This book is a compilation of chapters from leading physicians in the spine arena. These leading spine surgeons discuss a wide variety of issues related to spine care. Their discussions will run the gamut from clinical related discussions to business related and management issues and discussions.
This first discussion lays out a few core concepts related to the balancing of cost versus innovation in the treatment of spine related issues.
There are various different ways to attack spinal related diseases and spinal related disorders. On the cost and treatment side, there is one basic concept of utilizing what generally already exists in terms of technology, devices, implants, grafts, anesthesia, pharmaceuticals and other efforts. These efforts at managing cost in this way can include things like determining 1) the lower cost place of service (e.g.,, whether a procedure should be done at a surgery center versus a hospital), 2) bundling payments and managing risk and payment models (e.g., using bundled models to try and cause better management of care in a variety of ways), 3) looking at more efforts as to evidence based care and means of judging what is needed and what is not needed, 4) adding more standards to what procedures are permitted and not permitted, 5) managing limits on therapies, pain medications and other types of tools. For example, there are also efforts at making patients do a variety of efforts prior to surgery.
These things can be put in the bucket of different ways of managing costs using largely existing spine and medical technology. For example, can the system save cost by forcing somebody to control the overall cost of care or can we save cost by moving care to a lower cost facility or site of care.
Many of these efforts as implemented are on the smaller scale. Sometimes they are minor refinements to what exists. Other times they start to bridge into much larger scale innovation rather than refinements to existing devices and technologies.
On the more complex and full innovation side of spine care are a number of things that have proven to be extremely useful and arguably expensive. These include new kinds of devices, new types of biologics (an evolving area) and new types of surgery. Innovations in spine surgery include endoscopic spine surgery. 3D image guided surgery, artificial discs and more. Here, new devices, bone grafts and artificial discs have all played a large part. Further it's expected that robotic or digital surgery where it's not truly a robot doing surgery but really a much better help and visual help for the surgeon will play a big part going forward.
Further, some of the development has focused around improved anesthesia and minimally invasive surgery which is not necessarily completely new technology but does involve new technology and new pharmaceuticals. Here, e.g., more localized anesthesia if one example of a means to try and reduce length of stay. In addition, in part with the opioid crisis, there are all kinds of ideas on how to improve pain management and become less reliant on opioids.
As we move forward in spine care and in other fields, it is often the case that there is a constant need to improve how we use existing modalities and existing types of procedures. At the same time, there has to be efforts to move the ball more significantly forward. I.e., to provide things that could be breakthrough changes in the field.
Over the next 10 to 20 years, given the basic aging of the population and the involvement of the population in all kinds of active living, we would expect for a whole variety of reasons that the incidence of spine related disease and disorders will continue to increase. Over a previous ten-year period, costs for spine related disorders rose by several hundred percent. See, e.g., Primary Spine Care Services- Responding to Runaway Costs and Disappointing Outcomes in Spine Care. Donald Murphy. Rhode Island Medical Journal Oct 2014.
Over the long run we are really looking at a balance of the use and the improvement of the existing technologies and medical ways of doing things together with consistent innovation. The funding of this, whether privately or by government, remains a great question. Then, the payment for the innovative ideas that happens becomes almost a bigger question as often the innovation doesn’t tend to benefit the cost curve even if they do cause tremendous improvement in the care of patients.
I hope you enjoy this series of articles that are coming forth on this subject.
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