Nima Salari, MD, partner at Desert Institute for Spine Care in Phoenix, is a spine surgeon at the early end of his career. He discusses how recent healthcare technology and policy trends are affecting his practice and where he sees the best opportunities in the future.
Question: What are the biggest concerns for your practice today? What keeps you up at night?
Dr. Nima Salari: The healthcare landscape is ever-changing. There is continual uncertainty on the horizon and we try our best to keep up with increasing consolidation and narrowing networks.
With the implementation of MACRA, we were early participants in the voluntary episode payment model with bundled payments aimed at fostering affordable, accessible healthcare that puts patients first. The more efficient coordination of care and use of healthcare expenditures is a welcomed opportunity we hope to share with all patients.
It remains to be seen how value care systems will be implemented more broadly as commercial payers show more interest.
Q: What are you most excited about in terms of technology advancement in the spine space? Where do you see the best opportunity for growth?
NS: There is tremendous buzz around improved navigation technology and the emergence of robotics in spine surgery. We will see the technology further the adoption of minimally invasive techniques as it increases safety, accuracy, and reproducibility all while reducing radiation exposure to the patient and surgical team.
My concern, however, remains the capital expenditures required to implement such technology. The push to move care delivery to outpatient surgical centers and optimize cost savings is in direct contrast to this type of advancement.
Patient-matched 3D-printed drill guides carry the same promise of increased safety, accuracy, and reliability, but at a fraction of the cost. Medacta International first hit the scene with this technology for open screw placement in large deformity cases. Its latest line of drill guides take advantage of the cortical screw trajectory via a minimally invasive midline approach. The radiation exposure is minimized by obtaining a low-dose CT scan of the lumbar spine to create the patient-matched drill guides. Intraoperative fluoroscopy use is minimized, limited to final confirmation of implant position. This technology can easily be implemented in the outpatient surgical setting.
Q: Where do you see your practice growing or evolving in the next five years? What is the next step or evolution in your career?
NS: With many years of experience in practice, I think it is important to share knowledge with fellow surgeons and continue to nurture learning from one another. It is important to stay up-to-date on current and future developments, but also participate with your spine surgical society of choice to further shape how care is delivered. We have the opportunity to improve the efficiency of how individual patients receive treatment, but we also have a voice on the healthcare policy level.
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