it is behind on payments to vendors and is unable to pay rent. To help improve its financial position, the hospital closed its clinic in Madi- sonville, Texas, and plans to close its clinic in Riverside, Texas, by the end of August. Huntsville Memorial Hospital also cut expenses through employee lay- offs. "We have right-sized all of the depart- ments within the hospital, including reducing the administration staff by 40 percent," Michael Morgan, hospital interim CEO, said Aug. 22, according to the report. e hospital began seeking partner- ship opportunities several months ago, and has received interest from 38 organizations across the nation. "We are very pleased at the level of interest that has been shown so far, but no decisions have been made and we are continuing to evaluate all possibilities for charting the best path forward for the hospital," Mr. Morgan said. n

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