Becker's Spine Review

6 SPINE SURGEONS DOJ alleges system paid 'excessive' salaries to keep specialist referrals in network By Angie Stewart T he Department of Justice accused In- dianapolis-based Community Health Network of illegally paying special- ists "excessive" salaries in an "aggressive," "defensive" strategy to keep referrals within the system. From 2008 to at least 2017, CHN allegedly employed hundreds of physicians, including ones specializing in orthopedic surgery and neurosurgery, and compensating them well above fair market value using calculations based on referral and utilization patterns. CHN then billed Medicare for inpatient and outpatient services provided by those physi- cians, in violation of Stark Law, according to court documents. As a result, CHN "received millions of dollars in Medicare reimbursement to which it was not entitled," the DOJ alleged. Prosecutors alleged CHN leaders received "clear guidance" from a valuation firm that said the physicians' salaries were outside the range of fair market value and needed further justification to be in compliance with Stark Law, which prohibits physicians from refer- ring Medicare patients for care at a facility the physician has an improper financial relation- ship with. CHN allegedly provided the firm with falsely deflated compensation figures for four neuro- surgeons employed from 2008-10. e system also failed to disclose that it was guaranteeing compensation to three of those surgeons, the DOJ alleged. In one instance, CHN allegedly guaranteed one neurosurgeon a base salary of $650,000 for the first year of employment and $675,000 for the second year, but told the valuation firm that the figures were $420,320 and $463,052, respectively. Another surgeon — whom the system believed could capture one-third of the volume of neu- rosurgery and spine cases in four Indiana counties — was guaranteed a $921,600 salary based on 12,000 work relative value units, but the wRVUs were later significantly reduced to reflect lower productivity estimates. e government is seeking damages caused by improper payments, plus interest, costs and expenses. e lawsuit stems from a whis- tleblower complaint filed under the False Claims Act by omas Fischer, who served as CHN's CFO from 2005 to 2013. n Dr. Thomas Schuler: Key thoughts on stem cell therapy in spine By Alan Condon T homas Schuler, MD, is founder and CEO of the Vir- ginia Spine Institute in Reston and was a spine con- sultant for the Washington Redskins for 20 years. Dr. Schuler specializes in cervical and lumbar disc replace- ment and minimally invasive spine surgery. He founded the Virginia Spine Institute in 1992, which has grown to include regenerative therapy, stem cell therapy as well as robotic and ultrasonic spine surgery. Here, Dr. Schuler discusses the development of stem cell therapy in spine and how regenerative therapies are help- ing improve the quality of life for poor surgical candidates: Note: Responses were edited for style and clarity. Question: What breakthrough or event in spine had the biggest impact on your practice in 2019? Dr. Thomas Schuler: Last year has shown many advanc- es that are changing and improving the way we practice spine. Robotic surgery, augmented reality and artificial disc replacement are areas that have progressed in 2019. However, the area that I find most promising is the use of bone marrow concentrate/stem cell therapy to stabilize in- jured discs and delay or, in some cases, prevent the need for surgery. We have been treating patients for over five years with bone marrow concentrate injections into dis- cographically-proven painful discs. Our patients have not only avoided surgery, but regained full and active lifestyles and improved their quality of life. This may not be the appropriate treatment for every case or every situation, but for those who are candidates it is truly life changing. The most exciting cases are not the pa- tients with one or two degenerative discs, but those with their entire lumbar spine degenerated, who ultimately because of that, are extremely poor surgical candidates. The ability to return these patients back to full and active lives is impressive and promising, especially since there are no reasonable surgical options for these patients. Re- alizing the significant positive impact of the use of bone marrow concentrate/stem cells intradiscally in the properly selected and rehabilitated patient is truly a game chang- er for spinal healthcare moving forward. 2019 marks the year that this great advance became a clinical reality. Heal- ing patients naturally with regenerative medicine, while avoiding surgery in individuals who did not benefit from traditional nonoperative treatments, is truly an exciting par- adigm shift. n

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