Eeric Truumees, MD, is the administrative and development council director for the North American Spine Society. He is a fellowship-trained orthopedic spine surgeon and practices at Seton Spine and Scoliosis Center in Austin, Texas.

Here are seven things for spine surgeons to know for Thursday, May 16, 2013.

Six spine surgeons talk about the biggest challenges for spine surgeons in terms of healthcare reform.

More than half of physicians in the United States are employed by hospitals, including about 60 percent of family physicians, according to a Medscape report.

Daniel Resnick, MD, is a board-certified neurosurgeon who specializes in spine surgery. He serves on the North American Spine Society's board of directors as the research council director. Dr. Resnick has been a member of the organization since 1999 and co-chairs the lumbar fusion task force.  

After analyzing physician density, malpractice coverage, insurance competition, medical board activity, insurance mix, income tax and cost of living from across the country, Medscape released the best and worst places to practice in the United States.

Samuel Cho, MD, is an orthopedic spine surgeon and Assistant Professor of Orthopaedics and Neurosurgery at the Icahn School of Medicine at Mount Sinai in New York. Dr. Cho has expertise in scoliosis surgery, minimally invasive surgery, intervertebral disc biology and cervical spinal surgery. He spends one week each year practicing outside of the U.S. through global outreach programs. Here he discusses why he chose his field, current topics in orthopedics and his upcoming medical mission to China.

Medical care is more coordinated today than ever, and spine specialists are beginning to form groups and organizations that will provide comprehensive treatment for back pain patients. The Spine Center Network, developed by Prizm Development, Inc., two years ago, is a national network of credentialed Spine Centers of Excellence for payors and consumers to choose truly multidisciplinary spine care settings. Currently, there are 18 spine centers across the United States, including Ann Arbor Spine Center in Ypsilanti, Mich., where Jason Brodkey, MD, practices.

Texas Back Institute has spent the past three decades building a large spine practice, and with the ever-changing healthcare environment, an adaptable growth plan is more important now than ever.

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"We are spending a lot of resources on growth and it's a very exciting time," says Michael Hisey, MD, President of Texas Back Institute. "We are in a time where everyone expects change. You have to be in a position to take advantage of that; those who do will succeed. Everything is going to be redistributed and you want to be in a position to help decide how that gets redistributed to the benefit of stabilizing your practice and treatment for your patients."

Here are five ideas for spine practice growth in today's healthcare environment.

1. Merge with other providers. Merge or engage in formal partnerships with other providers, in your community. Work with them to build relationships which can more effectively facilitate patient care. This could help leverage your collective negotiating power.  

2. Build a presence in an underserved market. Another growth strategy includes filling the need for spine specialists in an underserved community. The practice could bring on another surgeon for a new location in the community; often the local hospital will partner with the spine practice for the recruitment of a new physician in the market.  

"Bring in the new surgeon and place him in the community with a potential for growth," says Dr. Hisey. "The hospital and the practice will support him with marketing infrastructure and staff."

However, don't expect the additional cases from a new surgeon to grow the practice's profitability. "Growth is beneficial to us for negotiating power and to leverage overhead, but we don't expect the newer surgeons to add to the overall profitability," he says.

3. Affiliate with other groups in saturated markets. In a well-served market, it's beneficial for surgeons and groups to affiliate with other groups in the community to grow their economies of scale instead of developing a new business or crowding others out of the market.

"It takes a while, perhaps two or three years to really develop a practice and hit a stride," says Dr. Hisey. "It's a faster growth strategy to team up with people who are already there. However, you have to understand and account for personalities in the groups when you are partnering. It's important for everyone to work well together."

4. Cover more of the episode of care. Seek opportunities to bring more care under your group's control.

"If you can negotiate better prices for the hospital systems and have influence over these costs, you will be in a better position for contracting for bundled payments," says Dr. Hisey. "The more pieces of the episode of care you have control over, the better place you'll be for the final deal."

5. Strategically align instead of bringing other specialists into the group. Depending on your referral network, it may make more sense to strategically align with non-operative and pain management specialists instead of bringing them into your group.

"Most referral networks are composed of family practice physicians, neurologists and other pain specialists who take care of the patients until they need surgery," says Dr. Hisey. "If you have those specialists in your practice, you could cut yourself off from potential referral sources. However, it is also important to balance this against the need to meet the demands of those patients and referral sources requesting a multidisciplinary approach."

Texas Back Institute offers a multidisciplinary approach either through our own physicians or in cooperation with other physicians in our market.  

More Articles on Spine Surgeons:
5 Factors in Posterior Cervical Spine Surgery Infection Rate
6 Strategies to Make Spine Practice Business Models More Patient Centric
6 Ways to Increase Spine Practice Profits From Dr. Douglas Won

James Califf, MD, a board-certified orthopedic surgeon, has joined the Charlotte, N.C., practice OrthoCarolina.