New technologies and techniques continue to benefit spine surgeons and spine patients and will help drive the industry in the future.
International Society for the Advancement of Spine Surgery's Coding and Reimbursement Task Force Chair Morgan Lorio, MD, of Hughston Clinic in Nashville, Tenn., discussed opportunities and challenges in the industry's future with Becker's Spine Review.
Question: How has the spine industry evolved over the past decade? Where do you see the industry heading?
Dr. Morgan Lorio: We have seen tremendous innovation in spine surgery in the last decade, however the cost of research and development is extremely high and thus, most innovation has been industry driven, not government/institutional driven.
Surgeons are still in the best position to conceptualize new techniques and technologies based on their clinical experience. However, once the idea is conceived, there is a gigantic amount of work to be done to get a product to market.
New technologies require a tremendous amount of engineering effort, regulatory investment, as well as the development of a significant amount of clinical evidence to achieve payer coverage. The bar is higher now which means it takes longer to do all this work; so the overall cost to bring a product from idea to full
commercial availability has risen dramatically.
As to specific technologies, I think 3-D printing in particular will play a much larger role in spine surgery in the next decade as we have a stronger push toward patient-centered medicine.
Q: What challenges will spine surgeons have to overcome in the next 10 years? Are the developments of minimally invasive surgery hindering physicians?
ML: There are many benefits to minimally invasive spine surgery for patients and surgeons alike. The challenge is ensuring proper valuation and reimbursement of these procedures so that patients have wide access to high-quality surgeons with extensive training in these techniques. In some cases the length of the
procedure may be shorter than open surgery, but the intensity and skill set required to deliver quality outcomes is much higher. The valuation and reimbursements of minimally invasive spine procedures often don’t reflect this difference. Emerging technology/minimally invasive surgery is expensive to develop,
intensely challenging to perform, and proven beneficial to the patient and the hospital; it should be valued appropriately so as to ensure broad patient access. As a group, surgeons will need to work hard to make sure that the relevant stakeholders fully understand this issue over the next 10 years.
Q: How has the introduction of bundled payments affected spine surgery? What trends do you see between spine surgery and bundle payments?
ML: We have not yet seen mandatory bundled payment programs for spine surgery similar to the mandatory joint replacement models (CJR) coming from CMS. Spine surgery is very nuanced, with marked heterogeneity, and thus cannot easily be standardized to a one-size-fits-all model. Bundled payment initiatives
must be surgeon-focused and surgeon-driven if they are to work for all.
Q: What work has the International Society for the Advancement of Spine Surgery done to promote and develop the spine industry?
ML: ISASS has been and remains the best forum for surgeons to come together to advance the science of spine surgery. Whether a surgeon is looking for cutting-edge, hands-on educational courses, advocacy with payers and regulators, or a high-quality, research-focused annual meeting, ‘ISASS has your back.’
ISASS is an organization that sets the politics aside and gets concrete things done to help spine surgeons do their best job while providing the best spine care for patients.