Becker's Spine Review

Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 "Payors are adding these guidelines and there is very little evidence that they are appropriate," says Dr. Wang. "We as spine surgeons have to collect evidence and outcomes — whether it is from registries or good prospective studies, to show what works and what doesn't. There are some things we can work on and it's incumbent upon the surgeons themselves to gather the evidence for these things and show what will be successful for our patients." The implementation of EMR and other healthcare IT may make this process easier in the future. "The one good thing coming out of EMR is that it will gather our data and show our treatments work," says Dr. Wang. "I think that's going to result in better outcomes. I think gathering outcomes and doing the surgeries that work is important. It may be harder for people in private practice to do it, but it's more important because private practices are dwindling and more surgeons are becoming hospital employees." 3. Hospital employment will likely increase. Today's tight regulatory environment, coupled with low reimbursements and rising costs for practice management, mean fewer physicians coming out of medical school are choosing to strike out on their own. Instead, they are becoming hospital employees. Established physicians are also selling their practices to hospitals at an alarming rate in search of more flexible hours and high salaries hospitals are willing to pay. "The trend of hospital employment of spine surgeons is growing and will continue to grow," says Robert Watkins Jr., MD, co-director of the Marina Spine Center at Marina Del Rey (Calif.) Hospital. "The larger hospital networks are gaining control of masses of patients which will make it more difficult for private practice surgeons. The private practice surgeons need to be able to spend adequate time with their patients and provide outstanding service." Dr. Robert Watkins Jr. When hospitals begin employing specialists it becomes more difficult for private practice surgeons to drive referrals. "The opportunities are going to become more constricted as more hospitals hire people to be staff members instead of independent contractors," said Donald Corenman, MD, a spine surgeon with The Steadman Clinic in Vail, Colo. "I think it's going to negatively impact care because doctors will become shift workers and that's going to diminish their quality and continuity of care." Even when surgeons are not employed by hospitals, hospital executives and leaders are dictating clinical measures, such as which types of implants surgeons can use.   4. Care will need to become more costeffective. All providers will be pushed further toward delivering the most cost-effective care possible as the government and payors pursue ways to lower healthcare spending and cut costs. Additionally, more patients with high deductible plans will shop for the best value and expect spine surgeons to deliver. Striking that equilibrium for better products with fewer complications while meeting lower reimbursement needs will make it more difficult to innovate. However, some innovations we are likely to see in the future include robotic guidance for spine surgery and biologics. "Technology will continue to make spine surgery safer and more effective," says Dr. Watkins. "Robotic computer navigation will continue to evolve." 5. Spine care is becoming more interdisciplinary. Spine care providers are now integrating more than in the past to provide patients with a one-stop location for all their spine and back pain needs. Spine surgeons are partnering with all types of non-surgical specialists, including physical therapists, pain management, physicians, massage therapists, chiropractors and acupuncturists to bridge the gap in care. Dr. Jeffrey Wang "Reimbursements are declining and they will continue to decline," says Dr. Watkins. "Patients expect better care and more time with doctors, but most people don't want to pay for it." This trend also holds true for spine innovations. "One of the biggest challenges in the medical profession is dealing with the decreased reimbursement and moving toward more cost-effective measures," says Matt Chong, MD, a spine specialist at White Memorial Medical Center in Los Angeles. "How do we make safer, more reliable implants and keep innovation going while minimizing the cost of developing and using this new technology." Dr. Donald Corenman 9 Dr. Matt Chong

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