Staying Current in the Spine Care Market: Q&A With Dr. Jeffrey Nees of Laser Spine Institute FeaturedWritten by Laura Miller | November 06, 2012
Jeffrey Nees, MD, is an neurosurgeon with Laser Spine Institute, based at its Oklahoma City surgery center. He previously served as a general neurosurgeon in Norman, Okla., where he was one of the first surgeons in the area to perform artificial disc replacements. Over his career, Dr. Nees has taken medical mission trips to Haiti and has published several spine-related articles in professional journals. Here, Dr. Nees discusses the biggest challenges in spine surgery and where the field is headed in the future.
Q: What is the biggest challenge facing spine surgeons today?
Dr. Jeffrey Nees: One of the biggest challenges I see is the situation with insurance companies, which seems to be slowly and insidiously disintegrating. They play a role in what we can and cannot do, whether they are outright blocking it or making us go through the full spectrum of conservative care before they are willing to cover surgery. In some cases, patients may be at risk of permanent neurologic deficit if they are not treated right away, but their treatment still isn't covered. Instead, we are forced to do something outside of our regular standards of care.
Another challenge is that we don't know how the medical field as a whole, or how our very specific specialty niche, will be affected when healthcare reform goes into effect. That's a challenge nobody can speculate on. I do believe that the leadership of Laser Spine Institute has positioned us to minimize those effects.
Q: What adjustments are Laser Spine Institute leaders making to prepare for the future?
JN: The leadership is looking at how healthcare reform can affect us and instituting safeguards so we can continue to deliver top quality care to our patients. It's something that has been very prominent and is becoming more prominent on our administration's radar. It's not necessarily about the business—although we are running a business to keep our doors open—but how we can make adjustments and adapt with healthcare reform in place and still deliver the kind of healthcare patients need.
Q: More hospitals today are employing surgeons — how does this impact surgeons in private practice like yourself?
JN: I think the trend toward hospital employment is a two-way street. From a hospital standpoint, they have seen surgeons investing in surgery centers and taking business away from them. The way they combat that is employing specialists and bringing all the patient care to that facility. Physicians are seeing decreasing reimbursement, increasing red tape and paperwork. One way to combat that is to say "I'll become an employee of the hospital and the hospital will be in charge of the staff, billing, appeals and preauthorization for my treatment and I can focus on doing my job—taking care of patients."
It's been mutually beneficial in that regard and that's why we are seeing that trend. The burden of running an office is hard because insurance companies are denying claims and cutting reimbursement, which is making it more attractive for a third party to do that and allow the surgeon to just practice medicine.
This will impact other surgeons because it's always going to be a competition for the patients. I think hospital employment does make it difficult for surgeons to run a viable practice because they are always going to be in competition with surgeons that are employed by the hospitals. In the future, hospitals with employed spine surgeons might make the decision not to give privileges to private practice spine surgeons.
I don't think that has happened in very many places, but it could.
Q: What trends will it be important for spine surgeons to watch in the future?
JN: I think one of the most important trends is something Laser Spine Institute has specialized in for a while now: minimally invasive surgery. Patients are becoming more educated and part of their own care; they are demanding operations that don't put a seven-inch scar on their back and they don't want six months of recovery. Instead, they want a one-inch incision and a few weeks of recovery. Minimally invasive procedures help gain coverage from insurance companies because if decision makers want patients recovering more quickly and returning to work, the less invasive procedures are beneficial.
I think another trend is going to be artificial disc technology, or motion preservation. Rather than doing a fusion, we want to treat and protect all levels of the spine from wear and tear. However, the biggest growth is in biologics—synthetic disc material or stem cell treatment.
If a surgeon doesn't prepare for these changes, they are going to be caught out in the cold. People who depend on hardware are going to find it hard to keep a market if they haven't kept current with other techniques. Minimally invasive surgery, motion preservation and biologics are areas of expansion in the future.
Q: How can surgeons stay updated on these changes as they come forward?
JN: One way to stay current is by communicating regularly with one or two device companies you know by reputation or experience have made a commitment to investigating new technology. Some companies don't do that and aren't invested in research and development; they simply provide goods and devices they develop, but they don't stay current.
Another way is going to meetings or reading in industry literature. Stay current for what is new and promising on the horizon.
More Articles on Spine Surgeons:
Inpatient vs. Outpatient Lumbar Fusions: 5 Points of Comparison
10 New Spine Device Launches
Spine Surgery Coverage: 3 Big Changes & How to Overcome Them
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