Jonathan Gottlieb, MD, of Miami, Fla.-based Minimally Invasive Spine Center of South Florida is a board-certified orthopedic spine surgeon specializing in the treatment of spinal stenosis, back pain and radiculopathy among other conditions.
Dr. Gottlieb served as an assistant professor at the University of Miami School of Medicine for six years and is a member of the North American Spine Society, American Medical Association, American Academy of Orthopaedic Surgeons and Florida Orthopaedic Society.
Here, Dr. Gottlieb discusses new payment models in spine and goals for the near future.
Question: How do you see new payment models such as bundled payments developing in spine?
Dr. Jonathan Gottlieb: I think at some level we are always striving towards efficiency whether it's in the operating room or when it comes to the best value for your dollar. There are a number of measures that are utilized to determine whether we are offering value-based care. But at the end of the day, it is going to be incumbent upon us to deliver a certain quality of care within an allocated number of dollars given to us. If somebody says, 'do what you need to do and let me know the cost,' in most cases it's going to cost more. But if you have an entity that says you have 'x' amount of dollars to complete the procedure, you will look for the most efficient ways to do it and I think invariably there will be cost savings in the system. It will put pressure on the people who are the least efficient and the ones that consume the most resources without providing anything meaningful in return.
Q: Are there any goals you're looking to achieve in your practice the near future?
JG: Unlike the trend for most physicians, I'm not part of a big group or employed by a hospital. I'm trying to find the most efficient ways to deliver good care but in a solo practice model. It's interesting: on the one hand, everyone wants to go to the doctor that can spend 30 minutes with them but on the other hand, your insurance company doesn't really want you to go to that doctor because you have a contract for a much lower rate with somebody else.
I have to be able to demonstrate to the patients and payers that what I am providing in time and service outweighs the additional cost incurred by patients coming to see me. But at the same time, I think it's important for all of us in medicine not to capitulate the power that we have to the payers. Keep the matter in this relationship between the patient and the physician; everybody else is really secondary.
The direction that we're going in in healthcare, invariably everybody Is going to know your scorecard as a physician. They're going to know our outcomes, how much we cost and whether people like us or not. I think that's good because it results in a more competitive marketplace. The more competitive it is, I think that quality of care will improve and be more efficient over time.