Becker's Spine Review

12 Thought Leadership Dr. Jocelyn Idema: Big payer trends in spine J ocelyn Idema, DO, is an orthopedic spine surgeon serving the greater South Hills of Pittsburgh and Washington, Pa., areas. Dr. Idema has built her career on providing ev- idence-based medicine and developing a suc- cessful private practice. Here, she discussed the biggest healthcare and business trends that will affect her practice in the coming year. Question: What are the three biggest business or healthcare trends you expect to affect your practice in 2019? Dr. Jocelyn Idema: Although there are many trends that could affect my practice in 2019, I find that the continual struggle with insurance compa- nies continues to be an issue for both patient and provider alike. Many in- surance companies continue to bundle and/or narrow procedures that can be done, as well as where the procedures can be done. As a result, many of my colleagues and I end up having to carry privileges at multiple hospitals and surgery centers in order to accommodate where procedures are allowed to be done. e second biggest trend that I see affecting my practice will be bundling of payments. Our spine team is continually working to stay on top of the latest changes with regard to bundling. For example, what used to be three separate codes for reimbursement is now one, thus this allows for decreased reimbursement to not only the physician but the facility as well. I have found that some facilities because of these changes, are now limiting the numbers of those types of surgeries to be done. Finally, in the private and independent sector where I operate, changes and high turnover of staff continues to work against developing great teams. I for- tunately continue to work with the same staff, however we have recognized the need to cross-train all members so that they may fill-in as necessary. Building a great team is key to continuing to thrive in this type of environ- ment and medical climate. n Dr. Andrew Schoenfeld: How key trends in healthcare policy intersect with spine A ndrew J. Schoenfeld, MD, asso- ciate professor in the depart- ment of orthopedic surgery at Brigham and Women's Hospital and Harvard Medical School, both based in Boston, as well as deputy editor of the Journal of Bone and Joint Surgery, discussed the biggest trends in spine today and where the field is headed. Dr. Schoenfeld was recently named to the inaugural "20 Under 40" list by the North American Spine Society's publication, SpineLine. Question: What are the biggest concerns for your practice today? What keeps you up at night? Dr. Andrew Schoenfeld: In my practice as a clinician scientist, I have concerns that span both patient care and the research realm. Some of these involve the ways in which healthcare re- form efforts may impact patient access to certain types of spine surgical interventions or the way external pressures might alter the delivery of care in the context of spinal disorders. For exam- ple, how does the implementation of ACOs alter the availability of spine surgical care, affect the types of interventions offered or restrict access to spinal healthcare? This also happens to be one of the particular areas of interest for my research. Q: What are you most excited about in terms of technolo- gy advancement in the spine space? Where do you see the best opportunity for growth? AS: I find minimally invasive surgical interventions to be one of the more exciting technological advancements and an area with the best opportunity for expansion. I think the potential for min- imally invasive procedures to reduce postoperative morbidity and improve recovery from surgery is one of the most attractive features of these interventions, and this also has the capacity to reduce systemic healthcare costs as well as individual expenses. How minimally invasive interventions can be leveraged to the benefit of the healthcare system as a whole remains to be seen, but clearly this represents an important area of exploration in the future. Q: Where do you see your practice growing or evolving in the next five years? What is the next step or evolution in your career? AS: I am presently an associate professor and clinician scien- tist in the department of orthopedic surgery at Brigham and Women's Hospital and Harvard Medical School. In this capaci- ty, over the next five years, I am hoping to broaden the scope of my present research, including surgical decision-making for patients with spinal metastases and the intersection of health reform with spinal healthcare. I presently have a K-23 National Institutes of Health grant and hope to obtain an R-01 over the next few years supporting a prospective multicenter investigation regarding optimizing treatment strategies for patients with spinal metastases. In line with my immediate career goals of increasing leadership and mentorship opportunities, I am also hoping to transition over the next five years into a vice chair of research position within a department of orthopedic surgery, a chief academic officer po- sition or an associate dean posting. n

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