Stephen Hochschuler, MD, co-founder of Texas Back Institute in Plano, discusses the best opportunities for spine surgeons and practices to thrive in the future.
Q: What do you see as the best opportunities for spine surgeons to expand their practices today?
Dr. Stephen Hochschuler: As we are aware, everything is changing right now. Will ObamaCare stay in place? There are some changes that will definitely be here no matter who wins the presidency. We'll still have quality metrics and efforts to deliver better care for lower cost and data analytics will play a bigger role.
We'll track everything from judging the physician's results as compared to others in the practice as well as in the regional, local and national databases. Everything is measured, so the sooner spine surgeons and practices recognize this and start producing their own data, the better off they will be.
Data can be sliced and diced in many different ways and insurance companies have your data already. One of the key measurements they are looking at is patient satisfaction, which goes far beyond what the surgeon is doing. The patient takes their office experience into account and wants everyone to treat them well.
There are several big companies trying to figure predictive analytics out; right now we only have retrospective analytics. We are trying to figure out what you can predict of a spine problem reoccurring, whether rehab will be necessary and the risk for complications. The whole arena of predictive analytics will be huge. It is an opportunity as well as a potential problem.
Q: How will data gathering and reporting change healthcare?
SH: The data is worth a lot of money. Surgeon will be measured whether they like it or not. The whole IT arena is so important and it allows us to think of integrating points of care. Unfortunately in spine, many surgeons haven't started using advanced technology to provide integrated and comprehensive care. Telemedicine is a fantastic opportunity and there are even surgeons in my group who don't see it.
We are also moving toward global fee, or episodes of care, and practices must understand their costs. When we make that transition to cost-effective care, telemedicine becomes a great tool because you can track your patients at home right from an app on their phone. You can find out how they are feeling, gather their VAS score and figure out whether they are running a fever so you can treat them before they need to be readmitted.
Telemedicine also saves space. If TBI has to open another office, we have to rent or buy space. But what if in the future we used a telemedicine portal in a chiropractor’s office and now that chiropractor can say he is an affiliate of our group. His patients can get to see their chiropractor and if there is a problem they can consult with a TBI physician and we can order medicine or an MRI. The patient won't have to travel back and forth between specialists.
There are also telemedicine opportunities for physical therapy. Right now, in most states, patients need to see a physician before they are able to attend physical therapy. What if instead I made the best physical therapy clinics affiliates of TBI and we can order their PT over Skype. Then if the patient needs further treatments—injections or sterile rehab—we can work that out.
Q: Are there any technologies or techniques you're excited about in the future?
SH: There is big opportunity in regenerative medicine studies. I don't believe you will be able to regenerate a disc, but you might be able to treat certain back issues with stem cells based on anti-inflammatory capability.
The other trend I'm seeing is robotics. It was a feeding frenzy initially with Stryker acquiring MAKO and now Medtronic is putting $20 million into Mazor robotic technology for spine surgery. Zimmer Biomet bought Medtech, which includes the ROSA robot application for brain and spine surgery. The accuracy is improved with the right robot and it becomes a marketing tool so if you don't have one, you want one.
Every other company is looking at this and trying to keep up with the changes.
Q: How is healthcare delivery changing?
SH: The biggest changes are in the IT space. There are global fees and episodes of care that will be huge. There is big opportunity, but will mean limiting risk. You have to figure out what your costs should be and associated factors, including hospital, anesthesia, postoperative rehabilitation and infection costs. Anything that will cut down risk is a huge opportunity.
We are also seeing surgeons send patients to prehab to get them in shape before surgery because they will have better outcomes.