Issue link: https://beckershealthcare.uberflip.com/i/346340
44 Data Transparency F our spine surgeons discuss the Medicare and Medicaid data recently released on spinal fusions and how data transparency is changing healthcare, for better or for worse. Q: How has the release of Medicare and Medicaid data impacted spine surgeons? Frank Phillips, MD, Professor of Orthopaedic Surgery, Co-Founder, Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chi- cago): The data was released with little explana- tion or context. We have already seen media out- lets using this data to generate stories about high volume Medicare providers. The data could reflect badly on surgeons if they have a high number of fusions compared to the national average; some- times the volume may be justified based on prac- tice patterns whereas in other instances the num- bers may reflect excessive surgical volume and inappropriate care. It's hard to differentiate these scenarios based on the raw data provided. This data likely will also be combed by attorneys to imply that higher surgical fusion volume predicts a lower level of care and less optimal results. Hyun Bae, MD, Medical Director, Director of Spine Education, Cedars-Sinai Medical Center (Los Angeles): People are being scrutinized more and that brings more negative publicity to the field, but ultimately I don't think it will make a big im- pact on how surgeons practice. I think a lot of sur- geons were more surprised at how little we make for the work we're doing. The data release has made good fodder for the media, but I think it will have little impact on most surgeons and patients. A. Nick Shamie, MD, Chief, Orthopaedic Spine Surgery, UCLA Health System (Los Angeles): The old adage is, if you haven't done anything wrong, why would transparency be a problem? I agree with the general rule, but I think we are in a very critical stage of determining what transparency will do for society; are we going to use it to elevate healthcare in this country or are we opening doors for skeptics who will continue criticizing us all by focusing on few bad examples. Q: Have any patients asked about the data release or questioned your rates? Dr. Bae: I don't have patients in my practice asking me questions about the Medicare data. The data release is an annoyance, but it won't impact the way I interact with my patients. Michael Hisey, MD, Medical Director, Texas Back Institute (Plano): This data will be interesting for patients as they choose their surgeons and physi- cians will be able to see where they stand, but the data can't be taken at face value. Physicians need to have the ability to see the data and challenge it be- fore it's published. Surgeons have the ability to log in and see their information, which is important. Q: Are there instances where surgeons have legitimately high fusion rates? Dr. Hisey: Someone who has a high number of fusions may be seeing a high volume of patients, or just the surgical candidates instead of all back pain patients. The data really can't be looked at in a vacuum, and people should not chastise sur- geons based on just the data. I think it's a good thing overall to have the information available, but it should be evaluated in context. Dr. Shamie: Just because you are fusing 20 per- cent or more of the patients you see as a surgeon doesn't mean you are doing unnecessary surgery. But now, we have a figure for national average and anyone who is above this national average is be- ing criticized. If you really think about it, the data is promoting surgeons to be average. Is that, as a medical society, what we want to promote? Or do we want to excel? Does that mean surgeons with higher fusion rates should lower their rates? Are surgeons going to fuse fewer patients out of fear, rather than what is right for their patients? Maybe the surgeon is only referred operative pa- tients, already screened by a colleague, so they have a high fusion rate. In other practices where surgeons have a low fusion rate, the patients might not be triaged appropriately. I think data transpar- ency is good, but how we interpret the data must be in a guided fashion and the beneficiaries. Pa- tients should be involved in the discussion. Q: Ideally, how would the data be released? Dr. Phillips: If the data were presented with con- text, it would be more meaningful. There are many nuances in terms of patient demographics and surgeon practice patterns that could drive the number of fusions performed on the Medicare populations by a particular surgeon in a specific geographic location. Dr. Shamie: I think there is more policing going on today and the data release has created a feeling of apprehension rather than teamwork. Ultimate- ly, the beneficiaries are the patients, and they are the most silent group when it comes to discussions about what is right and what is wrong. I hope that this will not limit access to care or have a negative impact on our healthcare delivery systems. Q: What is the long term impact of CMS data transparency? Dr. Phillips: I certainly support transparency and believe that if appropriately provided, helps bet- ter inform patients about their medical care and treatment and provider options. However, unless the CMS data is provided in a way that actually allows reasonable and informed conclusions to be drawn, it will eventually become "noise" out there that really doesn't have a significant impact on healthcare or services provided. n Medicare Data Released: How Data Transparency is Transforming the Spine Field By Laura Dyrda "Most truly revolutionary medical device in- novation has been conceptualized and driven by surgeons rather than device companies," says Dr. Phillips. "But now that surgeons are being alien- ated from the development process, we are seeing less game-changing and more incremental, mar- keting-driven device innovation. I think unfortu- nately meaningful device development is going to suffer as a result of the Sunshine Act." Dr. Hisey sees the biggest changes with the little expenses, such as taking surgeons out to dinner, while the larger transaction relationships stay in place. Likely, these relationships will continue in some fashion going forward. "I think the vast majority of these relationships are good," says Dr. Singh. "For most surgeons, I don't think the Sunshine Act has made much of a dif- ference in their behavior. It's taken away some of the more shady relationships. It's going to clean up the system." Future impact Surgeons in the future may continue to develop intellectual property and make huge royalties as a result. "Sometimes in the process of working on projects with device companies, surgeons develop ideas that are patented and it's reasonable to col- lect royalties on those projects," says Dr. Hisey. "It's not a bad thing. I don't mind that we keep an eye on these relationships and make disclosures be- fore presenting study results, but receiving money doesn't mean that someone is abusing the system." However, the negative tone of this new legislation and media coverage has made an impression on young surgeons. When Dr. Phillips first began prac- ticing, it was acceptable to form a relationship with device companies to enable surgeons to take their promising ideas to the next level; now those types of relationships are disincentivized and new ideas may never make it past the surgeon's imagination. "I've noticed among my young spine colleagues, when they have innovative ideas and great concepts for devices, they don't have the same access to the device manufacturers that I did 20 years ago," says Dr. Phillips. "The relationship is more standoffish. It's definitely going to affect innovation because surgeons will be less likely to be able to commer- cialize their ideas and are more distrustful of device companies. The bottom line is that failure to inno- vate is a lost opportunity to progress spinal care." n