How Will the Role of Spine Surgery Evolve? 5 Predictions From Spine Leaders

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At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference on June 14, a panel of spine leaders discussed trends and challenges for spine surgery going forward in a keynote session titled “The Changing Role of Spine Surgery.”

The panel featured Richard Wohns, MD, JD, MBA, of NeoSpine; Kenneth Pettine, MD, founder of The Spine Institute; Jeff Leland, chief executive officer of Blue Chip Surgery Center Partners; and Stephen Hochschuler, MD, of the Texas Back Institute. Forrest Sawyer moderated the session.

Here are five topics the panel discussed as to how spine surgery’s role will need to change and evolve.

1. More outpatient procedures. Currently, about 80 percent of all surgeries are available to be performed at multispecialty ASCs. However, only 10 percent of spine surgeries are currently done in an outpatient setting. And of the 600,000 spine surgeries performed nationwide, about 5 percent were done in ASCs.

“We have a marvelous opportunity to lower costs by transiting out of the hospital to the lower cost [ASC] setting with patients who are happy to make the move,” Mr. Leland said.

Since the 1990s, spine surgeons have proven they can effectively treat patients in outpatient facilities, and patients are receptive to the transition, Dr. Wohns said.

“They don’t want to be in the hospital,” he said. “They know about the higher patient satisfaction [in ASCs]. They want to be in a boutique care setting and to go home the same day with smaller interventions. People are pushing it themselves; we don’t have to push it at all.”

2. Focus on high-efficacy procedures. Spine surgeons need to focus on perfecting procedures with the highest efficacy and shift away from procedures that have created controversy, Dr. Pettine said.

“The direction of spine is to focus on doing procedures we do best, to get back to basics and to procedures that can be done with newer, minimally invasive techniques,” he said.

Procedures such as decompressions have very high success rates and proven efficacy, while surgeries such as three- and four-level fusions for treating chronic lower back pain in multidisc disease haven’t been as successful.

3. Lower costs. When hospital prices become more transparent, patients will naturally move toward ASCs, who are providing high-quality surgeries at significantly lower price points, Dr. Pettine said. It’s not uncommon for the same spine surgery to cost $75,000 in a hospital and $35,000 in a surgery center, he said.

“The cost difference is substantial, but when the hospital has to publish those prices and people are paying more and more in co-pays, then there will be a complete paradigm shift,” he said. “The consumer-patient is interested in the cost of surgery.”

Another key problem in healthcare as a whole is that patients aren’t paying for the services, insurance companies are, Dr. Hochschuler said. “Once they care what it costs, when co-pays go up, then the patient will be shopping. They are going to be shopping for many things in addition to cost,” he said.

4. Develop less invasive procedures. Spine surgery needs to allow patients to regain function more quickly through less damaging and invasive procedures that cost less, Dr. Wohns said.

“If we don’t constantly change to provide less costly, invasive intervention then we will be out of business,” he said.

5. Reach out to consumers. Direct-to-consumer marketing will become a more prevalent way for ASCs to reach potential patients and get their message out so patients can understand the value and quality of outpatient spine surgery.

“Spine surgeons have done a miserable job of collecting quality information and presenting themselves to patients,” Mr. Leland said. “We need to pay attention to how other industries have gone directly to the consumer.”

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