Four spine surgeons discuss the ways they seek to control costs this year.
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. We invite all spine surgeon and specialist responses.
Next week's question: What is your advice for spine surgeons looking to enter the outpatient care arena?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 4, at 5 p.m. CST.
Question: What are some ways in which you are seeking to provide cost-effective care in 2018?
Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): Being cognizant of the costs of materials I use during surgery. Sometimes a preferred vendor provides significant cost savings with a product almost identical to one I would have chosen before. This also goes for implants and biologics.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Streamlining is this year's theme. We are cutting costs on our EHR and our internet service provider. We have also decided to take back our web presence and use a slick self-guided do-it-yourself website like Wix or Squarespace. Over seven years in business has taught me one thing — people will sell you a bill of goods given the chance. In terms of cost-effective patient care, I am continuing to refine postoperative care by continuing to drive down postoperative complications, such as wound infection and readmits for pain, by working with a home health agency and by coordinating with reliable community pain doctors.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Same as in all prior years, I try to offer each patient the right treatment for the right problem at the right time. By far not every spine problem needs to be fixed with surgery, and less invasive and cheaper treatments often yield great outcomes. In some cases, however, surgical intervention is needed and delaying this necessary treatment —often due to insurance denials — causes more harm and more expense as yet another "trial of nonoperative measures" for a clearly surgical problem drags on.
Sometimes such delays lead to greater long-term disability and greater overall costs, both due to the ongoing medical expenses for chronic pain and due to loss of the patient's ability to be gainfully employed. Minimally invasive surgery might have greater upfront costs due to the need for more sophisticated tools and equipment, but multiple studies have shown that overall cost of care is actually cheaper. This is mostly due to shorter operating room time, less need for blood transfusions, shorter hospital stay, less need for pain medications and faster return to work and function. When possible, I try to perform surgery at an ambulatory surgery center. The results are the same but with much lower facility fees than at a traditional hospital.
Medhat Mikhael, MD. Pain Management Specialist and Medical Director of the Non-operative Program at the Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): Simply minimize practicing defensive medicine. Order tests — whether it is a lab or imaging — only when the case warrants ordering and use clinical experience for diagnosis. Also avoid repeating any workup or interventions done by previous providers, order medications that are available in generic formulas instead of the expensive brand names that will do the same job and avoid unnecessary visits to hospitals, emergency rooms and surgery center facilities as this usually increases the cost significantly. The challenges with that is while you are trying to cut cost and provide excellent care, you will find that many insurance carriers oppose your plan because those responsible for making the decision are unfortunately adhering to old and obsolete guidelines.