Issue link: https://beckershealthcare.uberflip.com/i/1305916
10 SPINE SURGEONS 6 spine surgeons on the biggest obstacle they face going forward By Alan Condon I nsurance companies and the ramifications of the COVID-19 pandemic are some of the issues at the forefront of spine surgeons' minds. Here, six surgeons discuss the biggest obstacles to the specialty going forward. Note: e following responses were lightly edited for style and clarity. Question: What is the biggest obstacle facing spine pro- viders in the modern landscape? Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Insurance companies are the biggest obstacle facing spine providers today. Our ability to diagnose prob- lems, employ minimally invasive surgical tech- niques, and restore and maximize quality of life for our patients has never been stronger. Unfor- tunately, onerous processes of preauthorization, denials of care, and pointless and exhausting peer-to-peers have inun- dated spine surgeons' offices with unnecessary work [and] increased overhead costs, and ultimately le patients shortchanged due to un- reasonably denied or delayed care. Furthermore, an emphasis on maximizing profits by prioritizing low cost care — irrespective of quality — has driven reimbursement rates down, put a squeeze on practitioners and limited patient options for treatment. Until spine surgeons retake control over their practices, patients and decision-making independence, insurers will continue to minimize our role and limit our ability to push the field forward. Jeffrey Wang, MD. USC Spine Center (Los Angeles): e largest obstacle right now is how to continue our educational activities and surgi- cal training, given the lack of the ability to travel to academic meetings, teach new surgical tech- niques and learn research advances. Although much can be done virtually with webinars and virtual education, surgical techniques require hands-on and laboratory training, which is best accomplished in face-to-face settings. I am excited about potential virtual reality and augmented reality, in perhaps allowing us to develop new ways of surgical education. However, this needs a lot of work and there is no substitute for live teaching in hands-on cadaver courses. John Burleson, MD. Hughston Clinic Ortho- paedics (Nashville, Tenn.): ere are two major obstacles facing spine surgeons today as I see it: e first is the need to better advocate for new technology for our patients in a market that con- stantly wants to cut and contain costs. ese new technologies will make surgeries safer and more predictable, but in some situations come with necessary upfront capital expenses. e second is our need to advo- cate for fair reimbursement. As CMS continues to decrease specialists' reimbursement in favor of other specialties, it is important that we speak up about the value we provide and the risk that we take on in doing so. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): e biggest obstacles facing spine providers and most physicians in the modern landscape of the U.S. healthcare system are de- clining reimbursements and burdensome and ever-increasing regulations by government agencies and private health insurers. I get paid significantly less to perform the same spine sur- gery procedures now as I did when I first started practicing in 2010, even though now I perform such procedures more efficiently, less in- vasively, and with better patient outcomes and satisfaction. In the meantime, the salaries of my staff, rent costs, insurance costs and supplies costs are only going up. If the overall healthcare costs are going up and my payment rates are going down, where does all that money go? To make matters worse, CMS is planning to cut reimburse- ment for surgical procedures by approximately 11 percent on Jan. 1, 2021. If this trend continues, patients will face longer waits and lower access to spine care as more surgeons will not be able to be in-network with their insurance plans because of such low reimbursement rates. e ever-increasing burdensome regulations that are imposed on spine surgeons by CMS, state medical boards and the private insur- ance companies require the physicians and their staff to spend more time on administrative tasks to stay compliant and to obtain prior authorizations. is time could be better spent providing the actual patient care and improving quality of such care. Most of these regu- lations are not designed to help the patients, but are instead aimed to limit the amount of care provided, regardless of whether the patient needs that care or not. Colin Haines, MD. Virginia Spine Institute (Reston): In my opinion, spinal healthcare has advanced more than almost any other aspect of medicine over the last decade. is tremendous growth has in large part been tied to econom- ics. If companies continue to have a financial incentive to innovate and develop new prod- ucts, as has been the case recently, then we will keep improving exponentially. However, concerns over bundled care models, declining reimbursement and an increasingly more difficult authorization process for surgeries have made the business of spine more challenging. To continue to improve, there needs to continue to be an incentive to improve. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: e continued creeping of in- surers into the space between physicians and pa- tients. We, as physicians, have been completely lax in terms of keeping the payers out of the relation- ship. Now, we are seeing them doing peer-to-peer reviews for follow-up CT scans for fusions done for dens fractures. Forms are sent to my office demanding enumerating the manufacturer, model and make for each implant correlated with a CPT code. So again, due to complacency, we have seen more insinuation into the medical relationship space. If we, as a specialty, want to continue to practice in a safe, compassionate and effective manner, it is time we extracted the same from payers in our professional relationships. n