Becker's ASC Review

12 ORTHOPEDICS Spine practices in 2035: 7 predictions By Carly Behm A mid surgical advances and increased challenges in spine practices, surgeons discuss the future of the landscape. Editor's note: Responses were lightly edited for clarity and length. Question: What will spine practices look like in 10 years? Jeffrey Deckey, MD. Spine surgery chair at Hoag Orthopedic Institute (Irvine, Calif.): Even more than general orthopedic practices and medical groups, spine practices will evolve demonstrably. Spine care is a high cost and complex medical delivery system for all providers. Technology and AI will transform the nature of spine care both in and out of the operating room. Spine practices will rely on artificial intelligence tools in 10 years to improve every step of diagnostic, practice and patient selection based on predicted clinical outcomes. Wearable technology, patient matched implants and orthobiologics will be employed to greater effect. On the practice side integrated spine teams comprised of spine surgeons, pain management, PT, physiatrists and behavioral health and others will collaborate on a mandated "conservative spine care" first agenda, where spine surgery is considered as a last resort. In the value- based marketplace of spine care, outcomes will dictate new care models, reimbursement and care settings, such as the trend toward more outpatient surgery. Bundled payments for all episodic care under a risk model will be normal. Data metrics will create the spine practice of the future. Change in orthopedics and spine care is oen very slow to adopt in practice management and clinical care. at era is over. e future spine practice, like a lot of orthopedic care, is in a race to better measurable, predicted and reimbursed- based patient outcomes. Welcome and brace for the future. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: In a decade we will all be 10 years older and still trying to solve the same problems, unless we get better at making a cogent argument to improve healthcare. In my 15 years of practice, doctors have gotten to be better advocates. Unless we get even better we will be watching the same reruns. We have to make our case to the public, be prepared for industry-funded hit pieces in major news outlets of all stripes and enlist our patients to help. Mohammed Khan, MD. New Jersey Brain and Spine (Paramus): In 10 years spine practices will be fundamentally reshaped by precision medicine, advanced imaging and AI-driven decision-making. Surgeons will rely on real-time data to tailor treatments, with minimally invasive and outpatient procedures becoming the norm. Value- based care will shi the focus from volume to outcomes, emphasizing long-term function and quality of life. e most successful practices will blend surgical excellence with integrated, patient-centered care delivering not just procedures, but durable solutions. Patrick Roth, MD. New Jersey Brain and Spine: Spine practices in the next decade will evolve alongside broader healthcare reform. As reimbursement shis from procedure-based payments to outcomes- based models, spine care will need to deliver measurable improvements in health, not just services. is will require databanks that track outcomes beyond subjective pain scores, incorporating radiographic findings, physical exam results, and broader measures of well-being. Artificial intelligence will become integral to diagnosis and treatment planning. Patients will input their symptoms and AI, informed by anatomical and functional imaging plus a structured physical exam, will generate precise diagnoses and optimized care plans. ese systems will continuously improve with outcome data feedback. Diagnosis and treatment will occur within integrated care models. Physical therapists, chiropractors, and pain management will be part of the same team. PTs will help conduct baseline exams and shi focus toward education and patient accountability. Virtual visits will enable comprehensive initial assessments from home. As financial incentives realign, spine practices will focus on delivering health. Providers will become "knowledge workers," using real-time data to fine-tune care and build collaborative, accountable relationships with patients. is will benefit both clinical outcomes and professional fulfillment. Krishna Satyan, MD. Dallas Neurosurgical & Spine (Plano, Texas): As the practice of medicine continues to evolve, so does the practice of spine surgery. ere are many external factors that affect how a spine surgeon can manage his or her patients. Unfortunately insurance and pharmaceutical restrictions will continue to impact what decisions can be made, consequently affecting the care provided to patients and the cost to patients. is will continue until it is addressed by legislation. Additionally with advances in artificial intelligence, we will see more and more diagnostic studies interpreted by AI, with physicians overseeing these results. While in some ways there may be increased accuracy, there is also the potential for increased errors, as there are no dedicated physicians for each study, and a supervising physician may miss things if they are evaluating too many studies and overseeing too much artificial intelligence. Spine surgeons will have to become more reliant than ever on interpreting films on their own, rather than relying on interpretations provided by the radiologist or AI expert. Alex Vaccaro, MD, PhD. President at Rothman Orthopaedics (Philadelphia): Current day spine surgery primarily relies on preoperative and/or intraoperative fluoroscopy and CT imaging, which can be associated with substantial radiation and increase the lifetime risk of malignancies. However, there are several enabling technologies that are already in use and will transform spine surgery practice over the "As financial incentives realign, spine practices will focus on delivering health. Providers will become 'knowledge workers,' using real-time data to fine- tune care and build collaborative, accountable relationships with patients. is will benefit both clinical outcomes and professional fulfillment." - Dr. Patrick Roth

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