Six spine surgeons talk about the biggest challenges for spine surgeons in terms of healthcare reform. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Do you use any mobile technology, such as a smartphone or tablet, to enhance your practice? Which ones?
Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, May 22, at 5 p.m. CST.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: The biggest challenges include declining revenue, an increasing number of denials for medically necessary treatments, increasing practice costs, increasing administrative costs, declining numbers of patients that are willing to undergo treatment, declining number of patients that can afford to undergo treatment, rising patient co-pays/deductibles and coinsurance. In a nutshell, the biggest challenges for spine surgeons are the same for all physicians practicing today. I expect these issues to worsen over time. All of these "challenges" are driven by private insurers.
Kern Singh, MD, Rush University Medical Center, Chicago: [The biggest challenge is] balancing the costs of healthcare reform while still managing patients that are medically difficult. More and more physicians will be opting out of Medicare and other insurers in which it is currently impossible to treat because of declining reimbursement and increasing medical liability.
Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: More covered persons with less money can only mean lower reimbursement or rationed care. I believe we will see both which will lead to tightened budgets. There will be a greater need to use physician extenders. Practices will continue to utilize ancillary services to help supplement income lost from traditional revenue streams. Staff will need increasing training to deal with denials. Finally, I think it will be difficult to explain to patients how reform affects their options and level of service. Many people have listened to and believed the rhetoric we have heard over the past few years. The reality is that rationing will occur; in fact it is happening already with treatments such as spine fusions and disc replacements.
Andrew Cordover, MD, Spine Surgeon, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Ala.: As with all healthcare providers, spine surgeons have to balance the challenges of healthcare reform while improving care quality, lowering costs for patients and our practice and providing care to an older population.
An important aspect of managing care while dealing with the challenges of healthcare reform includes our effort to stay well-informed on the latest technologies available for our use. Part of remaining knowledgeable about developments in our industry also includes having input on the development of techniques in spine surgery. We must work hard to develop cost saving, safe and effective treatments for our patients.
Along with all of this, spine surgeons must continue to develop ways to measure and track quality outcomes of their patients.
Sanjay Khurana, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina Del Rey, Calif.: As the healthcare reform act rolls into 2014, a large pool of previously uninsured individuals will be entering the healthcare market. Spine surgeons will undoubtedly see more patients with spinal disorders, and as a result surgical volume across the board will increase. As technology as progressed in spine surgery, so has cost. It will be paramount for spine surgeons as a community to document clinical outcomes to justify the increasing use of sophisticated and expensive technologies. Providers and insurance companies will likely both spend resources in carefully documenting outcomes and utilizing this information to support the use of progressive surgical spine technologies. In some instances, new technologies will prove to be beneficial and others not as much.
Purnendu Gupta, MD, Medical Director, Chicago Spine Center at Weiss Memorial Hospital: Where do I begin? From the Congressional level to the local level, even at the bedside, healthcare is in a crisis. The decisions made at a national level are not necessarily made in the best interest of patient care and further progress in improving the delivery of healthcare and medical research and progress. At a local level, from community hospitals to large hospital systems and academic tertiary care centers, changes are being made to economically brace for healthcare reform and the need to better align resources to control costs. This has led to more limited personnel, ancillary care and most importantly bedside nursing care. For a spine surgeon, all these issues impact the ability to care for patients from a micro-discectomy to a complicated scoliosis reconstruction. Furthermore, the payors are becoming more restrictive and denying appropriately-made decisions and monitoring the use of testing, therapeutic modalities and medical devices. All of these changes continue to challenge surgeons to seek out new ways to deliver quality care to patients.
More Articles on Spine:
A Maverick Spine Surgeon's Quest to Develop Minimally Invasive Technique & How He's Passing It to the Next Generation: Q&A With Dr. Anthony Yeung
Drs. Fred Scialabba, James Greenspan Team With Albany Medical Center Hospital
8 Trends for Surgical Management of Lumbar Spinal Stenosis
Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, May 22, at 5 p.m. CST.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: The biggest challenges include declining revenue, an increasing number of denials for medically necessary treatments, increasing practice costs, increasing administrative costs, declining numbers of patients that are willing to undergo treatment, declining number of patients that can afford to undergo treatment, rising patient co-pays/deductibles and coinsurance. In a nutshell, the biggest challenges for spine surgeons are the same for all physicians practicing today. I expect these issues to worsen over time. All of these "challenges" are driven by private insurers.
Kern Singh, MD, Rush University Medical Center, Chicago: [The biggest challenge is] balancing the costs of healthcare reform while still managing patients that are medically difficult. More and more physicians will be opting out of Medicare and other insurers in which it is currently impossible to treat because of declining reimbursement and increasing medical liability.
Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: More covered persons with less money can only mean lower reimbursement or rationed care. I believe we will see both which will lead to tightened budgets. There will be a greater need to use physician extenders. Practices will continue to utilize ancillary services to help supplement income lost from traditional revenue streams. Staff will need increasing training to deal with denials. Finally, I think it will be difficult to explain to patients how reform affects their options and level of service. Many people have listened to and believed the rhetoric we have heard over the past few years. The reality is that rationing will occur; in fact it is happening already with treatments such as spine fusions and disc replacements.
Andrew Cordover, MD, Spine Surgeon, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Ala.: As with all healthcare providers, spine surgeons have to balance the challenges of healthcare reform while improving care quality, lowering costs for patients and our practice and providing care to an older population.
An important aspect of managing care while dealing with the challenges of healthcare reform includes our effort to stay well-informed on the latest technologies available for our use. Part of remaining knowledgeable about developments in our industry also includes having input on the development of techniques in spine surgery. We must work hard to develop cost saving, safe and effective treatments for our patients.
Along with all of this, spine surgeons must continue to develop ways to measure and track quality outcomes of their patients.
Sanjay Khurana, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina Del Rey, Calif.: As the healthcare reform act rolls into 2014, a large pool of previously uninsured individuals will be entering the healthcare market. Spine surgeons will undoubtedly see more patients with spinal disorders, and as a result surgical volume across the board will increase. As technology as progressed in spine surgery, so has cost. It will be paramount for spine surgeons as a community to document clinical outcomes to justify the increasing use of sophisticated and expensive technologies. Providers and insurance companies will likely both spend resources in carefully documenting outcomes and utilizing this information to support the use of progressive surgical spine technologies. In some instances, new technologies will prove to be beneficial and others not as much.
Purnendu Gupta, MD, Medical Director, Chicago Spine Center at Weiss Memorial Hospital: Where do I begin? From the Congressional level to the local level, even at the bedside, healthcare is in a crisis. The decisions made at a national level are not necessarily made in the best interest of patient care and further progress in improving the delivery of healthcare and medical research and progress. At a local level, from community hospitals to large hospital systems and academic tertiary care centers, changes are being made to economically brace for healthcare reform and the need to better align resources to control costs. This has led to more limited personnel, ancillary care and most importantly bedside nursing care. For a spine surgeon, all these issues impact the ability to care for patients from a micro-discectomy to a complicated scoliosis reconstruction. Furthermore, the payors are becoming more restrictive and denying appropriately-made decisions and monitoring the use of testing, therapeutic modalities and medical devices. All of these changes continue to challenge surgeons to seek out new ways to deliver quality care to patients.
More Articles on Spine:
A Maverick Spine Surgeon's Quest to Develop Minimally Invasive Technique & How He's Passing It to the Next Generation: Q&A With Dr. Anthony Yeung
Drs. Fred Scialabba, James Greenspan Team With Albany Medical Center Hospital
8 Trends for Surgical Management of Lumbar Spinal Stenosis