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19 SPINE SURGEONS Dr. Gregory Lekovic: Emerging technology in spine and the reimbursement headwind to watch By Laura Dyrda G regory Lekovic, MD, is the medical director of the spine surgery program at California Hospital and Medical Center as well as a surgeon with House Clinic in Los Angeles. Dr. Lekovic sees both the clinical and business sides of practicing spinal medicine changing in the next few years. Here, he discussed the most interesting trends in technology and head- winds to consider for the future. Question: What emerging technology are you most interested in today and why? Dr. Gregory Lekovic: e most interesting emerging technology to me is the introduction of advanced optical imaging techniques to op- erative microscopy. Ever since the introduc- tion of the microscope to neurosurgery in the late 1950s, the optics of microscopy have been taken for granted and the means of operative visualization — whether with a traditional mi- croscope or endoscope — have been passive. At the House Clinic in LA, we are excited by the recent explosion in new fluorescent dyes and imaging processing capabilities. Technology is now emerging that will allow us to use our mi- croscopes (and soon endoscopes) to not only see the tissue but to query it for function, and perhaps one day soon to also interact with it in ways that were not previously possible. Q: How do you think your practice will change in the next three years? What are you doing today to prepare? GL: It is more important now than ever before to pick your friends wisely by seeking align- ment with a health system or other institution- al partner that understand your culture of ex- cellence and can help you grow. Nevertheless, the more things change, the more they stay the same: the key to a 'destination' practice such as the House Clinic in LA remains excellence in clinical outcomes, high volume, assiduous commitment to detail, and communication with patients through their whole treatment journey. Q: What is the most dangerous trend in healthcare, spine or orthopedics to- day and why? GL: Headwinds abound, mainly in regulation and reimbursement. By far and away the most dangerous trend in healthcare is proposed leg- islation to combat 'surprise billing': the leading legislation will place the burden of payment for "out-of-network" (which in this context should read: "under-insured") patients on surgeons and other hospital-based specialists, who will in turn have to seek subsidy from hospitals in order to survive. is will also strengthen the negotiating hand of insurers with regard to all doctors, bolstering narrow network plans and lowering physician reimbursement across the board. n