Becker's Spine Review

34 OUTPATIENT SURGERY What should change in spine care over the next 5 years? By Alan Condon S ix spine and neurosurgeons discuss what they would like to see changed in the next half-decade. Issada ongtrangan, MD. Microspine (Phoenix): I would like to see: 1. Less involvement of payers and hospitals in directing spine care. is should be directed by physicians and experts, not by the insur- ance carriers. 2. Fair reimbursement models as we as surgeons have been increas- ingly dealing with the high complexity of cases and patients but the reimbursement for our service has been continuously decreasing. 3. Clinical outcomes of evolving technologies as I predict there will be evolving technologies around stem cell, endoscopic technique, artifi- cial intelligence, robotics, 3D printing, and more in spine care. Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: In a perfect world, private insurers see the light and start playing by the rules, and we fix the current healthcare system. Prior authorization is now linked to payment — gone will be the days when you do the case you get authorization for and instead we will have to go through an entire new and frustrating process, and then get paid 6 months later. Physicians are paid for both being good doc- tors and by being reasonably good postoperative managers as well. We are listened to when it comes to policy. Bundling falls flat and implodes. Remuneration stops shrinking and grows, albeit slowly. William Taylor, MD. University of California San Diego Health System: I would like to see the continued push toward minimally in- vasive spine. is can be a technique driven area such as the use of lateral approach surgery. is will continue to improve complications and length of stays with the cost savings clearly documented, and minimally invasive surgery from transforaminal lumbar interbody fusion to long term outcomes with endoscopic surgery. Mark M. Mikhael, MD. NorthShore Orthopaedic & Spine Insti- tute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): I would like to see a continued push toward improving value-based care. We need more advancements in that area to safely decrease the length of stay for spine patients post-surgery. is will also help us move toward more outpatient surgeries. ere's an exciting future with outpatient spine surgery, but right now we need to be cogni- zant of patient selection. I am very careful with the patients I choose for outpatient surgeries. ey must be otherwise healthy people and motivated to endure intense postoperative rehab. As we push the en- velope of innovation, we need to prioritize the safety of our patients. If we do, we will realize shorter hospital stays and better patient out- comes. Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): I would like to see effective and respon- sible uses of technology. As we have seen in the past, numerous pro- cedures, devices, technologies and ideas have not provided the results initially promised. Avoiding this and being introspective with our outcomes needs to be paramount. n Twin Cities Orthopedics' new collaborative aims to preserve physician autonomy — 5 takeaways By Angie Stewart T win Cities Orthopedics and three other private practices are partnering to form the Infinite Health Collaborative, a group designed to preserve physicians' autonomy in the face of industry consolidation, the StarTribune reports. Owen O'Neill, MD, an orthopedic surgeon at Edina, Minn.-based Twin Cities Orthopedics, is one of the col- laborative's owners. He told the StarTribune about the idea behind the Infinite Health Collaborative and what the partnership will look like. Five takeaways: 1. The collaborative was established on the belief that "independent practices and independent physicians are really at the center of patient care," Dr. O'Neill said. "And ultimately, it's in partnership with patients that we can help drive value in healthcare." 2. The collaboration will include two primary care prac- tices and an OB-GYN practice, which will all integrate into a larger entity. Physicians will remain partners and owners in the new business. 3. Dr. O'Neill estimated more than 160 independent physicians will be part of the collaborative upon launch. 4. The partners decided not to involve any private equity funding because "it's taking money out of a system de- signed for patient care," Dr. O'Neill said. No insurers are investing in the venture, either. 5. The larger entity will give physicians an economy of scale that smaller groups don't have on their own, according to Dr. O'Neill. "It's very difficult for smaller groups, particularly if they're independent, to manage, I would say, the necessary government regulations in terms of electronic medical records, IT, those types of things," he said. n

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