Insurer requirements limit most patients' options, CEO says

Thomas Schuler, MD, serves as the chief executive officer, founder and spinal surgeon at Reston-based Virginia Spine Institute. 

Dr. Schuler will serve on the panel "Independent Spine Practices: The Big Threats and Even Bigger Opportunities to Thrive" at Becker's 19th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place in Chicago from June 16-18. 

To learn more and register, click here.

Question: What issues are you spending most of your time on today?

Dr. Thomas Schuler: The issues that I am spending the most time on today are centered on maintaining and improving patients' access to the spine care they need to regain their lives. The government and insurance companies are using policies and reimbursement decisions to decrease utilization/access to essential spine care. Too often, treatments are denied for bureaucratic policy decisions rather than medical facts.  An obvious example is disc replacement surgery. Preserving motion produces the best results, yet 3-level and/or hybrid cases are routinely denied. This does not yield the best short-term or long-term results. Patients are forced to pay personally or receive an inferior treatment that the insurance companies or government will approve. Many other examples of denied care occur routinely. I spend enormous hours educating patients, helping the patients to navigate insurance bureaucracy, and appealing to insurance company review panels to enable patients to receive the appropriate and needed treatments. This is not the most effective use of my time and training, but unfortunately necessary to achieve the desired result for patients in today's insurance denial world. Our patients deserve access to the incredible success that quality modern spinal treatments provide.

Q: What are you most excited about right now? 

TS: I am most excited about the amazing treatment opportunities we have in 2022 to improve our patients' lives. I have been practicing for 30 years, and today's technology and treatment options enable modern spine specialists to work medical miracles on our patients daily. Quality rehabilitation, precision pain management techniques, regenerative medicine, low-profile segmental spinal fixation, robotic spine surgery, cervical and lumbar motion preservation, and minimally invasive techniques all are epic gains that have transformed our field over the past 30 years. The future is bright for our patients. I have medically benefited from these epic gains as a spine patient myself. My life is better for it and so are my patients' lives. We are blessed to live in this era of incredible spinal treatments!

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