From anticipated payer challenges to Trump presidency expectations and more, several experts in spine and orthopedic surgery shared their insights with Becker's during the fourth quarter.
Five quotes to know:
On anticipated payer challenges in 2025
Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): "In 2025, spine surgeons may anticipate several payer challenges, including:
1. Value-based care models: As healthcare shifts toward value-based care, spine surgeons will need to demonstrate the effectiveness and cost-efficiency of their treatments. Payers may require more evidence of outcomes and patient satisfaction to approve procedures.
2. Prior authorization requirements: There may be an increase in prior authorization requirements for spinal surgeries and related interventions. Surgeons will need to prepare for potential delays in treatment while navigating these processes.
3. Cost transparency initiatives: With a growing emphasis on cost transparency, spine surgeons might face pressure to provide clear estimates of procedural costs, including all associated fees. This could necessitate adjustments in how they discuss financial aspects with patients.
4. Changes in reimbursement models: Payers may continue to revise reimbursement models, possibly reducing payments for certain procedures or shifting toward bundled payments. Surgeons should stay informed about these changes and adapt accordingly.
5. Regulatory and policy changes: Ongoing changes in healthcare regulations and policies can impact how spine surgeries are reimbursed. Staying updated on legislative developments will be crucial for surgeons to navigate the payer landscape effectively.
By being proactive and understanding these challenges, spine surgeons can better prepare for the evolving healthcare environment and advocate for their patients effectively."
On how spine surgeons can thrive in 2025
Michael Boblitz, CEO. Tallahassee (Fla.) Orthopedic Clinic: Know your market and understand where the opportunity and your business is. Really stay laser focused on where you have opportunities, and don't hesitate to take advantage of those opportunities. Another thing I've really focused on at TOC is recognizing that no matter what your strategy is, it's your people that really power that strategy. When I came to TOC we didn't have an entirely engaged culture. So I worked on a new strategy and purpose and shared the vision with all of our workforce. Values are something that's often forgotten.
Going to TOC I knew that I needed to create engagement, and I needed a workforce to really power our strategy. Our values are pretty simple. It's POWER. P is for 'passion.' O is for 'ownership.' W is for 'we, not I' because it's a team. E is for 'excellence' because we have to be great in this environment. R is for 'recognition' because if our workforce does all that, the least I can do is to recognize the great work that our people do every day. Creating that POWER culture to help fuel our strategy and doubling down on the importance of our workforce is huge advice that I would give to any leader in the industry.
On new technological advancements
Rachel Bratescu, MD. George Washington University Hospital (Washington, D.C.): No. 1 is don't be afraid to try new technologies, think outside the box and think about ways that you can constantly be improving from a surgical standpoint or offering less invasive options when that's appropriate.
No.2 is to take a patient-centered approach. It's very easy to get caught up in what surgeries you could do for a patient and the whole thought process of everything. But you really have to consider what the patient wants, what's best for them and what's going to help them reach their recovery goals.
What a Trump presidency means for spine and orthopedic providers
Brian Fiani, DO. Spine surgeon. (Birmingham, Mich.): A second Trump presidency could have various implications for spine surgery and practice management, particularly in terms of healthcare policy and regulations. If previous policies are reinstated, we might see changes in reimbursement models, which could affect how spine surgeries are funded and managed. Additionally, there may be a push for more deregulation, potentially impacting quality control and reporting requirements in surgical practices.
However, it's also important to consider the potential for increased focus on specific healthcare issues, such as opioid management and pain management strategies following surgery, which could shape practice protocols and patient care standards in the spine surgery field. Overall, the exact impact would depend on legislative priorities and the political climate at the time.
Vladimir Sinkov, MD. Sinkov Spine. (Las Vegas): While it is nice to dream, realistically I do not expect any significant changes. The $4 trillion U.S. healthcare industry is very complex. There is a lot of money to be made and the powers that currently control this system (the government, insurance companies, and the hospital systems) are very unlikely to allow the system to change or improve in any significant way. So the reimbursements are likely to continue to decrease, regulations are likely to continue to become more burdensome, and the physician's independence is likely to continue to decline.