Becker's ASC Review

31 ORTHOPEDICS COVID-19 and a new presidential admin- istration are unpredictable variables facing the delivery of spine care in 2021, we remain optimistic that clinical advancements coupled with market pressure will yield positive results for patients and other purchasers of care as well as spine surgeons. Currently, 34 percent of all spine surgeries performed by our physicians occur at our ASC offering excellent outcomes and dramatic cost savings. Recognizing this value, insurance plans and self-insured employers continue to expand coverage for advanced spine procedures in the ASC setting, so we expect this volume to increase in 2021. Facilitating this increase are ongoing advances in intraoperative imaging and perioperative pain management, including ERAS. Our group recently included eight spine surgeries in the bundled surgery menu on our website. All spine bundles include the surgeon and assistant fees, ASC facility fee, implants, anesthesia and 90 days of routine follow-up care. As health- care purchasers clamor for price transparency, we expect 2021 to bring us more patients, self-funded employers and their third-party administrators who appreciate our easily acces- sible pricing menu. Finally, as the burden of data collection is continually reduced by technology improve- ments, registry participation and reporting of truly meaningful surgical outcome data becomes easier. We expect to enhance our quality tracking and reporting capability in 2021. Overall, a successful year for our practice includes abundant opportunity to set ourselves apart as providers of choice who offer healthcare purchasers enhanced value through excellent surgical outcomes, exceptional patient experience and fair, transparent pricing. Scott Boden, MD. Emory University Orthopaedics & Spine Hospital (Atlanta): A successful 2021 will see a return to above pre-COVID-19 patient/procedure volumes (some catch up on deferred care), and main- taining some of the innovations that were accelerated as a result of the pandemic, such as telemedicine. Helping patients realize that the insurance they purchased will not cover the modern therapies, especially with regard to biologic injections and cartilage replace- ment, that they desire and deserve. Domagoj Coric, MD. Carolinas Medical Center (Charlotte, N.C.): I am expecting a slow transition back to a semblance of normalcy with the availability and distribu- tion of the COVID-19 vaccines. ere will be a continued trend toward consolidation in hospital systems, payers, industry and surgical practices. e pandemic has acceler- ated the transition to telehealth and virtual medicine as well as increasing the amount of spine surgery being delivered in the ambula- tory setting. e continued adoption of MIS techniques will also accelerate the trend to outpatient and ambulatory spine surgery. ere will be a return to physical meetings even as surgeons and industry continue to take advantage of virtual interactions. I an- ticipate the first major physical spine meet- ings will be well-attended as a welcome relief from COVID-19 fatigue and isolation. Innovation trends will continue with advances in intraoperative navigation, including more sophisticated robotics and AR platforms. Spinal arthroplasty will continue to evolve with the impending FDA approval of a third cervical artificial disc device, the Simplify Disc, for two- level cervical disease, and two other devices — Baguera-C and Synergy — in active IDE study. Lumbar arthroplasty may see something of a renaissance as the Tops lumbar artificial facet pivotal IDE study completes enrollment and the Balanced Back posterior lumbar artificial disc launches its pivotal IDE trial. Core fusion technologies should also benefit from pent-up demand as the pandemic recedes in the second half of 2021. A successful 2021 will entail navigating the continued fallout of COVID-19, including the spectre of a second widespread elective sur- gery slowdown. On top of the myriad medical challenges brought by the pandemic, surgical practices must also deal with looming CMS cuts. In what can only be described as impec- cably poor timing, neurosurgical practices are looking at a cut of 6 percent due to changes in Medicare's physician fee schedule. Success will ultimately be determined by the physical health of our medical providers as well as the financial stability of our practice. Raymond Gardocki, MD. Vanderbilt Uni- versity Medical Center (Nashville, Tenn.): I expect endoscopic interbody fusion to grow significantly. I also expect that outcomes data will be collected, showing higher fusion rates and less subsidence due to better visualized disc prepration and less endplate violation. Look for new instrumentation advancements and technique refinements that make this procedure feasible for more surgeons to per- form outpatient and awake one- and two-level lumbar fusions. I think this will lead to more mainstream acceptance and use of endo- scopic spine surgery. A successful year for my practice would be doing all of my posterior one- and two-level thoracic and lumbar cases endoscopically by Christmas 2021. omas Lous, MD. Austin Neurologi- cal Institute (Texas): It's difficult to predict 2021. e response to COVID-19 has been stifling to surgeons and their patients across the country. New Medicare rules with decreased payments and new prior authori- zation requirements are only going to limit patient access to their health care even more. I am hoping there will be more pushback by spine surgeons on the newer regulatory and pricing burdens in 2021. Innovation is likely to be slow due to limited meeting and social interactions among surgeons and scientists in 2020. A successful 2021 would be hopefully recovering some of the financial losses accrued in 2020 by restoring access to patients and healthcare delivery in general. Mick Perez-Cruet, MD. Michigan Head & Spine Institute (Southfield, Mich.): I expect to see continued growth in the spine field in 2021. Increasingly, patients suffering from spinal dis- orders are recognizing the benefits of outstand- ing spine care in achieving a better quality of life and getting them back to an active lifestyle. is is being achieved through advancements in minimally invasive spine surgery and a better understanding of spinal disorders. Large collaborative spine surgery patient-generated data pools such as the Michigan Spine Surgery Improvement Collaborative, a Blue Cross Blue Shield-initiated program, are showing us the true benefits of spine surgery care in improving the lives of our patients. Continued constructive analysis of patient outcomes and procedures that work to pro- duce optimal patient outcomes will lead the spine field in 2021. A successful year would involve continued growth and prosperity through the provision of outstanding, com- passionate and affordable spine care. Our ASC continues to grow as we bring more cases to the outpatient setting. Philip Louie, MD. Virginia Mason Medical Center (Seattle): Next year will be a huge relief, in that 2020 will be finally over. Unfortunately, similar challenges will persist. Working in a large medical center in a large metropolitan city, we are faced with large volumes of surgery cancellations and in-person clinic visits due to the pandemic. Our first challenge will be to coordinate, maximize and support patients through extended conservative measurements. Reassuring patients on the safety and efficacy of providing surgical care will be paramount. As such, I think spine providers will need to turn to new methods of patient engagement and mobile health options. is includes using mobile technology for health education, treat- ment adherence, chronic disease management and remote monitoring of health conditions. Given the wide range of applications and the increasing popularity of smart devices, mHealth has the potential to transform the way healthcare is delivered. However, similar to the introduction of telemedicine, we will need to learn to adapt and trust a new tech- nology that may create increased work bur- den during the early stages. New modalities and programs that take us out of the comfort zone — away from the traditional model of providing care — can be challenging. n

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