Issue link: https://beckershealthcare.uberflip.com/i/1406663
29 Thought Leadership of infection and way faster recovery. Most im- portantly, you're not burning any bridges with this approach. ese surgeries all can be done outpatient and most of them going home the same day. I also think robotic spine surgery — just like how robotics advanced in urology and other general surgery procedures — is going to con- tinue to advance in spine, where I can poten- tially see where the robot is performing the en- doscopic decompression, performing precise osteotomy cuts and placing pedicle screws. However, I would be very wary about adver- tising laser spine surgery as it does not have a big consensus for good outcomes or advertis- ing minimally invasive procedures as nails and a hammer where every single surgery can be done that way. Not every decompression or fusion can be done as minimally invasive. Unfortunately, there's recently more bad results of spinal deformity surgery that are being done minimally invasive with suboptimal outcomes that require a ma- jor revision reconstruction. ere will always be spinal deformity cases that should be done with a traditional open approach. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: By looking backward, we can see that very few MIS technologies have completely phased out. ere are technologies that perhaps have not had their moment as of yet. I have seen some companies with innova- tive solutions, for instance for interbody con- structs, especially stand-alone transforaminal lumbar interbody devices that probably need two to three more revisions as well as peer-re- viewed studies conducted to properly select patients. e fad technologies can oen be found in the dustbin of the last 20 years. And perhaps not justifiably so. Not to name names, but we can all give examples of things we real- ly miss and liked that have been relegated to the elephant graveyard. I think you can predict the ones that will endure are technologies that make you work faster or do something you al- ready do in a novel, faster or safer manner. John Burleson, MD. Hughston Clinic Or- thopaedics (Nashville, Tenn.): I think en- doscopic spine surgery might finally be ready to make it. ose utilizing this technique are more enthusiastic than in the past and the technology to support it has expanded. As with most technologies, I believe the real key to new technology sticking is their utilization at teaching programs. As more residents and fellows are exposed to endoscopic spine sur- gery, they will perform these procedures from the beginning. n How provider-payer relationships will evolve in spine: 4 surgeons weigh in By Alan Condon N ew partnership models with aligned goals, an increased push toward orthopedic Centers of Excellence and heightened calls for a single-pay- er system are among the major trends these four spine surgeons see over the next five years. Question: What payer changes do you anticipate in your market in the next 3-5 years? Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): The evolving payer changes we're seeing pertain to the development of part- nership models with aligned goals. The days of out-of-network legal battles and fights with the insurer for utilization are in their final stages of dying off. The pay- ers will look to the ASC and physician network to bring to them quality, cost-effi- cient solutions and develop relationships such as Centers of Excellence with fair contracted rates that let all involved — patient, provider and payer — win. As these relationships develop, you will find great satisfaction working as a part- ner with payers to do what we do best: Deliver well thought-out, quality care. This is work that requires complete commitment to data-driven results and time spent to develop payer relationships. Find a champion that will lead this within your group and rally behind that effort. For those that sought to abuse the system, I look forward to further legal regula- tion and prosecution, as we have recently seen, that shuts down those pathways. It harms the entire system and needs to be removed. Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: There will likely be a two to three-fold increase in state-managed care. As we head further and further from the starting point of the ACA, and simultaneously a disdain for actually fixing the fixable on the part of Congress, we move closer and closer to single payer. Regardless of your political affiliation, there is very little that would be satisfactory in a single-payer system in this country. In our state, there have already been clear warning shots. Feasibility moves toward single payer. Despite the untenable price tag, not to mention the unmanageable beast such a system would become in a state as populous as ours, powers that be continue to discuss and push for it. My belief is that by creating an environment where the insurance companies do what they are supposed to —pay for the care that patients contracted with the insurer to remunerate for — you will have coverage, stability and affordability. By giving the laws that govern these insurers teeth, along with some very basic and enforceable consequences when they don't use case law, precedent and common sense, you will have a less mortally wounded system. That, is a start. Andrew Hecht, MD. Mount Sinai Health System (New York City): There will be increased push to shorten hospital stays and move cases to the ASC. Sur- geons must be careful about doing appropriate cases in the ambulatory setting. Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): I anticipate that the authorization will get more difficult especially when the surgery involves expen- sive implants. The reimbursement will be cut in both professional and facility aspects. There will be a push toward bundled payments. n