Becker's Spine Review

16 SPINE SURGEONS 6 trends gripping the spine industry By Alan Condon S pinal procedures shiing from inpatient to outpatient set- tings, evolving payer-provider relationships and a minimally invasive surgery boom are some of the key trends dominating the spine industry this year. Here are six key trends at the top of spine surgeons' minds: 1. Decreasing reimbursement. CMS has been steadily trimming physician fees for many years, with commercial payers following suit. In its 2022 Physician Fee Sched- ule proposal, issued July 13, CMS outlined more cuts to physician pay. CMS proposed reducing the physician pay conversion factor 3.75 percent in 2022, from $34.89 to $33.58, which would result in changes in the relative value units and expenditures related to other proposed policy updates. "Spine surgery outcomes have gotten significantly better in recent years, especially with the introduction of such innovations as min- imally invasive spine surgery, disc replacement, and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year," according to Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center. "Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (com- mensurate with increasing practice costs, inflation and increasing regulatory burdens) for the work done." 2. Evolving relationships with payers. New partnerships are expected to take shape between providers and payers as they increasingly push to shorten hospital stays and move cases to ASCs. Orthopedic practices that can get ahead of this shi and work with payers to find cost-effective solutions to care will stand to benefit the most. "Payers will look to the ASC and physician network to bring to them quality, cost-efficient solutions and develop relationships such as Centers of Excellence with fair contracted rates that let all involved — patient, provider and payer — win," according to Robert Bray Jr., MD, of DISC Sports & Spine Center in Newport Beach, Calif. "As these relationships develop, you will find great satisfaction work- ing as a partner with payers to do what we do best: Deliver well thought-out, quality care," Dr. Bray said. "is is work that requires complete commitment to data-driven results and time spent to de- velop payer relationships. Find a champion that will lead this within your group and rally behind that effort." 3. Advancement of minimally invasive surgery. Surgeons are increasingly treating spinal conditions using minimally invasive procedures, which have smaller incisions and are associated with less postoperative pain and fewer complications risks. Device companies are focusing more of their businesses on developing in- strumentation, implants and other surgical technologies to facilitate minimally invasive procedures, which has contributed to more of these procedures being performed at surgery centers for a fraction of the cost of the same procedure at a hospital. "e drive toward outpatient surgery will accelerate," according to Jeremy Smith, MD, of Hoag Orthopedic Institute in Irvine, Calif. "Techniques involving single-position surgery (lateral or prone) will continue to improve and allow 360-degree fusions with minimal blood loss and perioperative morbidity. Endoscopic spine surgery continues to grow, and as surgeons continue to refine their skills, in- dications will become broader. Industry competition has allowed for multiple navigation and robotic technologies that continue to maxi- mize accuracy and minimize invasiveness." 4. Outpatient migration. Spine procedures have been steadily migrating to outpatient surgery centers for many years, but the COVID-19 pandemic significantly accelerated this trend. Over the past 15 months, more surgeons have been pushed to do cases in ASCs, opening more eyes to the safety and efficiency of the outpatient setting. In addition, many patients are still reluctant to have surgeries done at hospitals, which are still dealing with COVID-19 patients. "e surgery centers are a good out for both the surgeon and the pa- tient," Frank Phillips, MD, director of spine surgery at Rush Universi- ty Medical Center in Chicago, told Becker's. "We've had no pushback from patients coming to the ASC, but have had people nervous going to the hospital. I think this has got to accelerate spine ASC surgery." 5. Rising consolidation. Consolidation is expected to rise among orthopedic practices in the next three years. Spine care will continue to shi to the outpatient setting, where payers see cost savings and providers have greater op- portunities for ASC ownership. "Trends are shiing toward employment models and consolidation of practices, as we see hospital systems, private equity and insurance companies continue to employ a greater percentage of the workforce," according to Adam Bruggeman, MD, CMO of MpowerHealth in Ad- Endoscopic spine surgery market to grow 8% by 2031 By Carly Behm T he global endoscopic spine surgery market is predicted to hit a compound annual growth rate of 8 percent from 2021 to 2031, according to a July 16 report from Persistence Market Research. Four details: 1. The market for endoscopic spine surgery was valued at $573.6 million in 2020. 2. An increase in spine surgeries and minimally invasive procedures is a key factor in market growth. 3. Endoscopic devices account for more than 67 per- cent of market share. 4. North America is dominant in the global market for endoscopic spine surgery. Hospitals contribute to a large share of the market. n

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