Value-based care and price transparency is on the forefront of physicians' and healthcare executives' minds, especially after President Donald Trump issued an executive order to require healthcare price disclosure.
Here, six spine surgeons discuss how both trends will affect spine care and what surgeons can do to prepare for the future.
Wellington Hsu, MD. Clifford C. Rainsbeck Distinguished Professor of Orthopaedic Surgery and Director of Research at Northwestern University Feinberg School of Medicine (Chicago): I believe that price transparency and value-based care will force surgeons to consider the value added for different parts of the surgery. This will make us consider all facets of new technology before we accept them for the vetting process. Price transparency will allow comparisons of like surgeons to improve efficiency across-the-board.
Jason Huang, MD. Chair of the Department of Neurosurgery at Baylor Scott & White Health (Dallas): Price transparency and value based care will allow surgeons to work more efficiently with primary care physicians and other non-surgical providers from different areas (such as physical therapists, chiropractors and pain management doctors) to work collaboratively across the health system. Sometimes early surgical intervention is more cost-effective and can result in better outcome for spine patients; other times patients shall only be treated conservatively to allow for better outcome and less expenses. These trends will force spine surgeons to consider all facets of care in a health system before major decisions are made for more complicated spine patients.
Jesse Even, MD. Spine Surgeon at TMI Sports Medicine and Orthopedic Surgery (Arlington, Texas): The higher the deductibles go on our patients the more we are going to have to push for price transparency. Now that people are paying a larger and larger portion of their costs for their healthcare, and are consumers now instead of just receivers, we are going to have to be much more transparent in our pricing structures. The practices and hospitals that adapt to this will gain the confidence of the people they serve, and like other transparent organizations such as Amazon, Walmart, etc., they will gain a much larger market share.
William Richardson, MD. Spine Surgeon at Duke Spine Center (Durham, N.C.): It is going to be a growing trend. We now have insurance companies who offer patients a bonus to have an imaging study at a less costly facility. Data needs to be collected and openly shared. We can no longer sit back and think because we are a great, well-known facility that patients will come or be allowed to come by their insurance company. We need to be collecting data and sharing to get contracts and drive demand for services because of demonstrated value.
Jonathan Carmouche, MD. Section Chief of Scoliosis and Pediatric Orthopedics at Carilion Clinic (Roanoke, Va.): There will be more drive towards minimally invasive procedures to shorten length of stay and therefor decrease cost. Aggressive implant negotiations will be necessary to decrease implant-related costs. I also see continued optimization of patient-specific case packs to minimize sterilization of many trays and decreased fusions for axial pain.
Peter Passias, MD. Spine Surgeon at NYU Langone Health (New York City): While there is opportunity to improve our care in terms of price transparency and value-based care evaluations, unfortunately, there is also much potential for the level and availability of care to be negatively affected. Value-based care based on the current systems in place inherently implies cutting services. We need to be absolutely certain that we thoroughly assess the impact of such retractions on an individual, as well as from a general population basis, prior to implementation.