Here four spine surgeons discuss the non-patient issues that pose the greatest challenge to their work.
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.
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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Sept. 16, at 5 p.m. CST.
Question: What are the most challenging non-patient issues facing spine surgeons today?
Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: External forces upon the private physician are significant. Consolidation of practices and hospitals make it increasingly difficult to remain independent. Contracting with payers, and frankly, retaining access to hospital privileges can be a challenge. One must maintain a constant effort to grow to remain in business.
Thankfully, a practice that can evolve can survive and find opportunity. Additionally, there is greater overhead for administrative and regulatory compliance issues. More staff is required to deal with the same number of patients, hence overhead is on the rise and at the same time reimbursement is falling. The practices that ride the current wave will be very strong and poised well for future growth.
J. Brian Gill, MD, MBA, Nebraska Spine Hospital, Omaha: Where do I begin? Government regulations, insurance regulations and continually changing insurance coverage criteria are just a few of the challenges. With all the changing regulations, spine surgeons need to continue to show value in the care we provide through cost efficiencies and improvement in outcomes.
Alan S. Hilibrand, MD, Co-Chief, Spinal Surgery, Vice Chair of Academic Affairs and Faculty Development, Jefferson Medical College/The Rothman Institute (Philadelphia): The most challenging non-patient issue is remaining within the orthopedic or neurosurgical home for surgeons who commit 100 percent of their practice to spinal surgery — getting coverage from non-spine surgeons, sharing practice revenues and expenses, sharing residents in training programs, etc.
Jeffrey C. Wang, MD, Co-Director, USC Spine Center, Keck Medicine of USC, Los Angeles: I think the most challenging non-patient issues are the increasing requirements placed upon all surgeons for using EMR, documentation, paperwork, getting authorizations, meaningful use requirements and other tasks that we have to do — but we need to utilize our own time and resources to handle this work. This burden makes us less efficient. Certainly, we all adapt, but I am concerned about future changes and further impositions that will be placed on the surgeons. It is a challenge for both physicians and surgeons to stay on top of all the requirements and make the necessary changes to their practice. I am concerned not only about the current spine surgeons, but perhaps more concerned about future spine surgeons. They should choose a career in this area in order to develop relationships with their patients and help their patients with their pain and symptoms.
I worry that this will become a barrier to keeping the brightest of the younger generation from considering this career path. People should become spine surgeons to interact with their patients and perform surgeries that will help them try to alleviate their symptoms, not to spend their time on the phone and filling out paperwork all day in order to allow some administrator to make the decision regarding what medical care is appropriate and will be authorized.