Becker's ASC Review

23 ORTHOPEDICS The future of spine surgeon autonomy By Carly Behm From physician independence to data collection, spine surgeons are thinking about the future of autonomy in their field. Five spine surgeons discuss their perspectives on autonomy and its future. Note: Responses were lightly edited for clarity. Question: What will spine surgeon autonomy look like in five to 10 years? Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): In five to 10 years, spine surgeon autonomy may involve advanced AI-assisted decision- making tools, enhanced minimally invasive techniques, and improved patient engagement through telemedicine. Surgeons will likely have greater access to real-time data personalized care, fostering collaborative approaches while maintaining their expert judgment in treatment decisions. Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Autonomy is an evasive term in medicine. Today, we continually face prior authorizations that question our recommendations to patients. is is not necessarily a bad thing — we are all human beings and not infallible. In theory, having checks and balances is a good thing. However, prior authorizations have become more of a hoop to jump through, a hurdle to climb over, than a process through which we can collectively optimize care for patients. Rarely is the patient involved in this process either, which is perhaps its most important failure. I think even more important than spine surgeon autonomy is patient autonomy — will patients be free to choose their own care, based on their own values, goals and desires? Will they be adequately informed to make those decisions, and can we as surgeons make sure of this? We never had autonomy as surgeons — only the privilege to honor the autonomy of our patients. How do we ensure that this autonomy of patient's choice is honored and respected, not eroded? Morgan Lorio, MD, of Advanced Orthopaedics and Pain Management (Orlando, Fla.) and ISASS president (2024-2025): In the next five to 10 years, advancements in robotics, AI, and advanced imaging will enhance spine surgeons' decision-making and reduce the need for invasive procedures. AI, trained on large datasets, will ensure patient-specific outcomes, while telemedicine and mobile health technologies will expand surgeons' reach and improve patient care. Advances in genomics, bioinformatics, and AI will enable personalized treatment plans by identifying unique patient phenotypes. Collaborative networks will allow surgeons to leverage collective expertise while maintaining autonomy, and evolving healthcare policies will support disease prevention and early detection through AI and precision medicine. Continuous medical [spine] education will keep surgeons updated on new techniques and technologies, enabling them to handle complex cases independently. e convergence of AI and precision medicine will revolutionize healthcare by addressing challenges with patient-specific diagnostics and treatment. is synergy will enhance spine surgeon autonomy, focusing on prevention, early detection, and personalized care, ultimately reducing the disease burden and healthcare costs. e amalgamation of more granular ICD-10 codes for discogenic back pain with interventional algorithms, including MRI spectroscopy, will further ease the cost of managing low back pain. e integration of patient-centered high-value spinal endoscopy, including fusion procedures, will improve outcomes by minimizing invasiveness and recovery times. Rasch analysis will complement this process by providing a robust statistical framework to measure patient-reported outcomes and treatment effectiveness, ensuring interventions are precisely tailored to individual patient needs. Additionally, Rasch analysis will enhance surgeon experience by offering data-driven insights into treatment success, allowing for continuous improvement and refinement of surgical techniques and patient care strategies. Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: It will be reduced. Already payers who verbally state 'they don't practice medicine,' through their prior authorization system, practice medicine. CMS to finalize new episode-based pay model for spinal fusions, joint replacements By Laura Dyrda C MS proposed the Transforming Episode Accountability Model, a new five-year, episode-based payment model affecting orthopedics and spine, in April and the final rule is expected to drop soon. The proposal requires select acute care hospitals to coordinate care for patients in the traditional Medicare model undergoing surgical procedures and assume responsibility for the cost and quality of care for the first 30 days after leaving the hospital. Lower joint replacements, spinal fusions, and surgical hip femur fracture treatment are included in the proposed model. CMS pitched giving hospitals a target price representing most Medicare spending for the episode of care, covering inpatient and outpatient surgery as well as skilled nursing facility stays and follow-up visits. Participating hospitals would need to refer patients to primary care services to support continuity of care long term. The model would start in January 2026 and hospitals would be selected based on geographic region. There are three tracks proposed: first, with no downside risk and lower levels of reward for the first year; track two includes lower levels of risk and reward for safety net hospitals and other institutions; and track three includes a higher level of risk and reward. n

• Cover