Becker's Spine Review

28 Thought Leadership Spine care delivery will look very different in 5 years: 10 surgeon insights By Alan Condon F rom multidisciplinary spine centers to the continued growth of telehealth and rapid migration to the outpatient setting, 10 surgeons outline how spine care delivery will evolve in the next five years. Question: How do you see spine care delivery changing in the next five years? Colin Haines, MD. Virginia Spine Institute (Reston, Va.): 2020 was a year of evolution for healthcare. New challenges bring new opportuni- ties for innovation. Because of the concerns about in-person healthcare delivery during the height of the pandemic, our field has rapidly evolved to incorporate telemedicine. is has been revolutionary for multiple reasons. e speed and efficiency overall are tremendous — patients now have access to medical experts at their fingertips. Public health experts have long stated that we have a physician distribu- tion challenge in America. Now, we can have patients who live in regions without high-level spine care connect to us over the internet as opposed to having to travel long distances for their initial visit. Also, patients who are challenged by taking time off work or caring for their children can receive care from the convenience of their office or home. In essence, pa- tients are now more than ever able to get their spine condition addressed as the geographical barriers to entry are eroded. Telemedicine is not without its negatives, however. Quality spine care is so much more than a history and imaging review. An in-person phys- ical exam by a spine surgeon is paramount for accurate diagnosis and treatment — a critical step that cannot be achieved over the internet. Regardless, I firmly believe that telemedicine is a critical development that I integrate into my practice and has expanded my reach to those who need it the most. Burak Ozgur, MD. Hoag Neurosciences Institute (Newport Beach, Calif.): I believe spine care delivery should be delivered more by way of comprehensive multidisciplinary teams. In this way, there's more op- portunity for collaborative treatment and providers to learn from one another, ultimately improving outcomes. I also expect there to be more accountability to objective patient outcomes. We need to see what treat- ments yield better results and improved functional outcomes. Brian Gill, MD. Nebraska Spine Hospital (Omaha): Spine care will continue to evolve over the next five years with a greater emphasis on moving procedures to outpatient settings. It is already happening at an exponential rate, especially with CMS dropping nearly all spine-related inpatient codes and moving them to outpatient. is will move many procedures from a hospital setting to an ASC setting, continuing the on- going trend. Techniques and protocols will continue to evolve to facili- tate the progression of spine care to an outpatient setting. I am a strong proponent that providers need to have a vested interest in the care of their patients as it helps to drive efficiencies, controls costs and provides superior outcomes. In turn, this creates value to insurers, employers, and most importantly, patients. ere will continue to be cost scrutiny and downward pressure on reim- bursement for spine procedures. I recently saw where bundled payment models resulted in roughly a 10 percent savings in several surgery types. Insurers will continue to scrutinize spine surgery indications which may delay or prevent care from being delivered. I think bundle payment models will continue to gain traction as well as other models that will result in cost savings. e one silver lining of the COVID-19 pandemic was the widespread ad- aptation of telehealth. e emergency declarations temporarily suspended some of the telehealth requirements, making it more accessible to patients and providers. Telehealth has been around for some time, but it has had limited use due to many constraints. I think that telehealth is here to stay and will continue to increase as a percentage of overall patient visits. Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): As patients become more sophisticated in researching their care, they will look for data on their provider's outcomes. Increasingly, surgeons should set up a mechanism to collect their surgical outcomes, and ul- timately be able to publicly display that data. In addition, patients will want to receive their care in Centers of Excellence. Having all their spine care providers under one roof, in a one-stop shop, will be desirable and convenient. Patients will realize that coordination of their care will be easier if all providers are under one roof. Richard Kube, MD. Prairie Spine (Peoria, Ill.): With the rising costs of healthcare in general, healthcare consumers will be searching for op- tions that provide value. Many procedures, including those required for spine ailments, can be done safely in an ambulatory setting. e stream- lined and efficient nature of ASCs makes them well equipped to provide high value for the services rendered. I believe these market forces will continue to incentivize more care to be provided in the ambulatory set- ting, including spine surgery. Peter Derman, MD. Texas Back Institute (Plano): e pandemic gave us all an unanticipated crash course in telemedicine. While in-person office visits are now again the norm, virtual visits remain an attractive offering for certain patients. ese include those who must travel great distances for care; those with responsibilities at work or home that make it difficult to take time away; and those for whom travel is difficult due to physical limitations. Certain routine postoperative visits and imag- ing follow-up appointments are also quite amenable to telemedicine. As we increasingly demonstrate the value of telemedicine through research publications, I am hopeful that payers and regulators will break down existing barriers to allow more widespread utilization. Rather than being limited by their local geography, patients should be able to seek the care of leaders in the field from the comfort of their homes. "Increasingly, surgeons should set up a mechanism to collect their surgical outcomes, and ultimately be able to publicly display that data." - Dr. Alok Sharan

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