Becker's Spine Review

6 SPINE SURGEONS Dr. Robert Brady: How the 2020 CMS final rule will affect the spine field By Alan Condon C MS removed six spinal procedures from the inpatient-only list in the CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambula- tory Surgical Center Payment System Final Rule, issued Nov. 1. e changes took effect Jan. 1, and means Medicare will now reimburse for the pro- cedures in both the hospital outpatient and inpatient settings. Robert Brady, MD, an orthopedic surgeon and spine specialist at Norwalk (Conn.) Hos- pital and part of Danbury-based OrthoCon- necticut, discusses how the incoming CMS final rule will impact the field. Note: Responses are lightly edited for style and clarity. Question: How do you expect the incoming CMS final rule to affect the spine field come Jan. 1? Dr. Robert Brady: CMS rule changes have typically been aimed at lowering the costs of healthcare. I believe this rule change will ac- complish two goals. e first is to further en- courage the transition of hospital-based sur- gical procedures toward outpatient surgical centers. It is well known that surgical centers can perform most all procedures at a lower cost and typically with greater efficiency. e second consequence is that the new rule will make it easier for payers to deny inpatient admission costs and put a greater burden on physicians and surgeons to justify and meet inpatient criteria. Q: What has been the most challeng- ing part of your practice this year? What strategies or initiatives are you planning on implementing in 2020? RB: It has always been my philosophy to prac- tice evidence based medicine. is has been particularly relevant regarding the procedures I offer my patients. Robotic navigation for placement of pedicle screws has become a ma- jor part of my practice over the last year and a half. e robot has allowed me to become more efficient and more accurate, with less in- traoperative radiation, making it safer for the patient, staff and me. I am currently working on projects to expand the utility of robotic navigation to a greater portion of my proce- dures such as interbody insertion. Q: What is the next major regulato- ry change you would like to see in healthcare? RB: I am a big proponent of empowering physicians with the ability to institute the necessary diagnostic tools and treatment protocols to provide optimal patient care. With that being said, I don't believe more regulations will achieve that goal. With the practice of evidence-based medicine, phy- sicians need to be trusted with the ability to self-regulate and take the control out of the powerful insurance company lobbyist. n Dr. Kern Singh aims to make 85%-90% of his spine practice outpatient in 2020 By Laura Dyrda K ern Singh, MD, co-director of the Minimally Inva- sive Spine Institute at Rush in Chicago, discusses his big areas of focus for 2020. Question: If 2020 is a successful year for you, what will it look like? Dr. Kern Singh: A successful year is always defined by the ability to help people overcome their spine pain. With that being said, I hope that my practice continues to transition to the outpatient environment. Currently, over 70 percent of my practice is outpatient, and this year, I hope that num- ber grows to 85 percent to 90 percent. Q: Where will you focus most of your time and energy next year? KS: My focus continues to be on my family. My children are growing up quickly (now 5 and 7 years old) and I hope to spend as much time with them as possible. Fortunate- ly, with the ability to transition my practice to a more effi- cient outpatient environment I have been able to increase my free time to spend with my kids and family. Currently, my energy is focused on reading about unicorns (with my daughter) and killer whales (with my son). Q: What do you consider the biggest potential threat to your spine practice? KS: The biggest threat to all spine practices is market con- solidation both in the hospital and insurance markets. As payers, consolidate it becomes more difficult for small or- thopedic groups to sustain fiscal solvency with contested insurance claims, denials of payments for pre-authorized surgeries, and access to patients with closed healthcare systems. Fortunately, patients seek high quality physicians preferably over hospitals and insurers. As such, whatever we do as spine surgeons we need to make sure the patient is first and their care is improved. Q: What do you plan to start doing next year, and what will you stop? KS: Live in the moment. Too many times in life we get stuck in the monotony of the daily grind. Next thing you know, life has thrown you a curve ball. I will continue to take time off work and research to focus on family, friends and smelling the roses. n

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