Issue link: https://beckershealthcare.uberflip.com/i/1406663
26 Thought Leadership CMS changes that spine surgeons want to see By Alan Condon T hree spine surgeons have proposed Medicare changes that they say would significantly improve spine care. Note: Responses are lightly edited for style and clarity. Issada ongtrangan, MD. Microspine (Phoe- nix): e only hope I have is that the CMS will not keep trimming the professional fee. As we all know, advanced technology is not without cost, but it is for the patients' outcomes. It is sad to see that CMS looks at the surgical technique as one-all-be-all. For example, the open lumbar fusion is not equal to minimally invasive fusion or endoscopic fusion in terms of the work and instruments each surgeon uses. Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): Payment should be risk-adjusted and site of care should be irrelevant, so surgeons are paid properly for risk and expertise and to avoid gaming the sys- tem on where to do surgery and how long to keep patients in the hospital. 1. [CMS] needs to pay more. Spine surgeons have seen a steady decline in reimbursement. 2. Coding for outpatient anterior/posterior lumbar fusion is not up to date. 3. e bundled payment system is not good for spine. It needs modification. If the benefit is for patients, I would create ac- cessible, transparent, risk-adjusted outcomes data on each surgeon and facility, so they can compare apples to apples when choosing. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgery outcomes have gotten significantly better in recent years, es- pecially with the introduction of such inno- vations as minimally invasive spine surgery, disc replacement and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year for as long as I can remember. Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (commen- surate with increasing practice costs, inflation and increasing regulatory burdens) for the work done. In my 11-year career in spine surgery I have seen my Medicare reimbursement for most spine operations decrease every year, even though I can now do them better with better patient outcomes. I am not aware of any other industry where a professional gets paid less for doing the same work as their experience and quality of work improves over the years. n 'All instrumentation will be absorbable': 2 spine surgeons predict how technology will evolve in the specialty By Alan Condon F rom the growth of robotic technology to the increasing role artificial intelligence and machine learning will play in spine, bold predictions about the future of the specialty are shared by two surgeons. Note: Responses are lightly edited for style and clarity. Question: What's one bold prediction you have about the future of the spine industry? Lawrence Marshall, MD. UC San Diego Health: In a de- cade, all instrumentation will be absorbable. Interbody materials will be grown in the laboratory and mixed with nanoparticles coated with growth factors. The outer shell will be a temporary absorbable biopolymer. All implants will be placed by robotic percutaneous technique. Philip Louie, MD. Virginia Mason Franciscan Health (Se- attle): I think that machine learning and artificial intelligence will play a large role in further expanding the use of enabling technologies and driving down the cost of surgery, all in the name of providing greater safety and value to our patients. The expansive data we are currently collecting through di- verse avenues will allow multidisciplinary teams to assess how we can perform surgery through the use of more in- tegrated real-time systems that will reduce the number of trays necessary, improve surgical accuracy, reduce operative times and radiation exposure, as well as decreasing the risk of iatrogenic complications during surgery. The same data (that will be the background of these inte- grated systems) will ultimately drive our decision-making throughout the whole continuum of patient care — from pre- operative planning and risk stratification to real-time solution proposals intraoperatively, and guiding patient engagement and support postoperatively. We will see the collaboration of multiple industries and research minds that will drive these changes in an evidence-based manner that can keep up with the demands for higher quality care in a cost-constrained landscape. n