It is no secret that spine surgeons are facing increasing regulatory burdens and, at times, seemingly arbitrary pieces of legislation. Three spine surgeons discuss what legislation they would change and why.
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 are some of the most positive trends in spine surgery today?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, July 30, at 5 p.m. CST.
Question: If you could change one piece of legislation governing spine surgery, what would it be and why?
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: There has to be regulation in place for insurance companies. Unlike auto insurance, there is no regulation for medical insurance. They charge what they want and establish the fee schedules as they want.
There needs to be a medical panel and denials need to go to panel to be reviewed. There needs to be a limit for what they can charge and a certain schedule they have to follow.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I think the unending bundling of codes is an unfair business practice. There are portions of any spine surgery that require expertise and know-how. The diminishing reimbursement and bundling of codes speaks to the under-valuating of what we do.
Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: I would eliminate the certificate of need. Certainly, hospitals will argue the end of the world is upon them if such a measure would pass. Clearly that has not been the case in the dozens of state that do not have such a requirement. Institutions that can only survive in the absence of competition are not likely league leaders in efficiency, outcomes, cost containment, value, etc., which begs the question of whether those institutions are the ideal locations for healthcare delivery.
If everyone really wants to get serious about cutting costs while also improving quality in the healthcare arena, then competition should be welcome. It is the best way to promote value in the marketplace. The consumer would have a true choice for his or her own healthcare, and those choices would help shape the system. Institutions having eight tiers of management and layers of red tape and bureaucracy would not survive.
Everyone would be tasked with placing their primary focus on the patient and allocating as few dollars as possible to things that hurt outcomes, efficiency and satisfaction. Resources would be allocated to the patients where they belong. I've never heard anyone talk about how cost-effective a product or service became after creating a monopoly or eliminating choice in the marketplace.
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