Issue link: https://beckershealthcare.uberflip.com/i/1058309
23 June 2019 Speaker Series HD: Cutting edge is not always value-based, but some cutting-edge practices have the goal of reducing surgery morbidity, length of stay and downtime, and therefore are strongly value-based to the healthcare system. My goal is to remain inquisitive and evaluate objec- tively new technology as it comes out and find the right application for patients. e natural tendency for surgeons is to feel what they are doing works and therefore, they are skeptical of new ideas and innovation. MV: From a philosophical viewpoint, I'd like to think I'm trying to provide the best outcome for the patient at the lowest possible cost for the payer. is is what got me interested in predictive analytics and machine learning on the diagnostic side, in order to ensure anatomic pain generator identification before treat- ment planning. Currently, most clinically relevant data in the EMR world is in free-form text and not compatible with machine-learning techniques. Some IT authorities see artificial intelligence as a panacea for this problem, but like each patient we see in the clinic, the [maxim] "garbage in, garbage out" still applies. Due to advanced surgical and anesthesia techniques, we are at a point where most one- to three-spinal segment procedures can be done in the outpatient setting. is is more market driven rather then medi- cally or surgically necessary. NS: Being at an academic institution offers you the opportunity to be involved with the evolution of the science that brings us the cutting- edge technology, but attending our spine conferences and meetings also allows you to see some new offerings. But the first question you have to ask is if this new device or drug truly [is] better than what's already available. And then ask the question: is the added cost worth the potential benefit for our patients? Q: What is your best advice for young entrepreneurial surgeons with an idea to improve implants, instruments or technology used to improve the care of orthopedic patients? HD: I think it's difficult to introduce a new device that will cost more to do the same procedure. is is especially true since many institutions have formulary pricing. Devices that reduce costs are easier to sell to institutions. Oen, com- panies will come out with what they market as improved products. e companies have anecdotal clinical data, but the cost-effective data is not there to justify higher device prices. MV: One thing I remember from residency training is an attending who was performing endoscopic surgery on the cerebellum and the cranial nerves, [who] told me that new procedures and technologies are useless if they were not passed on to others. If the technology and techniques aren't safer, faster or teachable to others, then they will not grow and will die when the surgeon does. at physician passed away about four years later, at the age of 53, and the procedure has not gained widespread adoption. NS: Always, always think about your patients' interests first, and don't be lured into the temptation of becoming an expert with a technology just because you have the most experience using a given device, [or] loosening your criteria in indicating a patient for a new treatment. n Dr. Jim Sanfilippo: The biggest challenges in spine reimbursement today and the value-based solution By Laura Dyrda J im Sanfilippo, MD, is a spine surgeon at Reconstructive Orthopedics in Marlton, N.J. A New Jersey native, Dr. Sanfilippo joined Reconstructive Orthopedics in 2009 and serves as the chief of the spine section, as well as chair of the Virtua Brain and Spine Institute and medical director of the mus- culoskeletal service line at Virtua Memorial Hospital in Mount Holly, N.J. Here, Dr. Sanfilippo discusses the biggest opportunities in spine and how surgeons are evolving their practices to meet value- based care requirements. Question: What are the biggest reimbursement challenges for you today? What is the payer landscape like for your practice? Dr. Jim Sanfilippo: We are an in-network provider and on-par with most major payers in our area. With that said, one of our biggest challenges with regard to reimbursement surrounds third-party au- thorization companies. Some of the payers in our area have subcontracted out their preauthorization process. ese compa- nies tend to have indications for surgical procedures that differ from our commonly accepted standards of care and gener- ally agreed-upon indications, leading to