7 Spine Surgeons on Big Concerns Keeping Them Up at Night
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Where do you see spine research headed in the future?
Q: What concerns about the future of spine surgery keep you awake at night?
Jeffrey Cantor, MD, Founder, South Florida Spine Clinic, Fort Lauderdale: While healthcare reform legislation has been passed, its future is still very much in flux. This affects physicians everywhere.
The insurance industry is becoming increasingly more restrictive. Complex spine-care treatment decisions are being made by doctors who may lack the necessary experience and knowledge.
Due to the uncertain landscape, device manufacturers are going elsewhere. More regulation means greater difficulty in bringing new technologies to market. This poses a serious threat to the U.S. as a leader in healthcare technology.
Healthcare reform needs to come to a final resolution, and soon. Every day that goes by in limbo is a day that adversely affects our bottom line and our ability to innovate.
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: Not having any rights as a physician practicing under Obamacare. Not being able to afford to keep seeing the volume and complex patients I currently see. Patients losing access to specialty care. ACOs that pit physician against physician. Having to become a hospital employee.
Michael Duffy, MD, Spine Surgeon, Texas Back Institute, Plano: The future of the practice of medicine is in jeopardy across the board. First and foremost, there is an impending shortage of physicians on the horizon for a rapidly growing and aging population due to the boom of birthrates between 1946 and 1964. This, combined with less students seeking a career in medicine, creates a seemingly insolvable situation for healthcare delivery- enough to keep any physician or patient awake at night.
In regard to spinal surgery, I feel that our choices as physicians have started and will continue to be limited. Surgical decision making is guided more and more by boardroom policy based on poorly interpreted data. Patient care is directly impacted. The demand for "level of evidence" in our clinical data is becoming a mantra that haunts procedures and devices that inherently cannot afford the steep price tag of such a study; therefore clinical applications of these well-accepted treatments are being scrutinized and potentially not reimbursed by third parties. Also, new product development is considerably slowed due to federal tight-hold on the processes and regulations required to create advancement.
These are definitely troubling times which require all physicians to take note. Utilization and support of our governing bodies such as national, state and local medical associations, and more importantly our national specialty groups such as the North American Spine Society, is vital to help mold real change in the proper direction.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: Less approval for surgical treatment of chronic low back pain.
Brian R. Gantwerker, MD, Spine Surgeon, The Craniospinal Center of Los Angeles: The pressure to joint hospitals and hospital-run ACOs that will make spine surgeons a commodity rather than an asset. The continued free-roaming fraud that insurance companies perpetrate when your services are not remunerated in a timely and reasonable fashion.
Andrew C. Hecht, MD, Co-Chief, Orthopedic Spine Surgery, Mount Sinai School of Medicine, New York City: One of my concerns is the increasing extent that insurance companies are going to deny care to patients both preoperatively as well as postoperatively. I am also concerned about the diminishing access to care and lack of unity amongst physicians in expressing and organizing for their concerns for these disturbing insurance practices. It has become increasingly complicated and difficult to get insurance companies to approve our procedures and even then sometimes they are denied on the back end.
Very often when you confront an insurance company about these denials, you aren't talking to someone who understands the medical side of things. I might be talking to an obstetrician when I'm trying to get spine surgery approved.
Hopefully in the future the spine surgical community and the societies can put up a united approach to protect our patients' well being because this is becoming a very complicated process for helping patients.
Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.: More than any real specific issue, it is just the absolute uncertainty of things that is most difficult to address. With the constant change in regulations, e.g. passing Obamacare, then the Supreme Court decision and now the discussions regarding repeal; it is hard to plan for one's business. Making any financial investment into a medical practice is increasingly difficult when any given day could see legislation that completely changes the rules. It either delays new and valuable services being provided to patients or it creates the stress of financial uncertainty upon the medical practice that implements the new service.
More Articles on Spine Surgeons:
6 Spine Surgeons on Most Exciting Technology for the Future
How to Keep Costs Down: 3 Spine Surgeons on Their Tactics
7 Biggest Opportunities or Growth in Spinal Surgery
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