Becker's Spine Review

14 Thought Leadership Dr. J. Brian Gill: 3 observations on bundled-payments, high deductibles & payer approvals in spine By Laura Dyrda J . Brian Gill, MD, is a fellow- ship-trained spine surgeon at Nebras- ka Spine Hospital in Omaha. He has a special interest into deformity conditions, minimally invasive procedures and disc replacement. Here, Dr. Gill discusses three observations about the healthcare industry and predicts the biggest opportunity for growth next year. Question: What are the 3 biggest business / healthcare trends you expect to affect your prac- tice in 2019? Dr. Brian Gill: A. Over the past year, patients have had a greater re- sponsibility for out-of-pocket expenses for medical care, with higher deductible plans becoming more of the norm to offset rising premiums. is is only going to continue for the foreseeable future as employers try to offset their costs by pushing their employees into these type of plans. Additionally, insurers are promoting these plans to employers and con- sumers as it shis the risk to the patient to make the decision. B. Bundled-payments continue to gain traction as Medicare has launched a program for hospitals in an attempt to control costs. ere is more pres- sure to be more vertically integrated in an attempt to control costs from start to finish for procedural episodes such as spine surgery. Ongoing re- ports show independent practices are continuing to dwindle as healthcare systems drive to control costs and gain market share. As a partner in an independent practice, we have to continue to work with our healthcare systems to provide value with mutual strategic goals and alliances. C. is year, more than any other year that I can remember, insurers have taken longer to approve procedures and imaging. ere has been a greater burden of proof placed on providers to show documentation of medical records, which can be difficult to obtain at times. Additionally, the number of modalities necessary to be done has placed an undue bur- den on patients wasting time and money. I only see this trend continuing as insurers place roadblocks up for patients and providers. Q: Where do you see the best opportunities to grow? BG: Any progressive practice is always searching for continued growth in services, volume, revenue, etc. A status quo practice is one which gets passed by. From a service standpoint, we are looking at adding new ser- vices that can continue to allow us to be a comprehensive spine prac- tice. For example, we are developing telemedicine outreach clinics and weight loss clinics to address our outreach patients and obese patients, respectively, to name a few. In order to increase volume, we are develop- ing strategies to be more efficient in how we use our physician extenders. Additional outreach clinics within the community and in rural mar- kets are under consideration as well. We continue to develop relation- ships with other providers in our community and how to best treat their respective patients. ese initiatives help to drive revenue to- wards the practice. It is also important to keep expenses in check when developing new service lines or clinics as this can hurt the profitability of the practice. I am an eternal optimist, so I am hopeful that 2019 will be better than 2018. We will continue to do what is right for the patients that we serve. n Are stem cells the future for spine surgery? Dr. Sameer Mathur explains By Mackenzie Garrity M ore and more surgeons are beginning to talk about biologics, stem cells and regenerative medicine. Sameer Mathur, MD, an orthopedic surgeon, explains the future of stem cells in a sponsored article with WRAL.com. Dr. Mathur uses stem cells to treat patients with low back and leg pain. He estimates 85 percent of his pa- tients report improved symptoms following spinal stem cell treatments. The procedures Dr. Mathur offers with stem cells are out- patient and minimally invasive, taking roughly an hour from start to finish. "Bone marrow stem cells can be used to treat osteoarthritis, joint pain, low back pain and other spinal con- ditions," according to the report. Dr. Mathur also uses stem cells to treat degenerative disc dis- ease. However, he notes that some patients do not qualify for stem cell treatments and surgery may be necessary. "I have been treating back pain for over a decade," Dr. Mathur told WRAL.com. "Unfortunately, there have been no good treatment options, including physical therapy, medica- tions and even surgery. Regenerative medicine is the next frontier in treating low back pain caused by degenerative disc disease." n

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