Becker's Spine Review

32 Healthcare Trends BCBS of Texas Forms 1st ACO-Like Organization With State Medical Association By Emily Rappleye B lueCross BlueShield of Texas and the Texas Medical Association are partner- ing to launch a first-of-its-kind initiative: an ACO-like organization with a medical association, rather than a hospital or health system. The partnership, called TMA PracticeEdge, is especially significant in Texas, where about two-thirds of physicians practice in independent, solo or group practices, according to a 2014 TMA survey. While most ACOs are organized by a hospital system, the organizations say TMA PracticeEdge will help connect physicians cen- tered on the needs of their specific patients. Like other physician-led ACOs, TMA PracticeEdge aims to help TMA's extensive phy- sician network transition to value-based care for BCBSTX beneficiaries. With 48,000 physician and medical student members, TMA is the largest state medical association in the country. BCBSTX serves more than 5 million beneficiaries. The partnership will give participating TMA physicians access to resources to help them provide coordinated, collaborative patient care. TMA PracticeEdge plans to help physicians focus on patient care by providing consultations to reduce the data- entry burden and help coordinating care management teams for high-risk patients. "BCBSTX will work with TMA to give physicians alternatives to today's fee-for-ser- vice system," TMA President Austin I. King, MD, said in a statement. "With today's announcement, BCBSTX becomes the first health insurer to stand by independent Texas physicians in support of 21st century patient care." n Medical Errors Still a Leading Cause of Death in America By Laura Dyrda M edical errors rank third among the leading causes of death in the United States, according to some studies cited in a recent Vox article. They are ahead of car crashes, new disease outbreaks, breast cancer, AIDS, plane crashes and drug over doses. Here are five things to know from the article: 1. Around 2 percent to 3 percent of the people who go into hospitals receive severe harm as a result. 2. Errors can be caused by simple things such as messy handwriting or getting the drug dosage wrong in ad- dition to wrong site surgery and infections. 3. Estimates run from 44,000 to 98,000 Americans die each year as a result of medical errors, but when asked to estimate the number of medical error deaths, both physicians and the general public said around 5,000. 4. Errors with medical prescriptions were linked to 7,000 deaths annually. 5. Many medical errors go unreported, in part because physicians are embarrassed and afraid of lawsuits. n What will happen when there aren't enough spine specialists? By 2020 there is a predicted 90,000 physician shortage with about 50 percent being specialists. By 2025, the physician shortage is expected to in- crease to 130,000 physicians. At the same time, re- cent reports show undertreated pain impacts 116 million Americans, with many of those patients being back pain patients. But this may not be an issue for spine specialists. "When there aren't enough spine surgeons in the United States there will be less spine surgery performed, but that may not be a bad thing," says Scott Blumenthal, co-founder of Texas Back Institute in Plano. "When it comes down to it, I can't disagree that there is probably too much spine surgery done. Where there are the most surgeons, there is the most surgery done, and that may not reflect the population needs." Even if there isn't a physician shortage five and 10 years down the road in the spine specialty, other efforts will limit the amount of spine surgery done and improve care pathways for back pain patients. The Medicare website posting both cost and quantity data on spinal fusions will likely dial down how much surgery is performed. Insurance companies are also making guidelines for surgical treatment stricter. "If more public payments come about, and there is only one pot of money to take care of patients, people will figure out from evidence-based medi- cine what is most cost-effective and cost-efficient and we'll have a better ratio of surgical versus nonsurgical patients," says Dwight Tyndall, MD, of the Orthopaedic Specialists of Northwest Indi- ana in Munster. The practice goes beyond just surgical patients for many spine surgeons. Dr. Tyndall's practice relies on non-operative treatment as well as spine sur- gery to care for patients. In the future, evidence- based protocol and increased use of advanced practitioners will help direct patients to the right care, which may or may not include surgery. "I think there will be more allied help, whether it's a nurse practitioner or another non-surgical pro- fessional helping deliver spine care," says Dr. Tyn- dall. "The surgeons themselves will simply focus on the surgical aspects while the non-operative patients will be seen by other specialists." When dividing back pain patients between pain physicians, physiatrists, chiropractors and NPs, there is more than enough manpower to treat patients. Additionally, spine and neurosurgery remains a popular focus for new physicians graduating from medical school. n A Physician Shortage is Coming — Will it Impact Spine? By Laura Dyrda

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