Spine technologies come with a cost barrier for some ASCs even as more cases migrate to the outpatient setting.
Three spine surgeons discuss the cycles and strategies that will affect the costs of robotics and implants in the ASC.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: Many newer spine technologies come with a heavy price tag, especially for ASCs. What will it take to lower costs for the technologies and help them become more widespread?
Don Park, MD. UCI Health (Irvine, Calif.): The price for utilizing emerging technology in spine surgery is high due to the research and development required to develop the technology, the marketing required to sell the technology, and the personnel needed to implement the technology. These high costs can be prohibitive, especially in the ASC setting where reimbursement is much less than hospital-based settings.
Companies need to work with administrators to develop creative financial solutions to reduce these costs, such as at lease to own options, tiered discounts based on increasing utilization and volume, and programs based on purchasing associated products such as disposables and implants.
However, these companies need passionate surgeons who believe in the technology to advocate and champion the company to the hospitals and ASCs. This passion comes from technology that should provide considerable benefits to both the surgeon and patient, such as significant time savings in the operating room, greater accuracy and precision in surgery, and improved safety for the patient. Over time, the costs will inevitably decrease with more utilization, but industry needs to help with financial models that make sense in a financially restrictive environment with technology that can truly enable surgeons to perform better surgery for their patients.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Newer technologies in spine surgery (such as intraoperative navigation, robotic systems, augmented reality systems, patient-specific implants, etc.) inevitably come at a high cost. The cost includes both the expenses involved in developing, improving, validating and obtaining FDA clearance for the new technology as well as the expenses to build, maintain and update the new devices. As the use of newer technologies becomes more common and there is more competition in the market, the cost will inevitably decrease some.
There will be a limit, however, to such a decrease in cost. Newer technologies will always cost more than the older and simpler methods of performing spine surgery. Such higher expenses, however, will be justified by being able to achieve better outcomes by performing spine surgery in less invasive fashion, by making spine surgery more efficient, and by decreasing the harm to the surgeon and OR staff (such as radiation exposure and physical and mental strain).
With time, those who pay for the surgery (be it the insurance companies or the patients themselves) will recognize the value of newer technologies and improved outcomes and will be willing to pay the additional cost associated with such innovations. This will, in turn, further increase the utilization of new technologies until they become the standard of care. This cycle will continue to repeat itself in spine surgery and in healthcare in general, as the science and technology of medicine continues to evolve and improve for the benefit of our patients.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Implant prices can vary due to manufacturer negotiated purchasing agreements coupled with limited awareness of true cost. Reducing the price of surgical implants and increasing uniformity in costs has translated into extensive long term savings. Paring of companies unwilling to work within a system or price consolidation is also a most viable option for price reduction.
Common spinal injuries and surgical interventions in workers' compensation cases already require procedures associated with higher costs and implant intervention. Coalescing these patients to a center of known better outcomes and more efficient processes is another mechanism of potential utilization. Like big pharma and its profit-mongering legacy, biomedical companies play a role in cost, copyright and claw back cost impositions to patients. Happy mediums require negotiation and firm expectations.