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Gazing Into the Crystal Ball: The Next 5 Years of Spine Surgery

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At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, David Abraham, MD, a spine surgeon at Reading (Pa.) Neck and Spine, and Bob Reznik, MBA, and president of Prizm Development, discussed the immediate future of spine surgery and what developments may be on the horizon. Scott Becker, JD, CPA, partner at McGuireWoods, moderated the session.

Dr. Abraham started the conversation by addressing the threat of accountable care organizations. He said because of it, his center has fused four orthopedic practices together.

"You worry about the federal government controlling the revenue," he said.

Additionally, Dr. Abraham is seeking to get back to the basics of his practice by focusing on his medical niche.

"I'm still a member of the group, but I'm reorganizing my efforts to focus on spine because spine is fundamentally different than orthopedics."

Mr. Becker asked the panel if it's still sustainable to be a small spine group.

Dr. Abraham responded by noting the uncertainty of healthcare reform. "I don't think anybody can clearly predict the state of healthcare in the next 24 months," he said.

Later, Mr. Becker asked the panel clarify what an actual spine center of excellence is, a sometimes vague term.

The "term has been pretty well bastardized," Mr. Reznik responded.

Mr. Reznik used to suggest spine centers get certified as low back pain centers from the National Committee for Quality Assurance to receive some validation as an excellent center. However, NCQA recently pulled the plug on that program due to a lack of funding.

Mr. Reznik did suggest four keys spine centers looking to establish a high-quality center should follow.

  1. Only hire board certified physicians.
  2. Integrate spine and pain management.
  3. Utilize clinical report cards.
  4. To the extent possible, find physicians with fellowship training.

Mr. Becker then asked Dr. Abraham and Mr. Reznik their opinion on the biggest opportunities in spine surgery in the immediate future.

Dr. Abraham said spine centers have the potential to boost care options by hiring a sufficient amount of specialists who aren't surgeons.

"You really need three or four non-operative physicians for every spine surgeon," he said.

Dr. Abraham noted the challenge of finding physiatrists to work at spine centers, but sees a large upside in hiring muscular skeletal specialists to work in spine centers.

Mr. Reznik also addressed the important need for spine specialists to create a portfolio of business that comes from a mix of patients. He gave a rough percentage breakdown of the "valves" patients should come from.

  • 50 percent of the patient portfolio should be consumer-driven
  • 40 percent should be from physician referral
  • 10 percent should be business-driven, coming from work-related injuries

Mr. Reznik suggested spine centers develop business plans around these three types of patients. It's not good to rely on too many business-driven referrals because employers could pull the plug and change plans at any time.

Dr. Abraham suggested spine centers should also look to marketing to add business in the future.

"Direct consumer marketing is very challenging, but certainly something that requires a proper plan," Dr. Abraham said.

For spine centers to succeed, they will need to have a patient-friendly, customer service attitude, he added.

Spine centers could also work toward increasing efficiency in the future by implementing what Mr. Reznik referred to as a "Batman and Robin model."

The idea is to have physician assistants and nurse practitioners meet with the patient at preliminary appointments to assist the surgeon before Batman (the surgeon) sweeps in to spend the appropriate amount of time listening to and caring for the patient.

Mr. Reznik said it is essential for spine surgeons to see the patient for at least a few minutes during every patient visit. In surveys he's conducted assessing whether or not this is necessary, results show both patients and primary care physicians tend to expect a spine surgeon to meet with the patient during every visit.

More Articles Related to Spine Care in ASCs:

5 Tips for Developing a Spine Center of Excellence
Key Business and Clinical Issues With Moving Spine Procedures to ASCs
How to Assess the Profitability of Orthopedic and Spine Cases

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