Becker's Spine Review

11 SPINE SURGEONS Make sure they understand what the steps are and what to expect right aer surgery, so they're not going to the emergency room with issues that are expected aer surgery. e outpatient surgery center is geared toward getting patients home, so we really encourage pa- tients to get up and get ambulating, as well as understanding what their pain is supposed to be aer surgery. Problems urinating, nau- sea, vomiting and fever make it more difficult for patients to be at home. You need to really help your staff, especially anesthesia and nursing, to develop their skills for an outpatient center. Expectations around hospital-based surgery are different than at the outpatient surgery center. Q: What does a natural progression look like for surgeons moving toward adding multilevel spinal fusions to the surgery center? JC: If you're able to do the smaller surgeries — microdiscectomies or smaller cervical or lumbar decompression — then you can look at try- ing to add other surgeries. If you can do a lumbar discectomy at the surgery center, then the next steps would be adding laminectomies, then fusions, then interbody fusions. Continue to add to your skill and technique without harming surrounding tissues or increasing the pain related to the procedure itself. If you can do a microdiscectomy or a laminectomy through a one-inch incision, you may be surprised to see that you can put in screws through the same incision. And if you can do that, you're on your way to making an inch and a half incision to be able to do a two-level or three-level spinal fusion. Q: Are there any spine surgeries that you're considering adding at your surgery center? JC: We do pretty much everything at our surgery center. e only procedures that we're not doing are some of the long scoliosis surger- ies and posterior cervical spinal fusions. e bigger procedures that have more risk of complications, you may want to have them done in the hospital, as there is the potential need for an ICU. From a patient standpoint, there are those patients that have other medical issues or comorbidities that put them in a position where it may not be safe to have them at home aer a lumbar fusion or cervical spinal fusion. ose patients would need to have their surgeries at the hospital, where more staff are around to watch them closely. Q: How do you expect hospitals to compete with surgery centers as spine and orthopedic procedures continue to migrate to the outpatient setting? JC: I think hospitals will become more heavily involved at ASCs and partner with physicians to create these centers with a better patient experience. e patients are driving this. Physicians are having that direct patient care, understanding what the patients need and what the patient expectations are. A lot of patients, especially over the past year, don't want to have surgery at a hospital. at's something that physicians hear as they discuss surgery with their patients. Physicians having that direct patient care are able to guide that care and manage the needs of the patient. Q: How do you see spine care delivery changing in the next five years? JC: I think more physicians will lean toward outpatient procedural methods, migrating their cases and right-sizing the needs of the pa- tient to an outpatient or inpatient setting. Physicians and hospitals will be figuring that out. ere are procedures that can only be done in hospitals and there are those that should be done in an outpatient or ASC setting. We'll see that playing out more in the next few years. From CMS, we've seen total hips and total knees being moved to the outpatient setting, so commercial insurance companies are figuring this out as well. CMS is allowing physicians to make that call because they know that physicians are able to better direct patient care. Listen- ing to patients' expectations and needs, providing the best advice or procedure will lead to the best outcome. Physicians will be the ones who have that direct contact with patients to be able to make those calls more effectively. n 2 more spine surgeons sentenced for roles in $40M kickback scheme By Alan Condon T wo more spine surgeons received prison sentences March 18 for their roles in a $40 million kickback scheme at the now-defunct physician-owned Forest Park Medical Center in Dallas, according to The Dallas Morning News. Douglas Won, MD, was sentenced to five years in prison, and Michael Rimlawi, DO, received a seven and a half year prison term. The two surgeons were also ordered to pay almost $30 million in restitution, according to the report. A third spine surgeon involved in the case, Shawn Hen- ry, DO, received a seven and a half year prison sentence March 17 and was ordered to pay almost $6 million in restitution. The three spine surgeons were found guilty of bribery and both paying and accepting kickbacks to steer surgeries to Forest Park. Pain management physician Mrugeshkumar Shah, MD, also received a three and a half year prison term for his role in the scheme. Prosecutors said the physicians referred patients to the hospital in exchange for money to advertise their practic- es, which helped some of their practices grow significantly. U.S. District Judge Jack Zouhary said the case should de- ter others from engaging in bribery and kickback schemes, according to the report. The case could have long-term ramifications for physician-hospital financial arrangements involving marketing payments, which are widespread in the healthcare industry. n

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