Five spine surgeons discuss trends in spine surgery and the industry that will gain traction in the coming year.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What, in your opinion, is the most challenging aspect of the Patient Protection and Affordable Care Act roll out for spine practices?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Jan. 29, at 5 p.m. CST.
Neel Anand, MD, Spine Surgeon, Cedars-Sinai Medical Center, Los Angeles: One trend is minimally invasive spine surgery, another is biologics and a third is cost containment. Whatever we do there has to be cost containment.
Eventually it boils down to the fact that new technology is often stalled. New technology that has no precedent has difficulty getting into the market because of the cumbersome U.S. Food and Drug Administration approval process and because it is difficult to get reimbursed by insurance companies.
Paul Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: Spine surgeons always remain interested in emerging technologies to achieve improved clinical outcomes. There is a trend away from plastic interbody spacers and a strong interest in titanium as a surface which has favorable bone healing qualities. Spine surgery is now finally looking at the interbody implant as more than a simple spacer. This mirrors a trend [that] occurred several years ago when oral surgeons and total joint surgeons focused heavily on the surface characteristics of their implants to achieve better bone integration.
Also, the trend of cost-efficient and clinically effective care will emerge much more so in 2014, as reimbursement patterns shift the financial risk to surgeons and hospitals.
Hooman Melamed, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: Given all the recent changes in healthcare and more pressure to cut costs, [it is] more likely [that] more surgeries will be done with more traditional bone grafts such as iliac crest and cadaver bone with bone marrow aspirates rather than much more expensive bone substitutes and other commercial bone grafts.
The other issue to examine is the financial cost, saftey and overall patient outcome of minimally invasive correction of scoliosis versus more of traditional open correction. We need more data to determine which option is in the best interest of patient's quality of care.
Alpesh Patel, MD, Associate Professor in Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago: I think there are probably going to be two major trends — the movement of spine surgery care into the ambulatory setting and that spine care will be heavily influenced by changes in payment strategies. There will be a move towards bundled payments, and other types of payment models, which do not have a wide variation in cost. The current system we have is one in which there is a lost of variation in cost.
There will be dramatic changes in the next few years in terms of spine and neurosurgery. All this is in an effort to improve quality of work that we do and to improve outcomes for the patient.
Sanjay Khurana, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: Insurance companies will start requesting outcome data from physicians to support their reimbursement for a variety of increasingly complex procedures — both motion preservation and fusion.
Additionally, insurance companies will scrutinize the increasing use of ASCs for such procedures and the benefits from a patient safety, satisfaction and cost perspective.
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