Independence, healthcare business & outpatient spine — 4 spine surgeons discuss the next 5 years

Five years in the healthcare landscape can feel like five minutes. That amount of time will likely bring substantial change in the way care is delivered and reimbursed.

Spine surgeons discussed the current and future landscape of the orthopedic and spine ASC industry as well as physician practice during a keynote panel titled, "ASCs, Orthopedics and Spine: The Next Five Years," at Becker's 14th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine in Chicago.

The panelists included:

•    Richard Wohns, MD, JD, MBA, founder and president of Puyallup, Wash.-based NeoSpine
•    Robin Fowler, MD, chairman and medical director of Atlanta-based Interventional Management Services
•    James Lynch, MD, founder and chairman of Reno-based SpineNevada
•    Tim Adamson, MD, of Charlotte-based Carolina NeuroSurgery & Spine Associates

What it takes to be independent
Maintaining independence as consolidation sweeps the healthcare industry is no simple feat. Within a saturated market, independent physicians will likely realize the challenge of trying to change the market to support their independence, said Dr. Lynch.

The ultimate goal of an independent spine practice, therefore, involves presenting payers with an easy decision. Demonstrate you are "doing something different and you have a commodity and not just a surgical service," said Dr. Lynch.

For those physicians considering independence or holding on to it steadfastly, Dr. Lynch said knowing the market's intricacies proves crucial. "If you don't educate yourself on the business of medicine and the politics and geopolitical spectrum, and you can't have a conversation with an insurance company and say why you're better, then you deserve to be pushed to the sidelines."

Also, Dr. Wohns noted that narrowing one's focus helps a physician maintain his or her independence. "I delved into outpatient spine procedures," he said. "The niche has helped me balance my work and life and remain independent."

Dr. Adamson added that his practice achieved independence because it is made up of likeminded people. "Nobody really cared about us except us," he said, noting individual physicians must devote the time and energy to fight for their independence.

Dr. Lynch agreed that independence requires effort. He said some physicians may not want to sacrifice time for family and other activities to run a successful independent spine practice.

"At the end of the day, some ski double black [diamonds] and some do greens; some people will sail in the big leagues and some will stay at shore," said Dr. Lynch. "You have to have a leader in the group."

The business of medicine
Successful physicians will delve into the business aspects of their practices. Equipped with business education, a physician will likely enter payer negotiations with more confidence and power.

"It's a lot easier for us [physicians] to learn the business side than a hospital CEO to learn medicine," said Dr. Lynch.

Dr. Adamson's practice utilizes a different business approach, hiring people who view medicine the same way as each other, but understand business a lot better.

"We don't try to blend the medical and business side much," said Dr. Adamson.

Ultimately, you have to love what you do, said Dr. Fowler, who began his career at a hospital and then opened an ASC. He built his business by collaborating with strong partners.

"A year after I began the ASC, I wanted to expand locations," he said. "Physicians try to do everything themselves, but it is impossible to practice full time and take care of scheduling and keep abreast of regulatory changes and so on. You have to have good partners. It's a learning process."

The move to outpatient
The advancement of spinal technologies and techniques will continue to push more procedures into the outpatient setting.

"Patients want to get out the door. I think outcomes really are going to be an important goal going forward," said Dr. Adamson.

CMS added nine codes for spine procedures to the ASC-payable list, which took effect Jan. 1, 2015. Dr. Wohns took this as a sign that major payers were getting on board with outpatient spine procedures.

"I want that trend to catch on around the country," he said. "Patients will not accept the huge cost of spine procedures at hospitals anymore, and they will turn to ASCs."

Dr. Wohns initially looked into the safety and cost-effectiveness of outpatient spine surgeries while he was completing his master's in business administration degree. He conducted an outcomes study at business school.

"I used my outcomes database to get my first payer contract," he said. "If you go to payers with outcomes data, it is very powerful. They see not just the cost savings but also the patient satisfaction."

Advice for the next five years
With the healthcare landscape evolving as quickly as it is, physicians will find collaboration is key. Dr. Fowler urged physicians and healthcare providers to serve as resources for one another. "Don't live in a vacuum," he said.

Also, it is important for physicians to focus their time on what they like best and eliminate the things they don't, said Dr. Wohns.

While it takes a lot of discipline to let something go, according to Dr. Wohns, the things you like to do will take up the time and space of the things you don't.

"I gave up brain procedures when I went to law school and I've never looked back," said Dr. Wohns. "That was a big decision but it gave me more time to perform spine procedures, which I like to do."

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