I had the great privilege to talk at Richard Wohns’ Mazama Spine Summit 2018.
Richard Wohns, MD, has developed this event into a mini Davos-World Economic Forum of spine. People ask me how can you fly and drive nine hours to give a 15 to 30 minute talk and drive right back and I tell them Richard Wohns. Richard is loyal, brilliant, motivated and more. A Harvard Medical School grad, a black belt and a climber of the Himalayas, he also manages to have his adult children come back to the Mazama mountains and participate in the conference. Amazing.
On ASCs and spine we note as follows.
1. Growth of outpatient spine cases in the last 10 years from 5,000 to 300,000 cases, moving from a few percent to nearly 50 percent of spine cases being performed outpatient.
2. Spine device companies are still making plenty of money.
3. A transformation of payer-hospital relationships with increasing breakdowns in this very cozy traditional relationship.
4. ASCs and spine are a mixed bag, in part due to the relationship between hospitals and payers, and how much payers rely on hospitals for the supply side of medical care. Payers are still cautious about letting ASCs in even if they are cheaper.
5. United/Optum acquiring SCA and employing 40,000 doctors demonstrates a sea change in payer-hospital relationships.
6. Spine-focused ASCs tend to do well if built rationally, supplemented by a pain program or other specialties; the centers can be in-network and efficient. There are also some chains that still operate out-of-network but they are feisty and face challenges. Most don’t. Some great practices are still self-pay only.
7. The opioid epidemic will have a crazy level of fallout for some large companies that arguably really contributed to the epidemic. Who would have thought that Rush Limbaugh’s well-publicized problems with opiates would be a kind of canary in the coal mine as to opiates.
8. Healthcare reform remains tremendously uncertain. In the mean time, more pay is from the government in one way or another than ever before. Practices need to keep blocking and tackling and keep their eyes open; big disruptions are coming from outside healthcare and from the change to hospital-payer relationships.
9. Medicare adding spine codes to the ASC payable list is a net positive, but it has had a marginal impact at best on spine-driven ASCs.