Healthcare is changing at a rapid pace and healthcare reform pushes consolidation. However, hospital employment isn't the only option for independent spine surgeons struggling to get by.
Here are what some of the most prominent and entrepreneurial spine surgeons are doing to stay ahead of the field:
1. Data transparency is huge in healthcare and becoming vital to private practice survival. Individual spine surgeons can gather data on a small scale, but there are an increasing number of opportunities for surgeons to add their data to national registries as well — such as the National Neurosurgery Quality and Outcomes Database — or state initiatives like the Michigan Spine Surgery Improvement Collaboration. Some large orthopedic and spine groups, including Rothman Institute, joined together in the National Orthopedic & Spine Alliance to collect data and provide lower-cost care to large employers.
2. Learning new techniques and technology can be a great way to expand a practice. Spine surgeons with an eye on which devices and techniques provide better outcomes can incorporate them into the operating room. Better outcomes in the future will be key for marketing to insurance companies as well as consumers, becoming "preferred providers" and building a word-of-mouth reputation. Plus, as more patients research their providers online, being known as someone who uses "cutting-edge" techniques can make a big difference.
3. Become involved in information technology development. Spine surgeons traditionally spent their extra time developing gadgets for the operating room — updates to implants or new techniques — but as those opportunities slow down, new opportunities in mobile communications and healthcare IT are right around the corner. Tech-savvy surgeons are developing mobile apps for patients about spine care and incorporating iPads into their patient education material. They are advising electronic health record and practice management software companies on how to create the best platform for the spine surgeon's — or independent surgeon's — needs. Innovation in streamlining the surgical process and patient education with IT presents tremendous opportunity for the future.
4. Back pain is common among all demographics, and many people are willing to travel for the best care. Whether they're self-pay patients traveling cross-country to a world-renowned institution or rural patients making the trek into town for their appointments, it can be difficult to coordinate all care face-to-face. Many physicians — including spine surgeons — see the value in providing telemedicine consultations and resources. Spine surgeons can check in on their remote patients' progress as they go through conservative care online. Some are even monitoring their patients' physical therapy and recovery from remote locations using video cameras and the internet. As more patients travel for care and demand convenience, being known as the surgeon who connects with them remotely on their time could be a huge advantage as well.
5. There are some spine surgeons beginning to invest in ambulatory surgery centers and performing outpatient spine cases there. Minimally invasive technique and advances in anesthesia make it possible for appropriately-selected patients to return home only hours after surgery, and in some states ASCs can accommodate 23-hour overnight stays to monitor patients after more complex procedures. Surgeons are even performing fusions and disc replacements in these centers at a significantly lower cost than the hospital. As healthcare moves more toward risk-sharing payment models, ASCs could be a valuable asset to the healthcare system. Additionally, surgeons are seeing reimbursement decrease while costs for running a practice increase and ownership in an ambulatory surgery center could be another revenue stream to help them remain independent.
6. Risk-sharing payment models are an opportunity for spine surgeons wanting to lead the paradigm shift toward pay-for-performance. Payers are looking for hospitals and health systems to partner on bundled care, but individual physicians can get in on the action as well. SpineCare Medical Group in California is working on reasonable bundled payments with payers and a number of other large physician groups are gathering data to lead the way in their markets. Bundled payments take careful planning and dedication, but with the right advisors spine surgeons can benefit in the long run from forming a relationship with payers today.
7. Alignment is a key buzzword in healthcare, but not everyone is effectively making this change. Spine care involves many different specialists and sites of care, from physical therapy, chiropractic and interventional pain management care to the surgeon's office and ultimately the hospital or ASC if the patient needs surgery. In a perfect world, these specialists would align and communicate perfectly, but even in some hospital departments where everyone is centrally located, chaos ensues. It's more difficult when a private practice physician is referring to others across town for imaging, PT and pain management. Bringing these specialists into the same organization can do wonders to improve patient care and satisfaction. If that's not possible, at least form a healthy working relationship with the other specialists so everyone rows the boat in the same direction.
8. The most entrepreneurial-minded and big-idea surgeons will take leadership positions of their practices, in national societies or among local politicians to have an impact on where healthcare heads in the future. Many practitioners were blindsided by healthcare reform and are now begrudgingly becoming part of the post-ACA world, with increasing challenges for independent physicians. However, that doesn't mean the future is set in stone. Passionate physician advocates are lobbying for a seat at the table during important healthcare discussions to make sure patients have access to efficient and effective care. They are also becoming medical directors and CEOs of large practices or healthcare organizations to bring a practitioner's perspective into the business and politics of medicine. These leadership positions afford surgeons the chance to change healthcare on a large scale and leave a lasting legacy for the independent physicians who follow them.
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