Issue link: https://beckershealthcare.uberflip.com/i/936525
13 If the hospitals are consolidating, figure out what hospital you'll do defor- mity procedures in and whether they'll give you credentials. Additionally, surgeons need to go to national conferences. ey don't like to go, but that's where you make contacts and gain recognition in the field. Look at your situation: What is happening to your numbers? Do you have the same referrals as you did a few years ago? Are you achieving the same payment per case? Look at those trends, and from there you can predict what will happen in three to five years. Dr. Frank Phillips: Bundled payments will continue to evolve with the inevitable march away from a fee-for-service model. Bundles are readily managed for spinal procedures with reproducible and predictable outcomes, such as ACDF. More complex treatments, such as surgery for advanced spinal deformity, will remain a challenge in a value-based purchasing system. With increased emphasis on value and transparency, practices' and practitioners' outcomes will become increasingly available to the public, who will become much more sophisticated healthcare shoppers. Dr. Neil Badlani: Healthcare dollars are also being shied more to- ward our patients in the form of higher deductibles and co-insurance payments. is trend of consumerism in healthcare is not going away, and physicians should be equipped to handle it. As physicians, it is our responsibility to educate our patients with accurate and comprehen- sive information about their conditions and treatment options. Di- rect-to-consumer marketing is an increasingly important way to provide that patient education and an opportunity for physicians to grow their practices for continued success. Dr. Brian Gantwerker: As to why we are seeing diminishing reimburse- ments, I would guess that the main method is insurance companies are trying to squeeze more profit out of the insured and pay less to the physicians. It's not clear to me the logic behind paying less to quality doctors. My overall feeling is that more doctors will opt out of insurance completely to counter the trend. Dr. Brian Gill: From a clinical standpoint, spine surgeons are facing greater scrutiny in getting care authorized from insurance companies. Over the past year, I have had more peer reviews for authorizing care than I had in all of my previous years combined. Nitin Khanna, MD. Spine Care Specialists (Munster, Ind.): e most important trend for spine surgeons in 2018 is the move to outpatient spine. However, remaining independent will continue to be a challenge with the consolidation of healthcare entities. Gaining minimally invasive expertise and marketing knowledge to move cases to an outpatient facili- ty is the best opportunity this year. Todd J. Lansford, MD. South Carolina Sports Medicine & Orthopae- dic Center (North Charleston): e key clinical and business challenges will continue to be reimbursement issues and health insurance reform. ere is considerable uncertainty in this sector, which insurance compa- nies hate. is all leads to challenges for the patients and providers. From a business standpoint, corporate tax changes will be a challenge for many private practice groups. e challenge is not a bad one, but confusing nonetheless. James Sanfilippo, MD. Reconstructive Orthopedics (Moorestown, N.J.): Surgeons are more frequently exploring collaboration with non- operative physicians, such as primary care musculoskeletal medicine, rheumatology and pain management [physicians]. is allows for a controlled flow of patients to the appropriate provider depending on the patients' response to conservative treatment. In most cases, these phy- sicians can collaborate on an algorithmic patient care protocol to limit therapies and treatments that may not be producing results, thus driving down unnecessary costs of care. Vladimir Sinkov, MD. New Hampshire Orthopaedic Center (Man- chester, N.H.): Ironically, the demise of private practice will not be due to competition; it will be due to lack of competition. Competition is actually good, and makes everyone try harder and be better at what they do. is ultimately provides better care for patients and more efficient healthcare with fewer costs. e current system is anti-competitive. It provides an unfair legal and financial advantage for non-for-profit tax-exempt large hospital systems and insurance companies. Dean Toumbis, MD, PhD. Citrus Spine Institute (Crystal River, Fla.): I believe the future for independent spine practices is still a strong one, and is likely to become even stronger as many of the surgeons out of residency and fellowship are now seeking employed positions. Good personalized patient care will always be rewarded in the spine profes- sion. Additionally, collaborative efforts, with not only our orthopedic colleagues, but also with hospital administration, are key to success in the future. A successful spine practitioner will also need to be more business-minded now and in the future. Contract negotiations, cost containment and strong staffing are all critical to high profitability. Anthony Yeung, MD. Founder of Desert Institute for Spine Care (Phoenix): ere will continue to be downward pressure by payers on independent spine surgeons regardless of their reputation and skills. Unfortunately, the trend and pay for all surgeons, independent spine surgeons or salaried spine surgeons, will continue to trend downward in the long term. Reimbursement may increase temporarily in situa- tions in which even "above-average" or "superstar" surgeons who are dependent on insurance or government payers will be impacted. All who are expected to pay or receive payment will continue to leverage their dominance in the reimbursement industry to aggressively and routinely try to maximize reimbursement, while payers will continue to relentlessly reduce payment with their own reimbursement criteria. Either way, the reimbursement trend will force not just spine surgeons but all business entities to distinguish themselves by narrowing their surgical area of expertise. Technology John Finkenberg, MD. Sharp (San Diego): e most important trend for 2018 will be seen as the creation of instrumentation and procedures that blur the lines between MIS and minimal-access surgery. 2018 will bring on a new tax code, which may positively affect many professional businesses. Tax ceilings and opportunities to buy digital radiograph equipment with advantageous depreciation rules should be considered. Richard Chua, MD. Northwest NeuroSpecialists (Tucson, Ariz.): I believe there will be continued growth in the application of minimally invasive spine surgical techniques, including improvements in implant technology, biologics, instrumentation and biomechanical consider- ations. In addition, the move toward outpatient spine surgical services may continue to grow as reimbursement and payers demand more efficiency, reduced cost and better resource utilization. Kern Singh, MD. Co-Director of the Minimally Invasive Spine Institute at Rush (Chicago): 2018 will be the year of the robot in spine surgery. Almost every major spine company will have released their next-generation robot. Look for robots to do more than just help place pedicle screws. Navigation, surgical assistance and even help with the surgical decompressions are on the horizon. Mick Perez-Cruet, MD. Director of Minimally Invasive Spine Surgery and Spine Program at Oakland University William Beaumont (Roch- ester, Mich.): e most important spine technology trend for 2018 will be the further development of minimally invasive spine surgery and stem cell-based biologics. e best opportunity for spine surgeons will be to bring cases into outpatient spine surgery centers in which they hold an equity stake.