There is one major thing that orthopedic, spine and neurosurgeons can all agree is wrong with the musculoskeletal industry: red tape.
From prior authorizations to bureaucratic data and metrics reporting, seven surgeons told Becker's what they hope will change — and soon.
Question: As an orthopedic/spine/neurosurgeon, what is one thing you would change about the industry?
Roy Sanders, MD. President of the Florida Orthopaedic Institute (Tampa): Prior authorization is a waste of everyone's time.
Robert Nucci, MD. Orthopedic Surgeon at AdventHealth and Nucci Medical Center (Tampa, Fla.): Requiring authorization by non-physicians that follow a one-size-fits-all algorithm that has little or no basis in current medical practice as a way to deny medical care to patients.
Lali Sekhon, MD. Neurosurgeon at Reno (Nev.) Orthopedic Center: I would remove prior authorization. I have worked in systems where it does not exist and the delivery of care is more efficient, and the percentage of GDP spent on healthcare is less. This would streamline care, reduce overhead for practices and presumably payers, and improve delivery of care.
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: I would have the Centers for Medicare and Department of Health and Human Services publish the data, if any exists, of the different metrics and benchmarks surgeons have been following over the past 12 to 14 years and see which, if any, have positively affected patient outcomes. And, if none have, then we need to go back to basics. After over a decade of receiving the stick over the carrot, I think a lot of surgeons are burnt out and are having trouble with the idea of checking boxes for benchmarks with no evidence that they're helping our patients. To me, at least, it seems like a waste of time, and more importantly money. If you are really cynical, you would think it's just a way for third parties to make money off these guidelines and benchmarks.
Ali Mesiwala, MD. Spine Surgeon at DISC Sports and Spine Center (Newport Beach, Calif.): The methodology through which new technologies are introduced to spine surgery has become increasingly problematic over the last several decades. A combination of increasing government regulations, coding problems with insurance reimbursement, and an overall mistrust of the industry has prevented many innovations from being brought to patients. While it is important to ensure patient safety, and provide technologies and implants that have been thoroughly tested, many advancements are never brought to market because of the reimbursement system that exists in the United States. If new technologies cannot be covered by existing CPT codes, then T codes are issued, and that often leads to a suspension in clinical activity since reimbursement cannot be predicted or guaranteed. Similarly, the increase in cost of investigational trials makes new technologies extremely difficult for small companies to bring to the market. There needs to be a more efficient and comprehensive system through which new technologies can be brought from the bench to the bedside, while not penalizing surgeons for offering the latest advances in medicine to their patients.
Adam Bruggeman, MD. Orthopedic Surgeon at Texas Spine Care Center (San Antonio): I would change the influence that institutions are having on the practice of medicine. From healthcare systems that have directed care through financial incentives and employment contracts to insurance companies that arbitrarily develop coverage criteria and intrusive prior authorization requirements, the patient-physician relationship continues to deteriorate. This has led to delays in care, patient harm, physician burnout and ultimately suboptimal healthcare outcomes in the name of profit margins for (mostly) publicly traded companies.
Kevin Pauza, MD. Founding Partner at Texas Spine and Joint Hospital Baylor (Tyler): Spine regenerative medicine is the fastest growing area of spine, and the industry needs to know that not all spine regenerative medicine is equal. There's a deserved bias against spine regenerative medicine because most lack supporting research. It's for this reason I'd like the industry to know that some spine regenerative medicine is supported with excellent long-term safety and efficacy data. For example, research supporting fibrin of the Discseel procedure was awarded a NASS outstanding paper. This and other evidence contributed to the VA and Department of Defense awarding its largest spine contract to provide training and the Discseel procedure to all veterans and military personnel.