Becker's Spine Review

31 Thought Leadership The problem with value-based care: 2 spine surgeons weigh in By Alan Condon T wo spine surgeons discuss why they are not participating in formal val- ue-based programs and where they are focusing their resources when it comes to patient care. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: At this time, I have chosen not to participate. I am doing MACRA (Medicare Access and CHIP Reauthorization Act of 2015)/MIPS (merit-based incentive payment system) and working with my EHR vendor and a specialist — we have dialed into getting everything done. I have learned that if it costs something to lose less, then it's worth it. Those who refuse to participate, if they are Medicare physicians, will lose more and more. If one opts out of Medicare, which I predict more and more physicians will do, then it's a nonissue. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): We do not participate in any formal value-based programs. From my perspective as a spine surgeon, I have not found any of them to provide any actual value to my patients. Instead, I approach each patient individually, determine the exact diagnosis and create a treatment plan that is most medically appropriate and takes into account their living situation and financial resources. I spend a significant amount of time with each patient to explain the nature of their problem and how and why the proposed treatment plan can help them. This ensures proper compliance, best clinical outcomes and highest patient satisfaction. I cannot imagine anything more valuable than that in patient care. n Key considerations for adding spine procedures: 2 surgeons weigh in By Alan Condon F rom surgical benefits to payer challenges and implementation protocols, two spine surgeons out- line key considerations for adding a new spine procedure: Note: Responses are lightly edited for style and clarity. Question: What are your key consider- ations when adding a new spine pro- cedure at your practice? Isaac Moss, MD. UConn Musculoskel- etal Institute (Farmington, Conn.): First, one must ask: Does the new pro- cedure address an unmet need or have the potential to improve outcomes for my patients, practice or operating room workflow? If not, then one must question why a new procedure would be adopt- ed. If the new procedure does meet an unmet need or improve outcomes, then one must consider what barriers there may be to adoption. These include tech- nological, practical and financial. Once this analysis is complete, a cost/benefit profile can be created to determine if adoption of the procedure will be worth the investment of time and resources to implement it. Jonathan Stieber, MD. NYU Langone Health (New York City): Considerations: 1. Is there sufficient experience with the procedure to anticipate, at a minimum, equivalent safety and efficacy in compar- ison to my current standard of treatment? 2. Does the technology and technique associated with the procedure hold the realistic promise of improved outcomes for my patients? 3. Will the payer approval and reimburse- ment landscape permit the new proce- dure to be a viable option for timely treat- ment of insured patients? n Downsides to robots + 2 other thoughts on spine tech from Dr. Stephen Hochschuler By Carly Behm S tephen Hochschuler, MD, co-founder and chair emeritus of Plano-based Texas Back Institute, spoke to Becker's about spine innovations, technology and pri- vate practice. ree quotes from the conversation on spine innovation: 1. He said he was impressed with Alphatec CEO Patrick Miles for his work at the company and previously with NuVasive. "He just is a forward-thinking guy who gets on great with sur- geons," he said. "He's done a great job taking the stock from $2 per share to close to $17, and it's interesting to see how things are shiing." 2. He said he sees negatives to robotic technology because of cost. "It's a huge capital expendi- ture, and the add-on costs for doing a case is not inconsequential," he said. 3. Augmented reality has benefits over spine robots, including cost and workflow advan- tages. "Rather than having to look at a computer back and forth, you concentrate totally on the surgery itself because of the superimposition of their technology over the anato- my," he said. n

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