Becker's ASC Review

34 ORTHOPEDICS How spine surgeons will look back at the industry in 2034 By Carly Behm Ten years ago, spine surgeons were expecting outpatient spine surgery and image-guided navigation to become more prevalent in a decade. Now spine surgeons are thinking about how today's state of the industry will be looked back on in 2034. Editor's note: Responses were lightly edited for clarity and length. Question: How will spine surgeons in 10 years look at the current state of the field? Chester Donnally, MD. Texas Spine Consultants (Dallas): In 2034, I think we will look back at 2024 and actually be proud of ourselves! ere is such a great emphasis on concepts such as pelvic parameters, adult spinal deformity following 1 level fusions and motion preservation techniques. People understandably want a one- and-done fix; this applies to house repairs, car maintenance as well as spine surgery! Of course some of the need for revision surgery is age, genetics and wear-and-tear, but we as a spine community are doing a much better job at identifying risk factors for ASD. We are definitely on the right track! Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): It's difficult to predict exactly how spine surgeons will view the current state of the field in 10 years, but it's likely that they will continue to see advancements in technology, techniques and treatments. With ongoing research and innovation, we can expect to see improvements in patient outcomes, reduced recovery times, and enhanced surgical precision. It's important for spine surgeons to stay current on the latest developments in the field to provide the best possible care for their patients. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: at will depend a lot on the outcomes of elections and whose narrative about healthcare wins. Many people in the medical community and in the public believe single payer to be the messiah. It has worked for smaller, more capitalistic societies, particularly in Western Europe. e gigantic elephant in the room is the size of, and geographical diversity of our country. Putting the future of our healthcare in the hands of a single entity, governmental, paragovernmental, or private will certainly tank the quality of our system and drive costs through the roof. I see spine surgeons being the mammals at the end of the dinosaur era. Spine surgeons will move to physician-owned hospitals and ASCs. ey simply do it better for less. Patient experience and outcome are paramount and they enjoy the independence of their workplace and freedom to make changes without waiting for Godot to change it. Todd Lanman, MD. ADR Spinal Restoration Center (Beverly Hills, Calif.): In 10 years, I believe spine surgeons will look back at the current state of the field and shake their head at the number of fusions performed instead of disc replacements. e same thing happened in 1958 when John Charley invented the artificial hip. Most surgeons at the time laughed at him and said his device would not work. at hip replacement was a fad. Instead, knee and hip fusion were standard of care. In 10 years the field will have shied dramatically to motion preservation surgery — artificial disc replacement, facet joint replacement — to the point that we may see the ability to partially correct 20 degree to 25 degree scoliosis curves with motion sparing devices. Just like arthroplasty is now commonplace for hip and knee and fusion is rare, the same will be true of spine devices; cervical and lumbar artificial discs will be the mainstay of treatment and spinal fusion will be the rare exception. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Rereviewing a previous article from Becker's from 10 years ago, the interchangeable question was posed to the panel. e expected and foretelling answer of outpatient procedures, ASC predominance and image guided usage were discussed by the sage amongst us. is was all well and good, except the deleterious effects of the pandemic and its marked draw down on research and capital budgets was not factored. Having been referred to as a patriarch of spinal surgery recently, my direction of questioning towards my younger partners revealed some enlightening conversations and direction. eir reliance on imaging guidance and AI is notably stronger, albeit two of them are advanced endovascular trained. And attention to detail, collective reasoning and discussion precedes most complex surgical interventions. is type of scrutiny, at least on its face, is comforting and possibly a throwback to legacy-based training and clinically-based medicine. Patient-centric medicine will hopefully drive this field as it has in days of yore. n 2 CMS spine proposals to know By Carly Behm C MS is proposing two new developments in spine- related coding and payments, the International Society for the Advancement of Spine Surgery said April 17. CMS is proposing eight new MS-DRGs to delineate single and multilevel lumbar fusions, according to a news release. These are expected to better track resource utilization for specific procedures and adjust hospital payments for resources behind multilevel fusions. The other proposal is looking into an episode-based alternative payment model called the Transforming Episode Accountability Model. The TEAM model is expected to go into effect at the start of 2026. Participating hospitals will use it to manage total costs of care for spinal fusions and compare them to target CMS costs over four years. CMS also released a new set of diagnostic codes to specifically describe intervertebral disc degeneration with discogenic pain. Those will take effect Oct. 1. n

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