Zoher Ghogawala, MD, president of the North American Spine Society, is looking at the year ahead as an opportunity to unite specialties amid increased economic headwinds and CMS challenges.
Dr. Ghogawala, who was named president of NASS last month, spoke with Becker's about his aspirations in his new role and what excites him in the spine industry.
Note: This conversation was edited for clarity.
Question: What do you hope to achieve in this role?
Dr. Zoher Ghogawala: I'm really looking forward to this role, and I see the key priorities for NASS as being a society that focuses upon how to bring innovative new spinal treatments to patients, and by working with researchers, bringing the evidence to our annual meeting, working with industry and bringing other key stakeholders into the equation, I think NASS is ideally suited to advocate for the the development and ultimately the the delivery of innovative spine strategies to patients.
Q: Are there any particular innovative spine treatments that you are eyeing to get to a wider audience?
ZG: I think that there is a lot that we need to understand about motion preservation, and I think there's a lot of innovation being done in this space that will allow patients to be more active and a return to productivity after spinal surgery in ways that we did not have available to us in the past.
Q: When you think about motion preserving surgery with the technology and techniques that are available right now, what's going well in that area and where do you see the need for more improvement?
ZG: What is really emerging as a new strategy for patients with neck problems is a procedure called laminoplasty, which recent evidence suggests that patients treated with it have preservation of their motion in their neck after surgery, have less requirement for opioids, return to work faster and ultimately have a superior health related quality of life compared with more invasive strategies to treat patients with cervical spine disease.
Q: And what are some other top concerns among NASS members, and what are your plans to address them?
ZG: One of the chief concerns among members is prior authorization and access to care. NASS is very committed through its work in advocacy to help policy and lawmakers understand that we've got to reduce the barriers for pre-authorization, and we've got to have a more streamlined process by which patients who need spinal care can get it. What I would like to see happen, as NASS president, is working closely and collaboratively with organized orthopedic groups, as well as organized neurosurgery groups to present a united voice to the government as well as other key stakeholders in advocating for our patients.
Q: How much have these organizations such as the American Association of Neurological Surgeons or the American Academy of Orthopedic Surgeons collaborated so far? There's probably some overlap among some NASS members.
ZG: Yes, we have overlap. What I think we will see happen during this year with NASS is that we will actively work with the AANS and AAOS to unify our positions on points that relate to access to care. We plan to have more meetings with the leaders of these organizations and have them participate in our annual meeting so that we have greater visibility as a united front.
Q: What other areas of advocacy are you hoping to strengthen?
ZG: So I think that NASS has always been very interested in the patient perspective and in the ability to return to productivity and return to work. This is going to be one of the themes at next year's annual meeting for NASS — how do we work with employers, with payers and the government to develop strategies for patients with spinal disorders to get them back to work quickly? This is one of the most important things to patients as they're contemplating surgery. When is the patient going to be back to normal productivity and back to work? These are things that NASS is really going to be focused on in the next year and beyond.
Q: What are some of the unique challenges for spine surgeons when working with employers?
ZG: One of the challenges is that individual patients have different medical conditions that respond differently to surgery, and that's where we need to collaborate with the American Spine Registry and other important registries to develop better predictive models for patients who are undergoing spinal surgery, so that we can give individual patients more accurate assessments of their recovery process from surgery. There's tremendous opportunities for us to do this. The Cervical Spine Research Society has an important registry. The American Spine Registry is important because they record patient reported outcomes as well as return to work. As we put these types of data together, we're going to have a lot more very valuable information for patients and their doctors.
Q: Can you talk about some of the research that you've been involved with this year? What are some interesting findings?
ZG: I've always been very interested in the condition known as Grade 1 spondylolisthesis. A few years ago, along with several other spine surgeons and members, we did a randomized controlled trial that demonstrated that patients with Grade 1 spondylolisthesis benefit from a spinal fusion when compared to patients treated with decompression alone. However, there have been European studies looking at this same topic that suggest that patients who are treated with a decompression do just as well as patients with a spinal fusion. So I've been involved in some ongoing research that is trying to look at the specific characteristics of individual patients so that we can better tailor the right operation for the right patient. This will be presented at next year's NASS annual meeting, and we're very, very excited about it because it's a collaborative effort between NASS members, orthopedic surgeons and neurosurgeons all focused on trying to find what's the best treatment for patients with Grade 1 spondylolisthesis.
Q: What other healthcare trends that you've been following closely lately?
ZG: One of the things that we're all very focused on is cost-effectiveness. I'm also involved with Rob Whitmore, MD, who is a leading neurosurgeon who's focused on understanding cost-effectiveness. He is looking at different cervical spine operations and which operation is most cost effective in our society by not just looking at the cost of various spinal implants, but looking at some larger concepts such as return to work, lost productivity, as well as other health resource utilization after surgery.
What he does is he looks at how much physical therapy a patient needs after surgery, how many doctor's visits do they have after surgery, how often they have to go for an X-ray after surgery, and then compares different surgical strategies to see which one is associated with less overall health resource utilization with superior outcomes. That's also going to be a very exciting development in the next year to have that data come forward.