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29 ORTHOPEDICS Dr. Alexander Vaccaro: 2 Big Concerns and the Best Opportunity for Spine Surgeons in the Future By Laura Dyrda A s president of Philadelphia-based Rothman Institute, Alexander Vaccaro, MD, is responsible for a network of practices including around 200 physicians and surgeons providing orthopedic and spine care. He also serves as the Richard H. Rothman Professor and chairman of the department of orthopaedic surgery at omas Jefferson University Hos- pital and co-director of the spine fellowship program. Here, Dr. Vaccaro outlines his top two con- cerns for his practice in the coming year and the biggest opportunity for spine surgeons in the future. Q: What are the top two concerns you have for your practice today? Dr. Alexander Vaccaro: 1. Maintaining high quality care despite payer-side issues. We continue to face roadblocks with insurance companies declining evidenced based pro- cedures for patients. e time and resources dedicated to merely carrying out patient care through peer-to-peer calls and pre-autho- rization is unsustainable and burdensome. In addition, practices have been required to invest significant time and money into pre- paring for MACRA, despite the uncertainty of how healthcare legislation will eventually play out. 2. Public misinformation about the role of spine surgery. Our practice faces an on- slaught of misinformation from the internet and media (including social media) about the efficacy and utility of various nonsurgical treatments and surgical procedures. As our patients become savvier with technology and increasingly research their condition, physi- cians must become aware of these resources patients use for information and be prepared to answer questions on the topics. Q: What is the biggest opportunity for spine surgeons in the field? How is spine evolving? AV: Technology continues to be an evolving and exciting part of spine surgery. We believe the use of robotics and navigated technolo- gies providing advanced visualization and intraoperative assistance can improve effi- ciency and outcomes while reducing compli- cations. e big hurdle we face is integrating this into our workflow; until we become acclimated and familiar with the technology, we can't improve our efficiency. n