Becker's Spine Review

8 Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 Biggest Challenges for Spine Surgeons Heading Into 2013: Q&A With Dr. Jeffrey Goldstein Dr. Jeffrey Goldstein By Heather Linder J effrey A. Goldstein, MD, is a clinical professor and director of spine service, Department of Orthopaedic Surgery at NYU Langone Medical Center and sits on the board of directors for the International Society for the Advancement of Spine Surgery. Here, he discusses the biggest challenges for spine surgeons next year and where the field is headed in the future. Question: What will be the biggest challenges for spine surgery in 2013? Dr. Jeffrey Goldstein: The biggest challenges in spine surgery continue to focus on providing the right treatment for the right patient based on appropriate guidelines and protocols. The onus is on the spine surgeon to maintain an open and honest relationship with the patient to include them in the decision process and develop the best treatment for that particular patient. These decisions need to be based on what we as surgeons know, and not on what we believe. While our knowledge comes from the sum total of our experience combined with the evidence, which includes understanding the lifestyle and goals of the patient as well. Surgeons continue to be challenged by limitations of resources which are real in addition to those limits placed by payors. Q: How will healthcare reform affect the industry? JG: Healthcare reform will affect the industry, but to what extent and how remains to be seen. An influx of patients into the system will put greater demands on practitioners and providers and potentially lead to increased utilization. Utilization will be directed by the Independent Payment Advisory Board. Demand may very well increase which would put greater strains on the healthcare providers, challenging our ability to continue to provide timely care. Q: Do you expect the medical device tax to have a noticeable impact? If so, in what ways? JG: As a surgeon and teacher, I would be concerned if any changes moved resources away from the industry and decreased their capacity for innovation. The specific implications of a medical device tax would be better addressed by industry. Q: How will spine surgeons need to adapt to overcome these challenges? JG: Regardless of any change, spine surgeons should stay focused on doing their best to treat and advocate for their patients. Surgeons should provide care based on recognized treatment guidelines. Societies such as ISASS will play an important role in educating their members and collaborating with industry to foster innovation and provide algorithms for patient care. Additionally, we should work with patients to help them become better advocates for themselves and participate in forums such as International Advocates for Spine Patients or the Better Way Back. Q: What abilities must spine surgeons possess to deal with the future industry? JG: The future industry remains unclear. While this may sound obvious, surgeons will do best if they continue to do what they know best. Be a good doctor and do the right thing. Take good care of your patients and practice good medicine. This is what we know best. Patients will continue to seek out good doctors who demonstrate skill, intelligence, compassion and empathy. n 10 Key Trends in Spine Surgery for 2013 (continued from page 1) ever there is a new code or issue, NASS is there to respond and have an evidence-based approach. When payors announce an inappropriate coverage decision, NASS responds." "It really has become a vicious and ineffective cycle that I think will adversely affect patient care," says Dr. Anand. "It is delaying patient care and it's really sending them backwards. There is a very finite window for treatment, and that's become apparent now. If we are able to tackle the problem right away, patients can go back to work and their regular life. On the flip side, if the back pain digresses and they are unable to work for a year or more, patients don't tend to do as well." 2. All surgeons must gather data and practice evidencebased medicine. Insurance companies are increasingly implementing coverage guidelines that exclude patients and services from coverage that traditionally would have been approved in the past. The most glaring example in spine surgery is the Milliman guidelines, which have been adopted by insurance companies across the country. Professional societies are responding to payors and advocating in Washington, DC, so patients can receive the care they need without bankrupting the healthcare system. "It's becoming harder and harder to take care of our patients and deal with the payors," says Dr. Wang. "Because of the Milliman guidelines, when we try to authorize surgery for our patients we are getting push back from our payors. We need to advocate on the behalf of the patients and say these guidelines aren't accepted by the medical community." "I know the North American Spine Society is trying to start a registry to gather evidence," says Jeffrey C. Wang, MD, vice chair of clinical operations in the UCLA department of orthopedic surgery and chief of the orthopedic spine service at the UCLA Comprehensive Spine Center. "When- The Milliman guidelines recommend continued conservative treatment for patients who were considered candidates for spinal fusion in the past, particularly those presenting with just degenerative disc disease.

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