Becker's Spine Review

22 Thought Leadership The biggest opportunities in spine from 8 surgeons By Alan Condon From innovations in biologic treatments to physician advocacy and mi- grating cases to the outpatient setting, eight spine surgeons discuss the biggest opportunities in the field today. Question: Where do you see the biggest opportunities for spine sur- geons today? Note: Responses are lightly edited for style and clarity. Sanjay Khurana, MD. Hoag Orthopedic Institute Surgery Center (Marina Del Rey, Calif.): e progress of minimally invasive surgery over the past two decades is finally being realized in the outpatient en- vironment. We are increasingly performing higher-acuity cases from microscopic and endoscopic decompressions to multilevel disc replace- ments and anterior and posterior lumbar interbody fusions. e migra- tion of these procedures to the ASC have become a win-win for patients, physicians and payers alike. Patients are seeing improved satisfaction and clinical outcomes. Physicians are improving professional satisfac- tion, economics and time management. Finally, insurers are reducing reimbursement from higher-cost centers to more efficient and less costly ASCs. I view the continued migration to the ASC as the single biggest opportunity for spine surgeons today. Barrett Woods, MD. Rothman Orthopaedic Institute (Philadelphia): Significant challenges exist with insurance approvals, reimbursement and administrative burdens. With that said, opportunities to increase our footprint and improve access in our communities exist. With the COVID-19 pandemic, we have seen increasing utilization of telehealth platforms. Utilization of telehealth has improved office efficiency, de- creased patient wait times and improved patient satisfaction. e next advancement will be the utilization of smart phones as most patients, young and old, have access to these devices. James Chappuis, MD. SpineCenterAtlanta: ere are still significant opportunities for spine surgeons in private practice. Profit margins are much smaller than in the past, so first of all, it's important to make sure your costs are well contained. Secondly, as consumers are more in charge of choosing their surgeons, I think it's very important to focus on ex- cellent patient care and overall service when patients come to your of- fice. ey must see value. If so, they will reward you with social media referrals and good ratings on various sites available. is, in turn, will welcome many other referrals with which larger, vertically-oriented sys- tems, because of sheer volume, won't be able to compete. Finally, there are other referral sources that are outside of the traditional health insur- ance plans now becoming available, so keep an open mind and remem- ber to always put excellent patient care first. Noam Stadlan, MD. NorthShore Neurological Institute and North- Shore Spine Center (Evanston and Skokie, Ill.): e preeminent goal of spine surgery is the preservation/enhancement of the quality of life of our patients. e COVID-19 pandemic starkly illustrated the prom- inence of social factors in the health of our patients. I think there cur- rently is an opportunity to work for better and more equitable access to quality spine care for both current and potential patients. e pandemic has also illustrated the utility and effectiveness of telehealth, and this can and should be expanded. Finally, the growing move toward electronic medical records and large outcome databases should help guide spine surgeons by providing accu- rate data to improve surgical and nonsurgical decision-making. e data can also help provide better and more accurate benchmarks for quality care, identify areas that require improvement and supply recommenda- tions to achieve the needed improvement. Brian Gantwerker, MD. Craniospinal Center of Los Angeles: I think more surgeons need to be involved in advocacy. Instead of complaining about how things are, or "going with the flow," let your congresspeople and senators know how things are going. So many folks in advocacy have no idea why so many doctors are not more involved. Whether it's through American Association of Neurological Surgeons/Congress of Neurologi- cal Surgeons, the North American Spine Society, or American Academy of Orthopaedic Surgeons, or other organizations, only by creating a voice for your concerns will things get better. e largest opportunity by far, is affecting our collective destiny and patient outcomes in a positive way. Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): e biggest opportunities will be in providing advanced surgi- cal therapies, reducing the patient's pain and blood loss with minimally invasive techniques. ose that augment and improve the placement of hardware or implants necessary for the surgery, such as image-guided robotic-assisted spinal surgery, are becoming more prevalent. ere are new companies emerging with newer technologies that are more cost effective and help with precise screw placement, reducing incision size and decreasing the need for reoperation and repositioning. Secondarily, image-guided surgery can be done with neuronavigation techniques, as well as augmented reality technology. Not only will this benefit fusion surgeries, but also disc replacement. Patients who want to have motion preservation surgery want to avoid fusions and these tech- nologies will assist with lumbar and cervical artificial disc replacement to preserve patients' motions and reduce their pain. Approximately 10 years ago, there were 4,500 spine surgeons practic- ing in the U.S. Now there are approximately 3,600. As the number of surgeons is reduced, the demands and time are increased for seeing pa- tients and delivering proper care. Being familiar with these technologies broadens the opportunities for spine surgeons today. Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): I think there are two great growth opportunities for surgeons in the years to come: motion preservation technology and outpatient spine surgery. Motion preservation technology will likely be the standard of care in years to come as more and more data comes out supporting the clinical effectiveness of these procedures and as patients become more educated about their options and push for these procedures over fusions. e COVID-19 pandemic has highlighted the fact that outpatient spine surgery is safe, effective and here to stay. Medicare has done away with many of their "inpatient-only" codes. A great way to grow a practice is by getting on board with these trends now. Burak Ozgur, MD. Hoag Neurosciences Institute (Newport Beach, Calif.): I feel the biggest opportunities for spine surgeons today is to par- ticipate and collaborate in comprehensive multidisciplinary teams for improved accurate diagnoses and effective treatment of spine patients. I believe being a part of an effective team enables continued learning and enhancing effective patient outcomes. n

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