"Partnerships" is the name of the game in healthcare today. Different entities are aligning, collaborating and merging to better serve patients and make the United States' healthcare system more sustainable.
Spine is no different. There are several examples of spine surgeons collaboration today, some that have been around for decades while others are unique to the 21st century:
• Hospital and service line partnerships — sometimes co-management
• Industry partnerships to develop or educate about devices
• Payer partnerships in bundled payments or narrow networks
• Software developers on electronic data gathering and app development
• Neurosurgeons and pain specialists for patient care
• Web development and marketing coordinators on websites
Regulatory changes and increased oversight make even surgeons in appropriate relationships weary. "It's becoming more and more difficult to do things with device companies," says Scott Blumenthal, MD, co-founder of Texas Back Institute in Plano. "The companies are being over-regulated."
But while industry relationships are becoming more difficult, clinical relationships are becoming easier and more common. They are centered around similar quality and cost saving goals.
"Surgeons are partnering with institutions more than in the past and moving toward cost-sharing," says Sheeraz Qureshi, MD, MBA, Orthopedic Surgeon, Minimally Invasive Spinal Surgery, Icahn School of Medicine at Mount Sinai in New York City. "Certainly there is a trend that more and more surgeons are becoming employees of institutions or have an institutional tie. In the past, surgeons didn't consider the costs for new technology or specific screws and plates. But as hospitals increasingly involve surgeons in the decision-making process, we have shown cost-savings through gain sharing initiatives."
Many of the hospital partnerships contractually align physicians — employed or independent — to hospital administrators toward the shared goal of lowering hospital costs. When overall costs are down, the hospital can put more resources into new technology, microscopes and other initiatives to improve patient care.
"We have more of a reason now to look at different implants and consider whether we need one that costs more," says Dr. Qureshi. "Most of the time we can use something that costs less. Uniformity in products allows for a more cost-effective procedures as well. It's important for the surgeons and the hospitals to be on the same page when dealing with implant companies to get the price down. For us, whenever companies come in we have a set price we'll pay for certain devices. They can bring us whatever technology they have, but we're paying one price."
Beyond cost-sharing options, surgeons are taking more time out of their clinical practice today to sit on hospital committees. The hospital's overall goal is to improve quality for a reduced cost, and surgeons are becoming part of those leadership teams on committees.
"At many hospitals, a new thing is the 'Value Committee,'" says Dr. Qureshi. "Value in general is a newer term and almost every hospital has one now. Hospitals also have technology committees, which they didn't have before, and the chief technology officer works with surgeons across the hospital and health system on data initiatives."
There is also more collaboration between specialists. Orthopedic spine surgeons are working more with neurosurgeons to compliment their surgical expertise as well as interventional pain physicians and other nonoperative specialists.
Hospitals and large groups are able to bring all spine specialists together on one floor or campus.
"The orthopedic spine patients used to go to one floor and the neurospine patients to another, but now they are all going to the same floor," says Dr. Qureshi. "We found it decreased length of stay and increased our Press Ganey scores for patient experience. There are clearly efficiencies from bringing specific types of pathologies together. The nurses are also all on the same page and everyone is in tune with what should happen at every point of the patient's stay."
Surgeons are now also able to look beyond their borders to form relationships with surgeons overseas. "We're seeing more interaction between surgeons in different countries and we're potentially heading toward formal relationships with surgeons across the globe," says Dr. Blumenthal. "I meet once per month with a group of surgeons from countries like South Africa and China to create joint research programs. Global partnerships amongst practices is a new trend and something we'll see in the future."