Becker's ASC Review

30 ORTHOPEDICS What's next for spine in 2021? 12 spine surgeons share By Alan Condon T welve spine surgeons share their out- look on the spine field in 2021 and what success will look like for their practice. Note: Responses were edited for stye. Question: What are you expecting from the spine field in 2021? What does a successful year look like for your practice? Frank Phillips, MD. Midwest Orthopaedics at Rush (Chicago): I anticipate advances in enabling technologies allowing procedures to be informed in a less invasive, more efficient and reproducible fashion; ideally in an out- patient setting. ese technologies include augmented reality, enabling precision, less- invasive procedures and looking forward to robotics evolving to solve technical challeng- es in an efficient manner rather than being adopted for marketing purposes. In terms of my practice, a successful year includes COVID-19 becoming a more manageable situation with the resumption of normal interactions with patients, colleagues and friends. I anticipate my outpatient prac- tice expanding even beyond XLIF, TLIF and ADCDFs/TDR. William Taylor, MD. University of Califor- nia San Diego: In my opinion 2021 will be a year of continued expansion for appropri- ate technology. is will allow us to shorten recovery time, improve outcomes and shorten surgical times. ese improvements will come based on reduction in complications and decrease in reoperations from issues that can be rectified or prevented prior to leaving the operating room. In addition, improved outcomes will be based on our use of AI to help in patient selection. is will not only be based on entering appropriate patients in preoperative education and rehab, but lead to a decrease in the use of narcotics. at will allow us to select and individualize operative procedures that are appropriate for specific patients. Intraoperatively, the continued use of robotics, navigation and AR will allow us to avoid some routine issues. Success of our practice will be based on our ability to include this expanding technol- ogy in the appropriate setting, and working with stakeholders to ensure that it is used properly and effectively to provide increased value. Patients will continue to demand that we understand, implement and provide procedures that utilize the latest technology to improve their outcome. Lali Sekhon, MD, PhD. Reno (Nev.) Ortho- pedic Center: is year has been a challenging year for everyone and stability would be a nice way to enter 2021. Yet, we are immediately fac- ing possible elective surgery closures and most of us hope the COVID-19 vaccine will alter the downward spiral of healthcare and the com- munity. I expect a couple more things: • Pressure on reimbursement. We are already starting down the gun barrel of an almost 10 percent reduction in reimbursement for surgeries from CMS, with commercial pay- ers to follow suit. With most practices run- ning at greater than 50 percent overhead, this does not augur well. • More new technologies. Navigation, implant materials, bone gra substitutes, robotics and AR. • More questioning of new technologies. e question that hospitals and healthcare systems will ask about these new tech- nologies is where the value lies. I see health systems questioning the introduction of new technologies with some demonstration of the value they bring over "easier for the surgeon" or "surgeon preference." A lot of hospitals see some of these technologies as marketing stunts with entry level benefits. • e aging population. More Medicare recipients will need care. e case mix will continue to tilt away from commercial payers. • Consolidation of groups or organizations. • e importance of ancillaries to the sur- vival of private practice groups. • Challenges for small spinal implant companies as hospitals reduce vendors for savings. • More transparency in terms of payments/ reimbursement. • Gainsharing/co-management agreements between hospitals and surgeons becoming more prevalent. • More outcome data on surgeons and hospi- tals for consumers. Overall, 2021 may be challenging. We are fortunate to have somewhat recession-proof careers and are in a better position than other sectors of society, but with so much money spent at a state and federal level on COVID-19 -19 relief, reduced payments for Medicaid and Medicare are in the pipeline. e hamster wheel is going to go faster for less. Jonathan Gottlieb, MD. Minimally Invasive Spine Center of South Florida (Miami): I anticipate that 2021 will continue to chal- lenge the country for innumerable reasons, and the field of spine surgery is certainly not immune. In addition to the direct impact of COVID-19, the vitriolic political environment and uncertainties surrounding the extent to which the government will manage healthcare in the future will likely temper any substantial growth efforts in our field. Additionally, many people have either lost insurance, lost their jobs, or face incredible out-of-pocket expenses that limit their interest and ability to undergo treatment unless it is an absolute emergency. I am hopeful that we will have some modicum of control over this disease and that the expan- sive cognitive dissidence gripping our country will also mitigate over the next several months. At that point, we may begin to see some return to normalcy in our practices and in the field as a whole. We have been fortunate and able to maintain the practice without any personnel losses. However, the financial setbacks are real and cannot be tolerated indefinitely. Our reserves position was favorable at the onset of the pandemic and really reaffirms the need to plan for lean times. Lessons from this experience should never be forgotten. Private practices, already endangered species, will not survive unless we incorporate what we have learned and evolve before it is too late. Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): Next year will be a transformational year in spine surgery. Both physicians and medical device companies will have to adapt to a new normal. e trend towards outpatient spine surgery will only be accelerated by patient demand as well as insurance companies and Medicare encourag- ing more cases to be done in an outpatient facility. Increasingly, I am getting a number of calls from physicians asking for guidance on how to do awake spine surgery as more patients are asking for it. I recently helped guide a physician in Chicago to perform an awake spinal fusion aer his patient asked him for the surgery to be performed using this protocol. Medical device companies will have to adapt to this new normal and offer services to sur- geons to help them transition their practice to the outpatient space. is will include not only minimally invasive tools but also digital training tools, AR/VR technologies to train surgeons and staff, along with digital tools that will allow surgeons to do remote patient monitoring postop. William Rambo, MD, and AnnMargaret McCraw, CEO. Midlands Orthopaedics & Neurosurgery (Columbia, S.C.): While

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