The needs of spine surgeons and the needs of hospital leaders are unique, and this can lead to challenges in conversations between the parties.
Spine surgeons discuss what they want more of from these conversations.
Note: Responses were lightly edited for clarity.
Question: What's missing in spine surgeon conversations with hospitals?
Rachel Bratescu, MD. Weill Cornell (New York City): Conversations between spine surgeons and hospitals often lack the alignment of common goals or objectives which can cause friction between surgeons and administrators.
The first example occurs on examination of surgeon quality metrics, where hospitals can place undue pressure on surgeons when looking at objective measures such as complication rates and hospital length of stay. This scrutiny often lacks recognition of an adult deformity surgeon, for example, who performs high risk and more complex cases, which should not be weighed in the same manner as a surgeon who performs primarily more straightforward one- and two-level degenerative cases. Understanding the surgical indications and mutual understanding of pre-operative risk and expectations can help better align hospital and surgeon goals.
The second has to do with the adoption of and investment in new technology. From a hospital perspective, the acquisition of new equipment such as an intraoperative navigation system or robot is seen often as purely cost-based and at times a superfluous surgeon request. When in reality, the integration of these technologies often enables us to perform cases in a safe and often less invasive manner which can enhance patient recovery. A better shared understanding of the role of these emerging technologies and their influence on at least short-term patient outcomes when considering a surgical approach is integral to the alignment of surgeon/hospital goals and values.
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): What is missing in the conversations that hospitals are having with spine surgeons is the hospitals highlighting the importance and recognizing the value and contributions that spine surgeons bring to the hospitals. The hospitals should work to provide respect and appreciation to surgeons and work to foster a positive working relationship and ultimately benefit patient care. Hospitals should acknowledge the revenue that surgeons generate and show gratitude for their expertise and dedication to their work. Open communication and mutual understanding can lead to a more collaborative and successful partnership between hospitals and spine surgeons.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: One word. Transparency. It's hard to sit as partners at a table when all the information is not shared except as a 'need to know' basis. How much revenue we bring in is a starting point. No one wants us to know because it gives us leverage in negotiations. Lack of transparency allows hospitals to ask for more concessions!
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In our immediate locale, the conversational avoidance of physician/provider financial contribution to a hospital system or institution is almost taboo in its initiation or relevance when it applies to potential employment or contractual negotiation. RVU declarations to hospitals and physician's alike are well delineated and vary widely according to specialty. Neurosurgery and complex spinal disorders diagnostic codes are currently amongst the remaining apical reimbursement profiles afforded to surgical centers of care. This information and its transparency should be shared among all participants as strategies/prospectus can also be built on this data.