Becker's Spine Review

68 HEALTHCARE REFORM • Research fellowship completion • Letters of reference stating likelihood of pursuing academics on hiring the applicant Spine databases 37. is year, ProPublica released the "Surgeon Score- card," which is a database of complication rates for more than 17,000 U.S. surgeons, including spine surgeons. Former North American Spine Society president, Charles Mick, MD, hopes the database will better inform patients about required surgeries. 38. e CMS Physician Quality Reporting System for 2015 approved the National Neurosurgery Quality Outcomes Database as a Qualified Clinical Data Registry. Neuro- surgeons now have access to specialty-specific measures for use in public quality reporting programs. It's expected that neurosurgeons will use the register to fulfill PQRS requirements, thus bolstering the database with extensive information. Trends impacting spine 39. e International Journal of Spine Surgery published an article about seven trends in endoscopic spinal surgery techniques. A few of the following are: • ere are improved endoscopic optics and instrumen- tations leading to better spinal anatomy visualization with ultra-minimally invasive approaches. • e circumferential spinal stenosis resulting from concomitant congenital and acquired stenosis may have better outcomes with open decompressive tech- niques, especially if it's present at multiple levels. • Endoscopic techniques can treat the central, paracen- tral, foraminal and far lateral lumbar disc herniations. New endoscopic systems permit posterior interlam- inar lumbar decompression, anterior and posterior cervical and posterior lateral thoracic decompression. 40. e in-office ancillary services exemption is threat- ened again, according to a Mondaq report. In February, the Department of Health and Human Services implied the limitation of in-office ancillary services exemption might appear in the fiscal year 2016 proposed budget. e fallout of this could drastically hurt private practice, causing a rise in hospital employment. Spine surgeons may be affected by this change because they offer MRI and physical therapy services, among others, or are consider- ing adding those extra services to provide a more compre- hensive healthcare experience. e HHS claimed that in-office services are being overused and not used in the intended manner, resulting in money makers instead of convenient options for pa- tients. In other words, the HHS proposed the elimination of self-referrals for therapy, advanced imaging, radiation therapy and anatomic pathology services unless they are "clinically integrated" practices for cost containment. If implemented, these changes could save $6 billion over a decade. 41. Physicians rank shiing reimbursement, financial management, time with patients and the Affordable Care Act as the top four challenges they deal with in their practices, according to the Wolters Kluwer Health's 2013 Physician Outlook Survey. Healthcare IT, more legislation and uninsured patients cause the most stress about costs. Above all, physicians want to increase their practice's effi- ciency in the next five years. Spine in ASCs 42. Although the amount of spine surgeries continues to grow in ASCs, surgery centers face difficulties with pay- ment from payers. e Centers for Medicare and Medic- aid Services approved codes for spine surgeries in ASCs, which went into affect in 2015: • Neck spine fusion • Lumbar spine fusion • Spine fusion extra segment • Neck spine disc surgery • Laminectomy single lumbar • Removal of spinal lamina (code 63045) • Removal of spinal lamina (code 63047) • Decompression spinal cord Hospital rankings 43. e Mayo Clinic in Rochester, Minn., ranked first in U.S. News & World Report's best hospitals for adult neurology and neurosurgery. e New York-Presbyterian University Hospital of Columbia and Cornell followed at second and John Hopkins Hospital came in third. 44. e Hospital for Special Surgery in New York topped the U.S. News & World Report for best hospitals for adult orthopedics. Mayo Clinic and Cleveland Clinic followed. Bundled spine surgery statistics 45. Pacific Business Group on Health expanded its Em- ployers Centers of Excellence Network to provide bundled spine surgery for Walmart and Lowe's employees. e initiative started April 1. Within the network, large employers collaborate with three hospital provid- ers to send employees for healthcare. e hospitals are

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