Frank Phillips, MD, the director of the division of spine surgery and orthopedic surgery professor at Chicago-based Rush University Medical Center, spoke about the future of innovation and value in spine care during a keynote presentation at Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference on June 15 in Chicago.
Here are nine thoughts from Dr. Phillips on innovation in spine:
On personalized medicine: "When you think about the innovation in medicine, the first half of the 20th century was largely defined by serendipitous innovation," Dr. Phillips said. "I would suspect that spine's still stuck in the first half of the 20th century in terms of innovation. The 21st century is all about personalized medicine." According to Dr. Phillips, personalized spine care will be characterized by improvements in genomics, functional imaging and predictive analytics or "big data."
Do we need innovation in spine?: "Clearly we do — we're not that great, I hate to break it to you. Our outcomes are variable, our complications are unpredictable. We don't even have a good idea about diagnosis: if we asked every spine surgeon in this room what causes back pain, we'd get 12 opinions."
Types of innovation: "Incremental innovation is taking away chunks of competitors' piece of the pie, which is what we've seen in spine. True innovation is having killer product that allows you to own the whole pie. Disruptive innovation is when a superior product displaces an existing one."
Regulation versus innovation: "The regulatory process in the U.S. is long, expensive and unpredictable, and the FDA is not aligned with payers. Regulation blocks disruptive approaches from being used anywhere until they're proven good enough to be used everywhere."
Learn from tech and build monopolies: Without innovation in spine, it's a race to the bottom. "Monopolies own their market and can set their own prices. Monopolies drive progress because the promise of a sustained monopoly is an incentive to innovate, and they capture value."
Value: "We live in a value-driven society," said Dr. Phillips, and "value is all in the eyes of the beholder. For insurance companies, 'value' is returning value to shareholders. That's a fact of the economy."
Precision medicine in spine: "The overarching goal is to enhance predictability of outcome for a particular patient at the best cost: that's precision medicine. Spine has done a good job moving from intuitive medicine — solving problems by experimentation and pattern recognition — to empirical medicine. Diagnostics are key for precise treatment, but they are traditionally an unattractive investment. Maybe as we move to a value-based system, they will become more important."
Minimally invasive outpatient surgery: The average surgeon is able to reliably perform lumbar fusion in the ambulatory surgery setting, Dr. Phillips said. MIS techniques can be applied to more complex spine procedures, and Dr. Phillips predicts those procedures will eventually be done in the ASC setting as well.
Delivery of care and innovation: "Hospitals do everything for everyone; they're sort of a model from the 1800s designed to treat rare diseases and ill patients. They're not the best place to do elective specialty procedures. ASCs, on the other hand, are 'focused factories' optimized to do a specific job very well."
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