From joint-venture partnerships to innovation in spine technology and the evolution of value-based care, six surgeons discuss how outpatient migration will affect the specialty.
Note: Responses are lightly edited for style and clarity.
Brian Gill, MD. Nebraska Spine Hospital (Omaha): Spine care will continue to evolve over the next five years with a greater emphasis on moving procedures to outpatient settings. It is already happening at an exponential rate, especially with CMS dropping nearly all spine-related inpatient codes and moving them to outpatient. This will move many procedures from a hospital setting to an ASC setting, continuing the ongoing trend. Techniques and protocols will continue to evolve to facilitate the progression of spine care to an outpatient setting. I am a strong proponent that providers need to have a vested interest in the care of their patients as it helps to drive efficiencies, controls costs and provides superior outcomes. In turn, this creates value to insurers, employers, and most importantly, patients.
Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): I think hospitals will become more heavily involved at ASCs and partner with physicians to create these centers with a better patient experience. The patients are driving this. Physicians are having that direct patient care, understanding what the patients need and what the patient expectations are. A lot of patients, especially over the past year, don't want to have surgery at a hospital. That's something that physicians hear as they discuss surgery with their patients. Physicians having that direct patient care are able to guide that care and manage the needs of the patient.
Brandon Hirsch, MD. The CORE Institute (Mesa, Ariz.): I believe spinal endoscopy will play a large role in the future of outpatient spine surgery. While patients with spinal deformities will likely continue to receive inpatient care due to the complexity of their treatment, many of the treatments for common degenerative conditions will continue to migrate to lower-cost care settings. Endoscopic visualization and instruments have become highly advanced and, in many cases, allow for targeted treatment of stenosis on an ambulatory basis. While reimbursement has historically lagged on these procedures, I believe payers will eventually realize its value and align incentives appropriately.
James Mok, MD. Northshore Orthopaedic & Spine Institute (Skokie and Des Plaines, Ill.): There will be a major shift in spine surgery to the outpatient setting, whether it be ASCs or hospital outpatient departments, because they are lower cost. As providers get a handle on value-based care programs, there will be stricter emphasis on documentation and coding to fully capture the complexity — and therefore risk adjustment — of a patient's care. Neither of these represent a big change in surgeon behavior, but they set the stage for what comes next, when value-based care gets bigger. That's when surgeon practice patterns may be challenged.
Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): I expect there will be more spine cases being done in outpatient settings. There will be more adoption in motion preservation and endoscopic spine surgery on both sides, the surgeons and the insurers. I predict we will continue to see the growth in robotics, navigation and artificial intelligence.
Adam Bruggeman, MD. Texas Spine Care Center (San Antonio) and CMO of MpowerHealth (Addison, Texas): Spine care delivery will clearly shift toward the outpatient setting as payers see cost savings and providers have greater opportunity for ownership in surgery centers. Trends are shifting toward employment models and consolidation of practices as we see hospital systems, private equity and insurance companies continue to employ a greater percentage of the workforce. Also pushing this trend is the growing attitude of physicians who prefer to avoid the ever-growing practice management requirements and increasing burden of preauthorization associated with payers.