Becker's Spine Review

SPINE SURGEONS 11 The Most Significant Opportunities for Spine Surgeons in 2018 By Anuja Vaidya F ive spine surgeons weigh in on the biggest opportunities in spine care in the coming year. Question: What are some of the biggest op- portunities for spine surgeons in 2018? J. Brian Gill, MD. Spine Surgeon at Nebras- ka Spine Hospital (Omaha): ere has been a push to do more procedures in an outpatient setting. Surgeons have to be more selective in their patient population. A greater emphasis is being placed on preoperative narcotic use, smoking status, obesity and general health. All of these components are extremely im- portant. Surgeons are becoming more aware of these issues and their effect on procedures in an outpatient setting. us, many surgeons must address these issues preoperatively more so than they may have done in the past. Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Minimally invasvie spine surgery techniques are becoming easier to learn and more effective. I would recommend every spine surgeon become familiar with them and offer them to their patients when appropriate. With less pain and quicker recovery aer MIS surgery, more spine procedures will be mov- ing from hospitals to ASCs. Spine surgery bi- ologics for fusion and non-fusion procedures and robotic technology will continue to im- prove and evolve in 2018 as well. Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I think as a group, we have the ability to use data from peer-reviewed studies to support the use of motion-preserving devices. Devices such as coflex as well as cervical and lumbar arthro- plasty devices should be and will be covered by insurers. Quite simply, motion-preserving devices are not just equivalent, but are ap- pearing in some circumstances to be superior to previously used devices. I think we as sur- geons have the opportunity to leverage data, experience and expertise to get patients the right treatments, and not just the cheapest. Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I believe there will be more widespread bundled payment acceptance. In particular, as the self-insured market becomes educat- ed regarding the free market and its poten- tial impact on medical care and huge savings for the insured, we will see this sector grow. ose folks who embrace price transparency and deliver value-based care will have a leg up in this market. It is estimated that one- in-three insured individuals obtain coverage through a self-insured employer. at is a big opportunity. Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at Memo- rialCare Orange Coast Medical Center (Fountain Valley, Calif.): Continuing to col- lect data showing the value and efficacy of our treatments for the different types of spine pa- thology. Healthcare is becoming increasingly results-driven and in order to demonstrate the importance of what we do, we need to work hard on collecting outcomes and pub- lishing this information in a concise way. n Are Spine Bundled Payments Finally Here? Dr. Paul Slosar's 3 Key Trends for Spine Surgery in 2018 By Laura Dyrda P aul Slosar, MD, president of SpineCare Medical Group in Daly City, Calif., discussed three big trends for 2018, covering technology, business challenges and the best opportunities for spine surgeons this year. 1. The most important spine technology trend for 2018: The focus is now on surface technologies for fusion implants. The most sophisticated and advanced surface has a unique titanium nano-technology to stimulate the host bone to grow rapidly, promoting early osseous-inte- gration. This should lower surgeons' dependence on ex- pensive or inflammatory biologics. The porous implants may be better than smooth surfaces, but still lag behind in terms of stimulating a cellular response. 2. Key clinical or business challenges spine surgeons will face this year: The challenges to the remaining in- dependent spine practices persist. Large multispecialty groups and hospital systems continue to grow and erode market share opportunities for the smaller practices. On- going insurance company denials appear to be escalating, challenging physicians (and our patients) with denials for even the most basic tests and treatments (MRI/ injections/ PT). With patients (the insurer's customers) now respon- sible for enormous out-of-pocket deductibles, it seems incongruous that the payers would be routinely denying these simple upstream care items. 3. Best opportunity for spine surgeons in 2018: Al- though it's been on the radar for several years, this may be the year that bundled payment models finally hit their stride. While CMS has adopted a more voluntary posture toward participation, that hasn't discouraged interest in their BPCI program, now entering its third year. Commer- cial payers are following and, in 2018, some will begin with small, selective networks of spine specialists to grow their own risk-sharing programs. n

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