Nineteen spine surgeons discuss their top priorities for 2017.
All 19 spine surgeons are speakers at the Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine event in Chicago, June 22 to 24, 2017. Learn more and register for the event here.
Richard Chua, MD. Northwest Neurospecialists (Tucson, Ariz.): "The highest priority in my practice this year will be to continue to improve patient outcomes, while trying to balance professional-personal time commitments and demands, yet comply with all the regulatory, insurance, and governmental demands placed on our generation of healthcare providers. It will be incredibly challenging, but interesting to see how the recent election results will change the outlook, strategies and process of my practice especially after the last eight years. Hopefully, the next decade will not be so bleak!"
John Dietz, MD. OrthoIndy (Indianapolis): "It is time for physicians to take the lead in healthcare reform. We're all busy, but think about the last six years. More cost, more regulation and less productivity has been the price of physicians being on the sidelines. You either have a seat at the table or you are on the menu. The word for healthcare in the next four years is "competition." Competition improves quality and reduces costs. I hope that the new administration and Congress will reverse the emphasis on consolidation in healthcare and focus on programs which stimulate competition. Parts of the Affordable Care Act which stifle competition should be eliminated immediately such as [the] section which prohibits physicians from owning part of a hospital. Change brings opportunity. We need a seat at the table. We've been on the menu way too long."
J. Brian Gill, MD, MBA, Nebraska Spine Hospital (Omaha): "With 2017 approaching, my goal for the upcoming year is to continue to provide high-quality spine care to the patients I serve. Defining quality is what I would like to achieve for 2017 in terms of patient satisfaction, measurable outcomes and value. There is a greater push to provide valuable high-quality care but there is scant information on what defines this. The enactment of MACRA ties quality to reimbursement for the first time. This trend will continue amongst all payers, and I would like to have a position at the table that ultimately determines what contributes to 'high-quality' spine care in my local community. Thus, I plan on pursuing payers to establish contracts with them that ties quality to reimbursement at the provider and hospital level."
Stephen Hochschuler, MD, Texas Back Institute (Plano): "My primary objective for 2017 is to master the role of telemedicine as it applies to the practice of spine care."
Yevgeniy Khavkin, MD, Khavkin Clinic (Las Vegas): "Quality of care. That's the biggest and it's always our priority. It should be for surgeons and for doctors. It's becoming more of a challenge because of the dynamics from the hospital systems and the insurance companies. That's our job to make sure we maintain the highest quality of care for our patients because that's our direct responsibility and that's why patients come to us and trust us with their health and well-being.
We have to develop a more complex model involving the hospitals and insurance companies and providers.
I think another challenge is the education of new surgeons. The way we were trained is very different from how surgeons are trained these days. Exposure to the clinics has been limited because of the work hour restrictions. Surgeons have limited opportunities to get appropriate training in their specialties.
I used to be involved in training residents. Ultimately, I think it was all about the right applicant. If you bring people on board who are dedicated to the specialty and go to medicine for the right reasons and have their priorities straight. You're going to have doctors who end up graduating and being very well trained specialists. A lot of physicians don't take pride in their professions and it has changed the landscape dramatically."
Todd Lansford, MD. South Carolina Sports Medicine & Orthopaedic Center (N. Charleston): "The top priority of my spine practice in 2017 is the incorporation of more procedures in the ambulatory surgery center. This involves more than just the surgeon. The hardest aspect of this is the center itself. This includes getting the right equipment and personnel, but when it is in place the patients gain so much."
Pierce D. Nunley, MD. Louisiana Spine (Shreveport): "Continue to support our profession by developing and participating in outcomes, databases as well as publishing quality research that demonstrates the value of what we do as spine surgeons for our patients."
Pablo Pazmino MD. Spine Cal (Santa Monica, Calif.): "As we get ready for 2017, one thing is for certain: change is coming. And a lot of it. In this sea of uncertainty, we have to embrace our role as patient advocates more than ever. We need a renewed focus on efficiency and improved practice management to assess our patients, effectively document their diagnoses and streamline our billing. In this rapidly shifting marketplace, there will be no room for errors. We also cannot watch these new changes affect our practices from the sidelines. We will have to find the time to leave our offices and travel to state houses and Washington to ensure that our voices are heard. Finally, my work at my nearby medical school has taught me that we cannot forget the next generation of physicians. It is imperative to mentor them to not only ensure our high level of patient care, but to recruit the next wave of surgeons in our battle to preserve our specialty."
Mick Perez-Cruet, MD, MS. Head and Spine Institute (Royal Oak, Mich.): "My top priority is to advance the science of stem cell-based intervertebral disc regeneration and develop innovative technology that can make this an effective clinical reality."
Nazer Qureshi, MD. Princeton (N.J.) Brain & Spine: "The first thing that the industry needs to tackle is the 800-pound gorilla in the room — the changing healthcare system. Insurance policies are going to change and out-of-network is going away soon. I practice out of Pennsylvania and New Jersey, and in New Jersey, 80 percent of spine surgeons are out-of-network. Spine surgeons will need to come out with a physician service agreement with hospitals, as many payers are putting pressure on hospitals to not accept OON providers or face penalties.
On the clinical side, there are a lot of new techniques coming in and I have seen a lot of surgeons jump in on those. Not every patient should be done on a minimally invasive basis, and a problem I see is over-utilization of those techniques."
David Rothbart, MD. Spine Team Texas (Southlake): "My top priority for 2017 is continuing our focus on the delivery of value-based care. Driving down cost for episodes of care while continuing to improve outcomes will continue to gain momentum as a key differentiator in the marketplace."
Thomas Schuler, MD. Virginia Spine Institute (Reston): "My top concern is preserving patient access to appropriate spinal treatments. Third-party payers and the government are preventing doctors and their patients from determining what is the best treatment for that patient's unique condition and situation. Organized medicine is not doing enough to help our patients access the best and most appropriate treatments."
Thomas Scully, MD. Northwest NeuroSpecialists (St. Louis): "Unfortunately, rather than thinking about new techniques or patient care ideas, my top priority is staying on top of Affordable Care Act mandates. We are a small private practice with three neurosurgeons and one neurologist. Having the manpower to read the endless regulations, digest them, and enact them is time consuming, onerous and not of benefit to patients. Finding a path to maintaining economic viability while still providing high quality spine surgery is the challenge."
A. Nick Shamie, MD. UCLA Health: "2017 will be an interesting year for the healthcare sector in the United States. Many changes are in store and all these changes will affect the doctor-patient relationship; a relationship which I greatly value in my profession as a spine surgeon. Most patients are blinded to these changes. And even most physicians are not involved and have to react after these changes are put into place. With any change comes opportunities and I will make sure my patients can make educated decisions about their health and spine care, so we can navigate the upcoming challenges and opportunities together. Doctors have endured much pressure from the society in the last few years and [I] hope these pressures will transform to support for the doctors so we can all take better care of our patients."
John H. Shim, MD. Shim Spine (Tampa, Fla.): "For 2017, I am working on providing even more confidence and trust with my patients. The cost of patient care is inversely related to the trust patients have in their physician. The more trust, the less likely patients will seek the need for additional testing, third and fourth surgical opinions and alternative, but unproven therapies. More confidence will lead to better outcomes.
From a private healthcare business standpoint, it may not make sense to the bottom line. Healthcare entities spending time and resources to develop that trust, only to decrease the overall expenditure for each individual patient, is contrary to many business quotas and goals. Trusting the opinion may decrease in the use of certain ancillary and diagnostic services, as well as surgical volumes. But as a nation that is increasing facing the choice between healthcare, and other priorities, Physicians must lead on providing the best and most cost-effective care for our population. That leadership starts by gaining the trust and providing the best options for our patients."
Vladimir Sinkov MD. New Hampshire Orthopaedic Center (Manchester): "My first and foremost priority is to continue taking excellent care of my patients. Beyond the obvious clinical and surgical treatments this will include continuing to educate myself about new and emerging treatments and techniques. I am also planning to continue advocating for my patients in front of the insurance carriers and CMS – fighting for approvals for surgeries and encouraging them to change their policies to stay current with the evolving science in spine surgery. I am looking forward to the repeal and replacement of Obamacare with a more reasonable health policy."
Brian Subach, MD. Virginia Spine Institute (Reston): "My top priority as a spine surgeon in 2017 remains the delivery of outstanding patient care. With the time constraints placed on physicians, the ones who suffer are the patients. They are shuffled from pain management providers to surgeons to physical therapists, without ever really understanding their problem. Many have never even seen their MRI scans or X-rays. Define the care plan in clear terms, and when surgery is called for, perform the procedure with unparalleled excellence."
William Watters, MD. Houston Methodist: "Our practice has recently been acquired by a large hospital system in the Texas Medical Center so one of my priorities is pragmatic: learning a new computer system, learning the ins and outs of being a salaried surgeon (with RVU incentives, currently) and building up new relationships with referring doctors. Current data suggests that my situation is not a unique one for this coming year. Beyond these needs I will continue to work hard on NASS committees as in the past and try to apply the lessons learned academically to improve my practice of spinal surgery and its outcomes."
Richard Wohns, MD, JD, MBA. Neospine (Puyallup, Wash.): "My priority for 2017 is to recruit several outpatient spine surgeons to NeoSpine and build the outpatient spine surgery center of the future."