Key Challenges, Opportunities for Growth in Spine SurgeryAt the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Kenneth Pettine, MD, a spine surgeon at the Loveland (Colo.) Surgery Center; Larry Teuber, MD, a spine surgeon and president of Medical Facilities in Rapid City, S.D.; and Timothy T. Davis, MD, DABNM, DABPMR, DABPM, a spine surgeon and director of interventional pain and electrodiagnostics at The Spine Institute in Los Angeles, discussed trends in spine surgery and ideas for improving profitability and outcomes of spine programs. Scott Becker, JD, CPA, partner at McGuireWoods, moderated the session.
Mr. Becker kicked off the discussion by asking the spine surgeons some of the top spine surgery trends on their minds.
Dr. Davis said he sees a growing trend of spine centers and surgeons needing to meet certain criteria to get surgeries covered. He compared the trend to what he said has happened to cardiology.
"I think it's going to come down to really having to follow a strict algorithm of spine care, he said. "We already have to do this in the worker's compensation environment."
Electronic medical records will become increasingly important for spine surgeons to ensure every procedure has been tried and standards are being followed, which is critical for reimbursement.
Dr. Pettine said he's seeing a trend in payors denying spine procedures, what he called a "dramatic change" in spine surgeons' ability to get surgeries authorized. He suggested all orthopedic surgeons study insurance plans' guideline packets, which state the requirements needed to get procedures authorized.
"If you don't understand the rules, you can't play the game," he said.
He predicted the total number of spine procedures performed could drop by as much as 30 percent in the next year because of payor denials.
Dr. Teuber echoed the notion by saying the backlog of pre-authorizations for spine surgeries is huge.
Later in the conversation, Mr. Becker asked the panel about some of the most exciting developments they're seeing.
"Biologics are far and away the next frontier of spine," Dr. Davis said. He was referring to the use of biologics both in surgery and prior to it. He said it's the "biggest single improvement in spine care."
Dr. Teuber agreed and added "implants will always be a growth area too.”
Dr. Pettine discussed the future in terms of where spine procedures happen. "Spine care in an ASC setting is absolutely the future," he said. It's the place where "all of the modern minimally invasive techniques for spine" can be utilized.
"The hospitals absolutely cannot compete with an ASC," he added. "We can provide this care [for] significantly less."
In order to be profitable over the next five years performing spine surgery, Dr. Pettine said spine centers should seriously look at case rates. There's an opportunity for ASCs to pick up potential spillover patients from other surgeons who sign with hospitals but lack the time to perform as many surgeries, he said.
"As far as hospitals purchasing doctors, I think that's great. The minute the hospital purchases several neurosurgeons, then he's no longer competition," he said.
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