Becker's Spine Review

12 50 Spine Surgeon Predictions for 2018 H ere are 50 predictions from spine surgeons about the biggest clinical and business challenges for 2018, as well as the most exciting technologies emerging in the field. Healthcare market Frank Phillips, MD. Director of Spine Surgery at Rush University Medical Center (Chicago): As we move toward a value-based system, major challenges revolve around defining "value." Value is defined quite differently by the various stakeholders in healthcare. For an insurance company, value is ultimately defined by returns to share- holders and profitability. I believe physicians, with their expertise, are in a unique position to play a pivotal role in defining value. Simply put, value represents outcomes divided by cost. Both numerator and denominator in this equation are challenging to define. Spine surgeons need to engage in this process. A. Nick Shamie, MD. Chief of Orthopedic Spine Surgery at UCLA School of Medicine: 2018 brings us much change and turmoil in our healthcare delivery systems. It is imperative for us as physician scientists to use the "big data" of population and health records to better understand what's really going on. Clinical trials are an effective way to study certain new treatment modalities, but by using large data that is now available to us, we are increasingly able to see how certain treatments affect certain segments of a population and compare what happens with and without a particular intervention. Neil Badlani, MD, Chief Medical Officer of Nobilis Health (Hous- ton): Healthcare is becoming an increasingly consumer-driven industry. Patients have access to healthcare information everywhere because of the internet and direct-to-consumer marketing. ey are more educated about their healthcare choices and they have higher expectations and want to be active as long as they possibly can. Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): I think it is clear that public and private insurers are increasingly inter- ested in quality over quantity, but they pay based on quantity. With the transition to [the Merit-based Incentive Payment System] and the sig- nificant cost pressures, the treatment (operative and nonoperative) of spinal issues will be required to show value for the services provided. e easiest way surgeons will be able to show value is through part- nering with CMS and private insurers through bundling in a way that financially incentivizes the physician significantly and also provides the insurance company with cost savings. Brian Gill, MD. Nebraska Spine Hospital (Omaha): I think the typical issues of declining reimbursement and increasing expenses are always on the minds of practitioners. ere continues to be consol- idation in healthcare with various systems merging, which trickles down to individual groups merging. is is being done out of necessity rather than convenience. Brian Gantwerker, MD. Founder of e Craniospinal Center of Los Angeles: e pressures of increased regulatory requirements are pushing doctors to leave private practice and to seek the (possibly) safe umbrella of employment. Of those coming out of residency or training, they seem to either not want or cannot function in a private practice situation. William Tally, MD. Athens (Ga.) Orthopedic Clinic: I think the biggest impact [to the spine field] will be reimbursement and consol- idation. Hospitals will continue to use leverage and power to force us into employment models. ose that can navigate the reimbursement changes will be able to stay viably self-employed. My biggest concern is the overall transition to employment-based practice and our subse- quent loss of system control; that will not serve our patients well. omas Scully, MD. Northwest NeuroSpecialists (Tucson, Ariz.): Insurance companies' continued lack of authorizations for proce- dures or imaging and the incessant hoops to jump through to care for patients continues to loom large. I really think the progressively aging community makes it difficult to know how aggressive to be with oc- togenarians, etc. We need to be good stewards with Medicare dollars, but also not deprive patients of increased quality of life given the right spinal surgical procedure. Practice management John Chappuis, MD. Founder of SpineCenterAtlanta: Key business challenges will be to continue to stay in business for smaller practices. is means thinking outside of the traditional reimbursement setting and developing new and innovative reimbursement models, especially for many of our patients who are under-insured or uninsured. I really believe this third party-payer system is one of many problems. If you can find a way to deliver your services directly to the patient (consum- er), we return to the way mainstream business works in this country. is means, however, we must show good care, track and publish our outcomes, and show value! is cannot be accomplished in our cur- rent hospital model, but can in outpatient comprehensive spine care models such as ours [at] SpineCenterAtlanta. Stephen Hochschuler, MD. Co-Founder of Texas Back Institute (Plano): I've always believed you have to watch what the competition is doing. at doesn't mean it regulates what you do, but be aware of it. Sponsored by

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