Becker's Spine Review

14 SPINE SURGEONS Dr. Alexander Vaccaro: Why Rothman Orthopaedics is dropping out of bundles By Laura Dyrda A lexander Vaccaro, MD, PhD, is pres- ident of Philadelphia-based Roth- man Orthopaedics and Chairman of Orthopedic Surgery at omas Jefferson University Hospitals. Dr. Vaccaro has devoted his career to min- imally invasive spine surgery and building a leading practice focused on academic re- search and community engagement. Dr. Vac- caro participated in a fireside chat during the Becker's Spine, Orthopedic and Pain Man- agement-Driven ASC + the Future of Spine Virtual Event on June 19, discussing his out- look for spine, technology and private prac- tice in the future. In this excerpt, Dr. Vaccaro talks about val- ue-based care and the emergence of tele- health in spine today. Note: responses are edit- ed slightly for clarity. Question: What is your view on bun- dled payments and value-based care in spine? I know Rothman was an early adopter; how are you thinking about it now and what's on the hori- zon? Dr. Alexander Vaccaro: We go through stages. We were in bundled payments for the last 10 years, and we did great. We had shared savings with the insurance company and with the hospital. What happens is the growth changes every year; the better you get the more difficult it is to save money, so we're now bottomed out. In the federal govern- ment and a lot of their value-based systems, we're actually dropping out a lot of them be- cause we can't get any more efficient. We can get a hip fracture to the operating room within 24 hours and we can get them out of the hospital to a rehab or a home with- in one to two days; we've done everything. We looked at everything that we could to sort of squeeze out any inefficiencies. e next step is population-based medicine where you do per patient, a per member per month, per member per year arrangements. e low hanging fruit now is with the tech- nology with telemedicine, as long as all the players are aligned and they say, listen, this telemedicine, you're delivering the same amount of care, the same value of care to the patient. We're going to now share the savings if they do that, that's a big one for value-based healthcare. … We have to be aligned with the insurance company for the right care at the right time for the right person. If they come back and they cut that value in half or 75 percent, then what's going to happen? Phy- sicians aren't going to use telemedicine and we're going to lose our opportunity for val- ue-based care. As long as we're aligned and no one over-leverages there, we can continue to decrease the spend for healthcare. Q: How do you think the pandem- ic will change the spine field and healthcare overall? AV: Well, I think we're going to become much more efficient in accessing the appropriate care at the right time. You want every person on your team to live up to the license, and what I mean by that is a medical assistant, a PA, a resident fellow, an attending, a profes- sor, an expert. Right now we have clinics that we see, like say one day you see 35 to 45 pa- tients and maybe four will need surgery. Well, the best world would be the surgeon sees the surgical patients, the non-operative people see the non-operative patients and those that just need screening for back pain, get eval- uated by the PA. We can do interviews with patients using telehealth, so you call up front for an appointment and I could sit down and I could talk to you. I believe strongly that 80 percent of the time I can make a diagnosis appropriately through telemedicine, without ever seeing the patient, watching a patient through their visual ex- amination online. So it's going to change the world; no longer will we have those barriers to care. Because of 1135 waiver, I'm doing telemedicine with people in different states, because there's no state boundary anymore. [When the waiver expires] I won't be able to do that anymore, but it is phenomenal what we can do with telemedicine. at's how spine surgery will change, will be much more efficient, be less likely to get burnt out, be more resilient because we're do- ing things we really love to do. I'm exercising to the level of my license. e PA is doing ex- actly what he or she wants to do. So that's go- ing to be the change I see in spine surgery. n Michigan neurosurgeon permanently loses license, settles charges he misdiagnosed 250 children By Alan Condon N eurosurgeon Yasser Awaad, MD, on May 20 permanently surrendered his medical license and agreed to pay $5,000 to settle allegations that he misdiagnosed more than 250 children as suffering from epilepsy or seizure disorders, Detroit Free Press reported. Dr. Awaad practiced at Oakwood Hospital and Medical Center in Dearborn, Mich., now part of Southfield, Mich.- based Beaumont Health. A 2018 complaint filed by the state attorney general al- leged that Dr. Awaad made misdiagnoses "based on elec- troencephalograms that were either not performed or not interpreted properly." Children were given unnecessary medication that was sometimes harmful, according to the complaint. The com- plaint pertains to cases from 1997 to 2007. Dr. Awaad was found to be negligent in two civil cases. A jury awarded one patient $3 million, which was later reduced to $846,000 due to caps on malpractice claims. The patient in the second case was awarded almost $2.8 million, which is likely to be reduced too, according to the Detroit Free Press. Dr. Awaad has not practiced medicine since 2007, accord- ing to state officials. n

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