Becker's Spine Review

13 SPINE SURGEONS Consolidation boom expected in spine post- pandemic: 5 surgeons share insights By Alan Condon Five spine surgeons discussed the impact of COVID-19 on consolida- tion in the spine field. Ask Spine Surgeons is a weekly series of questions posed to spine sur- geons around the country about clinical, business and policy issues af- fecting spine care. We invite all spine surgeon and specialist responses. Note: e following responses were lightly edited for style and clarity. Question: Will consolidation continue to be a trend in spine post-pandemic? Brent Kimball, MD. CarePoint Neurosurgery (Lone Tree, Colo.): I expect to see consolidation to not only continue to be a trend, but to accelerate post-pandemic. Most smaller spine or orthopedic practices experienced disruption in practice and were introduced to compli- cated and time-consuming administrative tasks, including Payment Protection Program loans and the Medicare Advanced Payment Pro- gram. Many experienced a reduction in volume and a fear of what would happen to practice operations if one or more surgeons could not be productive. e pandemic serves as a wake-up call to the smaller businesses as they end up bearing a high degree of marginal risk due to such disrup- tions. Without scale in the business, there is less elasticity to modify the work environment and the number of staff. If one or two surgeons in a small practice are sick or out of commission, the practice may suf- fer cash flow and payroll problems. As physicians have a new aware- ness of the risks and tangible reality that external forces can create unpredictably, this will push physicians and businesses to consolidate for the protection found in a practice at a larger scale. In my opinion, the most powerful forces driving the consolidation are: 1. e need to reduce/limit overhead and administrative costs that have increased due to COVID-19. 2. More valuable payer contracts and insurance negotiation found in larger groups. 3. Having more partners to share risk and unpredictable expenses related to future disruptions in practice, such as another pandem- ic or economic/healthcare slowdowns. Richard Kube, MD. Prairie Spine (Peoria, Ill.): Consolidation will continue to be a trend due to insurance and large hospital forces. e financial advantages these groups experience through creating quasi- monopolistic business scenarios are still as profitable for them now as they were prior to the pandemic. I believe these forces will attempt to seize the opportunity created by the financial squeeze. e shutdown caused many small independent practices to forward their agenda of consolidation. Sadly, the government is also driving things in this di- rection as well. Limiting choices/competition does not improve the products and services provided in any industry. Medicine is much the same. Given that, the small and nimble practices that provide great value should survive and thrive through this time. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Con- solidation will behave much like gravity. My hope is that surgeons will partner with each other, rather than relying on a hospital or health sys- tem partner. We have always had the ability to coexist with comrades/ competitors. Smart surgeons will be seeking other capable surgeons to share space and cost with and to build a collaborative partnership. We can also act as support systems, as we can always sympathize with what we are going through. If you decide to be employed or partner with a larger group, learn the lessons the pandemic has taught us: 1. Everything is negotiable and can/will change. 2. Knowing No. 1: Get everything in writing. 3. ink about what happens when your contract ends. 4. Understand what your leverage and position are before walking into negotiations. 5. Trust but verify. John Liu, MD. USC Spine Center (Los Angeles): In academic medi- cine, consolidation has been occurring for the last few years. In South- ern California, all the major academic centers are buying other hospi- tals and absorbing practices to help compete with other conglomerate healthcare corporations. I think consolidation will be the key to sur- vive and cut costs in the future. Issada ongtrangan, MD. Microspine (Phoenix): I predict that this trend will continue aer the pandemic. e first question that I always ask myself if I am thinking about consolidation is "why?" For me, I will be looking at the partner who has the same visions and work eth- ics. I also look at their track records of success. I am also looking to partner with an organization or a company, so we can all share data in a fast, reliable and HIPAA-compliant manner. Another important as- pect is how we can lower the cost or expenses without compromising the quality of care. n Dr. Michael Dorsi appointed to leadership role at UCLA By Alan Condon N eurosurgeon Michael Dorsi, MD, will become director of community neurosurgery at the Uni- versity of California Los Angeles Sept. 1. Dr. Dorsi specializes in disc replacement, spinal fu- sion and spinal reconstructive surgery for deformities, among other procedures. Since 2012, he has practiced with Ventura (Calif.) Neu- rosurgery. Dr. Dorsi completed his residency at Johns Hopkins Hos- pital in Baltimore and was awarded a fellowship from the California Institute of Regenerative Medicine, where he spent two years researching spinal cord injury and stem cell transplantation at UCLA. n

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